Laparoskopik endometrioma eksizyonu sonras? ovaryen rezerv belirte?lerindeki erken d?nem de?i?imler

AMA?: ?naktif ve b?y?mekte olan folik?l havuzunu i?aret eden Antim?llerian hormonun (AMH), ayn? zamanda menstr?el siklus boyunca serum konsantrasyonunun minimal de?i?imi nedeniyle g?n?m?zde over rezerv belirteci olarak kullan?m? yayg?nla?maktad?r. Biz de bu ?al??ma ile endometriyoma nedeniyle laparoskopik kistektomi yap?lan hastalarda over rezervi belirte?lerini AMH'y? da kapsayacak ?ekilde kombine kullanarak rezervin nas?l de?i?ti?ini tespit etmeyi ama?lad?k. Ayr?ca laparoskopik kistektomi esnas?nda olu?an over dokusunun kayb?n? histopatolojik olarak inceleyerek over rezervindeki de?i?imi tespit etmeyi ama?lad?k. Y?NTEM: 18-45 ya? aras? endometriyoma nedeniyle laparoskopik cerrahi ge?iren 65 hasta ?al??maya dahil edildi. Preoperatif d?nemde menstr?el siklusun 3. g?n? kanda folik?l stim?le edici hormon (FSH), l?teinleyici hormon (LH), ?stradiol ve AMH ?l??m? yap?ld? ve FSH/LH oran? hesapland??? transvajinal veya transabdominal ultrasonografi (USG) ile her iki overdeki toplam bazal antral folik?l say?s? (BAF) ve endometriyoman?n boyutlar? bak?ld?. Laparoskopi ile endometriyoma eksizyonu uygulanan bu hastalarda operasyon esnas?nda endometriyoma boyutlar? tekrar de?erlendirildi ve Amerikan Reprod?ktif T?p Cemiyeti s?n?flamas? (Revised American Society for Reproductive Medicine Classification of Endometriosis, rAFS) skorlamas? yap?ld?. Postoperatif 6. haftada kontrole ?a?r?lan hastalarda menstr?el siklusun 3. g?n? FSH, LH, ?stradiol ve AMH tekrar kanda bak?ld? ve FSH/LH oran? hesapland??? transvajinal veya transabdominal USG ile de BAF tekrar de?erlendirildi. Al?nan her doku ?rne?i histopatolojik olarak incelenmek ?zere Patoloji B?l?m?'ne g?nderildi. Patolog kist duvar?na yak?n over dokusu olup olmad???n? de?erlendirdi ve semikantitatif bir skalayla bu dokular? 0'dan 4'e kadar derecelendirdi. (0= folik?l yoklu?u?? 1= sadece primordial folik?l?? 2= primordial ve primer folik?ller?? 3= birka? adet sekonder folik?l?? 4= normal over dokusundaki gibi primer ve sekonder folik?ller). Ayr?ca kesitte hesaplanan folik?l say?s?n?n FSH, FSH/LH ve AMH ile olan ili?kisi de?erlendirildi. BULGULAR: Folik?l stim?le edici hormonun ortalama postoperatif de?eri preoperatif de?erlere g?re anlaml? olarak daha y?ksekti (p SONU?: Endometriyoma ile birlikte eksize edilen normal over dokusu ve bu dokunun i?erdi?i folik?l say?s? artt?k?a AMH'n?n o derece d??t??? g?sterilmi?tir. Dolay?s?yla endometriyoman?n eksizyonu esnas?nda over dokusuna zarar verilmesi ve buna ba?l? olarak over rezervinin d??mesi ka??n?lmaz bir durumdur. OBJECTIVE: Antimullerian hormone that designates inactive and growing follicular pool is being used commonly as an ovarian reserve marker at present. Its serum concentration changes minimally during menstruel cycle. In this study, we aimed to show changes of ovarian reserve by using all markers in combination that includes AMH in patients who have undergone laparoscopic cystectomy of endometrioma. At the same time, we aimed to state change in ovarian reserve with histopathologic examination of loss of ovarian tissue during laparoscopic cystectomy. METHODS: 65 patients, 18 to 45 years of age, were enrolled who have undergone laparoscopic operation for endometrioma. Preoperatively on the 3rd day of menstruation FSH, LH, estradiol and AMH were measured and FSH/LH ratio was calculated?? also basal antral follicle (BAF) in both ovaries and dimensions of endometrioma were assessed with transvaginal or transabdominal ultrasonography. In these patients, during operation dimensions of endometrioma was assessed again and scoring was done according to revised American Society for Reproductive Medicine Classification of Endometriosis. Postoperatively on the 6th week, patients were called for control?? hormone profile that includes FSH, LH, estradiol and AMH were measured and FSH/LH ratio was calculated and BAF were counted by transvaginal or transabdominal ultrasonography on the 3rd day of menstruation. The pathologist evaluated the presence or absence of the ovarian tissue adjacent to the cyst wall and graded the morphological characteristics of this tissue on a semiquantitative scale of 0 to 4 as previously published elsewhere (0= complete absence of follicles?? 1= primordial follicles only?? 2= primordial and primary follicles?? 3= some secondary follicles?? 4= pattern of primary and secondary follicles as seen in the normal ovary). Also association between FSH, FSH/LH ratio, AMH and histologic analysis of excised specimens was evaluated. RESULTS: Mean level of postoperative serum FSH was higher than its preoperative level as statistically significant (p CONCLUSIONS: As follicular count increases in histopathologic examination, AMH level decreases concomitantly. So damage to ovarian tissue and decreasing of ovarian reserve is unavoidable during excision of endometriomas.