Laparoscopic Excision Ablation or Ablation Alone in Women with Endometrioma

Background: Effect of laparoscopic intervention in management of endometriomas could be associated with a deleterious effect on ovarian function. Objective: To compare the effect of laparoscopic ablation excision and ablation alone in patients with unilateral mild to moderately sized endometrioma on Antral Follicle Count (AFC), ovarian volume, day 2 FSH (D2 FSH). Method: Clinical randomized trial carried out on 62 patients was randomly allocated to, Group A: 31 patients where combined laparoscopic excision/ablation, Group B: 31 patients where laparoscopic ablation was done. Primary outcomes: AFC, D2 FSH and ovarian volume. Results: The range of age in both groups was 22-36 years, demographic data and endometrioma size were comparable, patients in group A was presented mainly by pain and secondary infertility while in group B, the main complaint was primary infertility. FSH showed statistically significant difference after 3 months (Median=5.85 versus 5, P value 0.004) and statistically significant difference found between both groups regarding AFC 6 months postoperative where the AFC decreased more in patients managed by ablation alone. Also, statistical significant difference found between groups regarding volume of ipsilateral ovary 6 months post-operative where the volume decreased more in patients managed by ablation (Median=11 versus 6.25 cm3, P value 0.003), no statistical significant difference found between the two studied groups regarding pregnancy or recurrence rate 3 and 6 months post-operative. Conclusion: Both laparoscopic excision ablation or ablation alone for management of unilateral endometrioma ≤ 5 cm decreased ovarian volume of ipsilateral ovary and improved serum FSH level but slightly increased AFC. Ablation alone had more negative impact on ovarian volume and AFC.