Features of the ovarian reserve in women with infertility after organ-preserving operations on the pelvic organs

In: HEALTH OF WOMAN · 2017 · pp. 46–49 · doi:10.15574/hw.2017.119.46 · W3116545803
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This study examined 128 infertile women and found that organ-preserving pelvic surgeries, especially ovarian resection or cystectomy, led to decreased ovarian volume, fewer antral follicles, and lower anti-Müllerian hormone levels.

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This study evaluated ovarian reserve parameters, including anti-Müllerian hormone levels and antral follicle counts, in 128 women experiencing infertility following organ-preserving pelvic surgeries. The researchers compared outcomes among patients with hyperplastic uterine diseases, noting that surgical interventions such as cystectomy or resection significantly reduced ovarian volume and follicle numbers compared to conservative treatments. A key limitation highlighted is that the extent of ovarian manipulation during surgery directly correlates with the degree of decline in reproductive potential. Relevance to endometriosis: cited in reference 10 regarding ovarian responsiveness after surgery for endometriomas, though the paper's primary focus is on hyperplastic uterine diseases rather than endometriosis itself.

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Abstract

Ovarian reserve (OR) – an important part of the reproductive potential of women, is the ability of the ovaries to provide growth of full-blown follicles containing healthy, fertile eggs. The objective: to evaluate the characteristics of the OR in women with infertility after organ-saving operations on the pelvic organs Patients and methods. 128 women with infertility and hyperplastic diseases of the uterus and appendages (HDUA) were examined. Of these, 54.5% had a chronic inflammatory process of the internal genitalia (CIPIG). 42 patients with HDUA with CIPIG were treated conservatively, 28 patients with HDUA under the condition of CIPIG performing organ-preserving treatment, 27 women with GDUA without CIPIG performed conservative treatment, 31 patients with HDUA without CIPIG carrying out organ-preserving treatment. The volume of ovaries and the number of antral follicles (AF), the amount of anti-Muller hormone (AMG) were studied. Results. In the surveyed women, after surgical treatment, a decrease in the volume of the ovaries and the amount of аntral follicles (AF) was revealed, mainly due to ovarian resection. There was also a decrease in AMG. Moreover, the volume of operated ovaries in the group of patients who underwent cystectomy was significantly lower than in patients after resection or bipolar electrodeletion of the cyst capsule. Such changes in the ovarian reserve in the postoperative period can be explained by the volume of surgical intervention not only on the uterus, but also on the ovaries. Conclusion. The condition of the ovarian reserve in women with infertility against the background of uterine fibroids largely depends on the concomitant volume of surgical intervention. Cystectomy or ovarian resection, even in a sparing volume, is accompanied by a risk of a decrease in primordial and antral follicles. Key words: ovarian reserve, infertility, AMH, operations on pelvic organs, ultrasound.
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- Features of the ovarian reserve in women with infertility after organ-preserving operations on the pelvic organs Features of the ovarian reserve in women with infertility after organ-preserving operations on the pelvic organs HEALTH OF WOMAN. 2017.3(119):46–49; doi 10.15574/HW.2017.119.46 Dubchak A. E., Dubenko O. D., Milevsky O. V., Obeid N. M. SI «Institute of Pediatrics, Obstetrics and Gynecology NAMS Ukraine», m. Kyiv KU «Central city hospital №1», Zhitomir Ovarian reserve (OR) – an important part of the reproductive potential of women, is the ability of the ovaries to provide growth of full-blown follicles containing healthy, fertile eggs. The objective: to evaluate the characteristics of the OR in women with infertility after organ-saving operations on the pelvic organs Patients and methods. 128 women with infertility and hyperplastic diseases of the uterus and appendages (HDUA) were examined. Of these, 54.5% had a chronic inflammatory process of the internal genitalia (CIPIG). 42 patients with HDUA with CIPIG were treated conservatively, 28 patients with HDUA under the condition of CIPIG performing organ-preserving treatment, 27 women with GDUA without CIPIG performed conservative treatment, 31 patients with HDUA without CIPIG carrying out organ-preserving treatment. The volume of ovaries and the number of antral follicles (AF), the amount of anti-Muller hormone (AMG) were studied. Results. In the surveyed women, after surgical treatment, a decrease in the volume of the ovaries and the amount of аntral follicles (AF) was revealed, mainly due to ovarian resection. There was also a decrease in AMG. Moreover, the volume of operated ovaries in the group of patients who underwent cystectomy was significantly lower than in patients after resection or bipolar electrodeletion of the cyst capsule. Such changes in the ovarian reserve in the postoperative period can be explained by the volume of surgical intervention not only on the uterus, but also on the ovaries. Conclusion. The condition of the ovarian reserve in women with infertility against the background of uterine fibroids largely depends on the concomitant volume of surgical intervention. Cystectomy or ovarian resection, even in a sparing volume, is accompanied by a risk of a decrease in primordial and antral follicles. Key words: ovarian reserve, infertility, AMH, operations on pelvic organs, ultrasound. REFERENCES 1. Ischenko AI, Morozova AV. 2007. Rezultativnost metoda ekstrakorporalnogo oplodotvoreniya posle operativnyih vmeshatelstv na organah reproduktivnoy sistemyi (literaturnyiy obzor). Voprosyi ginekologii, akusherstva i perinatologii 4:115–126. 2. Besplodnyiy brak: Prakticheskoe rukovodstvo. Pod red. chl.-korr. NAMN Ukrainyi, prof. VK Chayki. Donetsk: ChP «Lavis». 2012:384. 3. Beznoschenko GB. 2003. Problema operirovannogo organa v ginekologii. Rossiyskiy vestnik akushera-ginekologa 2:28–33. 4. Balabanova VV. 2001. Neoperativnaya ginekologiya. Nizhniy Novgorod, NGMA. 5. Doletskaya DV. 2006. Sravnitelnaya otsenka funktsionalnogo sostoyaniya yaichnikov i kachestva zhizni zhenschin, perenesshih v reproduktivnom vozraste miomektomiyu i gisterektomiyu po povodu miomyi matki. Avtoref. diss. kand. med. nauk: 14.00.01. :18. 6. Dubchak AIe, Zadorozhna TD, Milievskyi OV, Dovhan OI. 2015. Morfolohichni ta imunohistokhimichni osoblyvosti endometriia v period «vikna implantatsii» u zhinok z bezpliddiam na tli khronichnykh zapalnykh zakhvoriuvan vnutrishnikh statevykh orhaniv. Zdorove zhenshchynу 6(102):178–181. 7. Davyidov AI, Musaev RD. 2011. Otsenka ovarialnogo rezerva posle endohirurgicheskih vmeshatelstv na yaichnikah s ispolzovaniem vyisokih energiy. Voprosyi ginekologii, akusherstva i perinatologii 10;3:56–63. 8. Boyarskiy KYu i dr. 2009. Rol antimyullerova gormona (AMG) v norme i pri razlichnyih ginekologicheskih zabolevaniyah. Zhurnal akusherstva i zhenskih bolezney 58:74–83. 9. Zhordanidze DO i dr. 2010. Sostoyanie ovarialnogo rezerva pri nekotoryih formah funktsionalnogo besplodiya. Akusherstvo i ginekologiya 5:25–31. 10. Benaglia I, Armoldi M et al. 2007. Ovarian responsiveness to hyperstimulation during IVF-ICSI cycles in women operated on for bilateral endometriomas. Hum.reprod. 22:143 11. Reis FM et al. 2013. Endometriosis: hormone regulation and clinical consequences of chemotaxis and apoptosis. Hum. Reprod. pdate. 19(4):406–418. https://doi.org/10.1093/humupd/dmt010 12. Mostaejeran F et all. 2015. Evaluation of antimullerian hormone levels before and after laparoscopic management of endometriosis. Adv.Biomed.Res. 31;4:182.

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