Effect of laparoscopic excision of the endometriotic cyst capsule on the ovarian reserve (a retrospective analysis)

Effect of laparoscopic excision of the endometriotic cyst capsule on the ovarian reserve (a retrospective analysis) DOI: https://doi.org/10.26641/2307-0404.2022.3.265937Keywords: endometriotic cyst, AMH, Anti-Müllerian hormone, ovarian reserve, laparoscopy, excision of the cyst capsuleAbstract Endometriotic cyst is one of manifestations of the endometriotic process and its incidence among all women with endometriosis varies from 17 to 44%. This chronic process in the ovary is accompanied by persistent inflammation, which leads to fibrosis of the ovarian cortex and loss of follicles. Laparoscopic excision of the endometriotic cyst capsule is by far the mainstay of treatment for cysts of 3 cm or more in diameter. This standard surgical procedure can reduce an ovarian reserve marker such as anti-Müllerian hormone (AMH), raising concerns about reduced fertility after surgery. The aim of the study was to analyze the effect of operative, in particular, laparoscopic cystectomy, on the ovarian reserve in women of fertile age with endometriotic cysts. A retrospective analysis of the data of 202 women with endometriotic cysts who underwent examination, surgery and outpatient observation from 2011 to 2020 was carried out. The analysis was carried out in comparison before and after surgical treatment of all cases. The state of the ovarian reserve was assessed by the level of serum AMH. At baseline, the mean AMH in women with bilateral cysts 1,78 (95% CI 1,62; 1,91) ng/ml was lower than in women with monolateral cysts 2,44 (95% CI 2,18; 2,54) ng/m (p<0.001). When comparing AMH values 6 months after surgery, it was found that in all women the median AMH level significantly decreased by an average of 0,34 (95% CI 0,2-0,48) ng/ml (p<0,001). Laparoscopic excision of the cyst capsule is the main method of treatment of endometriotic cysts, and its minimally invasiveness and acceptability of use in women of fertile age makes it the standard surgical approach. However, the analysis showed that, nevertheless, laparoscopic excision of the endometriotic cyst capsule does not guarantee the safety of the negative effect of this method on the ovarian reserve, both during and after its application, on the contrary, significantly reducing the AMH values in comparison with its levels before surgery. References Andriiets A, Yuzko O. [Number of antral follicles as a marker of ovarian reserve in patients with infertility in ovarian endometriosis]. Neonatology, sur¬gery and perinatal medicine. 2018;8(4):43-46. Ukrainian. doi: https://doi.org/10.24061/2413-4260.VIII.4.30.2018.8 Feskov VО. [Modern approaches to the treatment of infertility in women with ovarian endometriosis, using in vitro fertilization]. Scientific Journal «ScienceRise: Medical Science». 2017;15(7):39-43. Ukrainian. Gruzeva TS, Lekhan VM, Ognev VA, et al. [Bio-statistics: a textbook]. Gruzeva TS, editor. Vinnytsia: Nova Knyha; 2020. p. 47-138. Ukrainian. Cranney R, Condous G, Reid S. An update on the diagnosis, surgical management, and fertility outcomes for women with endometrioma. Acta Obstet Gynecol Scand. 2017;96(6):633-43. doi: https://doi.org/10.1111/aogs.13114 Demirdag E, Guler I, Selvi I, Cevher Akdu-lum MF, Canan S, Erdem A, Erdem M. Analysis of 2438 cycles for the impact of endometrioma and its surgery on the IVF outcomes. Eur J Obstet Gynecol Reprod Biol. 2021;(263):233-8. doi: https://doi.org/10.1016/j.ejogrb.2021.06.034 Kitajima M, Khan KN, Harada A, Taniguchi K, Inoue T, Kaneuchi M, Miura K, Masuzaki H. Association between ovarian endometrioma and ovarian reserve Front Biosci (Elite Ed). 2018;1(10):92-102. doi: https://doi.org/10.2741/e810 Karadağ C, Demircan S, Turgut A, Çalışkan E, Turk J. Effects of laparoscopic cystectomy on ovarian reserve in patients with endometrioma and dermoid cyst. Obstet Gynecol. 2020;17(1):15-20. doi: https://doi.org/10.4274/tjod.galenos.2020.37605 Matalliotakis M, Goulielmos GN, Matalliotaki C, Trivli A, Matalliotakis I, Arici A. Endometriosis in Adolescent and Young Girls: Report on a Series of 55 Cases. J Pediatr Adolesc Gynecol. 2017;30(5):568-70. doi: https://doi.org/10.1016/j.jpag.2017.05.007 Gordts S, Koninckx P, Brosens I. Pathogenesis of deep endometriosis. Fertil Steril. 2017:108(6):872-85.e1. doi: https://doi.org/10.1016/j.fertnstert.2017.08.036 Petrie A, Sabin C. Medical Statistics at a Glance, 4th Ed. Wiley-Blackwell; 2019. Lee SY, Kim Mi-La, Seong SJu, Bae JW, Cho YJ. J Recurrence of Ovarian Endometrioma in Adolescents after Conservative, Laparoscopic Cyst Enucleation. Pediatr Adolesc Gynecol. 2017;30(2):228-33. doi: https://doi.org/10.1016/j.jpag.2015.11.001 Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666-82. doi: https://doi.org/10.1038/s41574-019-0245-z DiVasta AD, Vitonis AF, Laufer MR, Missmer SA. Spectrum of symptoms in women diagnosed with endometriosis during adolescence vs adulthood. Am J Obstet Gynecol. 2018:218(3):324.e1-e11. doi: https://doi.org/10.1016/j.ajog.2017.12.007 Whittier N, Wildhagen T, Gold H. Statistics for Social Understanding With Stata and SPSS. Rowman & Littlefield Pub. 2019(17)210-45. Seo JW, Lee DY, Yoon BK, Choi DJ. The Ef-ficacy of Postoperative Cyclic Oral Contraceptives after Gonadotropin-Releasing Hormone Agonist Therapy to Prevent Endometrioma Recurrence in Adolescents. Pediatr Adolesc Gynecol. 2017:30(2):223-7. doi: https://doi.org/10.1016/j.jpag.2016.10.004 Downloads Published How to Cite Issue Section License Copyright (c) 2022 Medicni perspektivi This work is licensed under a Creative Commons Attribution 4.0 International License. Submitting manuscript to the journal "Medicni perspektivi" the author(s) agree with transferring copyright from the author(s) to publisher (including photos, figures, tables, etc.) editor, reproducing materials of the manuscript in the journal, Internet, translation into other languages, export and import of the issue with the author’s article, spreading without limitation of their period of validity both on the territory of Ukraine and other countries. This and other mutual duties of the author and all co-authors separately and editorial board are secured by written agreement by special form to use the article, the sample of which is presented on the site. Author signs a written agreement and sends it to Editorial Board simultaneously with submission of the manuscript.