Laser doppler flowmetry and fluorescence spectroscopy in the study of ovarian microcirculation during laparoscopy

Abstract Aim. To assess the features of ovarian tissue microcirculation in patients with endometrioid cysts using in gynecological practice through the integration of laser Doppler flowmetry (LDF) and fluorescence spectroscopy (FS) into standard laparoscopic procedures for the surgical treatment of endometriomas. Desing. A longitudinal, prospective case-control study. Materials and methods. The study included 55 patients (45 with endometriomas and 10 patients without gynecological pathology, the comparison group, who underwent laparoscopy prior to the assisted reproductive technology protocol). All patients underwent optical biopsy during laparoscopy. Parameters assessed included microcirculation index (MI), oscillation amplitudes in different frequency ranges, and nicotinamide adenine dinucleotide (reduced) autofluorescence intensity (I460). Results. Patients with endometriomas showed a significant decrease in MI (3.5 ± 1.2 vs. 7.4 ± 1.1 perfusion units, p < 0.05), a tendency towards reduced oscillation amplitudes in myogenic, respiratory, and cardiac ranges, as well as a significant increase in I460 intensity (0.6 ± 0.1 vs. 0.2 ± 0.1 relative units, p < 0.05). These findings indicate microcirculatory and metabolic impairments in ovarian tissue associated with endometriosis. Conclusion. Multimodal diagnostic methods, combining LDF and FS, demonstrated clinical value in detecting hypoxic and microcirculatory disorders in ovaries of patients with endometriomas. Combined laparoscopic doppler flowmetry and follicle count provides high diagnostic value in identifying preclinical impairments, enabling risk stratification for declining ovarian reserve and optimization of fertility-sparing surgical approach in women with endometrioma. Keywords: endometrioma, microcirculation, hypoxia, laser Doppler flowmetry, fluorescence spectroscopy, optical biopsy.