Ovarian reserve and endometrioid ovarian cysts: clinical and ultrasound aspects

E.D. Dubinskaya, A Gasparov, А. А. Дутов, N.V. Lapteva, N.S. Pyatykh
In: Voprosy ginekologii, akušerstva i perinatologii · 2017 · vol. 16(4) , pp. 27–34 · doi:10.20953/1726-1678-2017-4-27-34 · W2766491288
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This study examined laparoscopic findings and Doppler parameters in infertile patients with endometrioid ovarian cysts and low or normal ovarian reserve.

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The study evaluated laparoscopic and Doppler ultrasound features of endometrioid ovarian cysts in 100 reproductive-age patients with primary infertility, stratified by ovarian reserve using AMH (10 IU/l) versus AMH (>2.0 ng/ml) and FSH (<8 IU/l). Using 2D/3D transvaginal ultrasound with grey-scale and color/power Doppler, and 3D-angiography to assess vascularization before and after surgery, the authors found that in patients with low ovarian reserve, perfusion and vascularization of normal ovarian tissue were significantly lower when cysts were located in the infundibulopelvic and proper ovarian ligament area than with marginal location, whereas in normal-reserve patients intraovarian blood flow was only insignificantly affected. The authors conclude that the effect on ovarian reserve depends on cyst size, location, capsule characteristics, and spread of extragenital endometriosis, noting that cysts 3–5 cm may be associated with either low or high reserve and that cysts >5 cm increased the likelihood of reserve damage by 3.5 times. This paper is centrally about endometriosis — it focuses on ovarian reserve and ultrasound/Doppler findings in patients with endometrioid ovarian cysts.

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Gynecology, Obstetrics and Perinatology - Gynecology, Obstetrics and Perinatology - 2017 volume 16 issue 4 Ovarian reserve and endometrioid ovarian cysts: clinical and ultrasound aspects Authors / Institutions Ekaterina D. Dubinskaya / Aleksandr S. Gasparov / A.A.Dutov / N.V.Lapteva / N.S.Pyatykh / The objective. To study laparoscopic values and establish specificities of endometrioid ovarian cysts and Doppler parameters in healthy ovarian tissue containing an endometrioid cyst in infertile patients with low and normal ovarian reserve. Patients and methods. We examined 100 patients of reproductive age with primary infertility and endometrioid ovarian cysts. Depending on the state of ovarian reserve, 2 groups were singled out: group 1 comprised patients with low ovarian reserve (n = 55) (anti-Müllerian hormone level (AMH) less than 2.0 ng/ml, follicle-stimulating hormone (FSH ФСГ) higher than 10 IU/l), group 2 – patients (n = 45) with normal ovarian reserve (AMH level higher than 2.0 ng/ml, FSH less than 8 IU/l). Before and after surgery, 2D- and 3D-transvaginal ultrasound was used in grey-scale, colour and power Doppler modes. 3D-angiography was used to assess vascularisation of ovarian tissue. Results. In the group of patients with low ovarian reserve, in case of cyst location in the area of the infundibulopelvic and proper ovarian ligament vascularisation and perfusion of normal ovarian tissue were significantly lower as compared to «marginal» location of the cyst in the same group (VI – 0.62 ± 0.16%, FI – 18.11 ± 2.53, PI – 1.77 ± 0.14, RI – 0.72 ± 0.05 and VI – 0.81 ± 0.57%, FI – 25.7 ± 2.53%, PI – 1.56 ± 0.11, RI – 0.65 ± 0.04, respectively). In patients with normal ovarian reserve, intraovarian blood flow in the affected ovary was damaged insignificantly. Conclusion. The presence of an endometrioid cyst is not always associated with damage to ovarian reserve: if the cyst size is more than 5 cm the possibility of damage to ovarian reserve increases by 3.5 times; if cyst sizes are 3–5 cm ovarian reserve might be both low and high. Influence of endometrioid cysts on ovarian reserve is conditioned by their size, location, characteristics of the capsule and spread of extragenital endometriosis. Key words: infertility, doppler ultrasound, laparoscopy, ovarian reserve, endometrioid ovarian cysts. For citation: Dubinskaya E.D., Gasparov A.S., Dutov A.A., Lapteva N.V., Pyatykh N.S. Ovarian reserve and endometrioid ovarian cysts: clinical and ultrasound aspects. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2017; 16(4): 27–34. (In Russian). DOI: 10.20953/1726-1678-2017-4-27-34 Patients and methods. We examined 100 patients of reproductive age with primary infertility and endometrioid ovarian cysts. Depending on the state of ovarian reserve, 2 groups were singled out: group 1 comprised patients with low ovarian reserve (n = 55) (anti-Müllerian hormone level (AMH) less than 2.0 ng/ml, follicle-stimulating hormone (FSH ФСГ) higher than 10 IU/l), group 2 – patients (n = 45) with normal ovarian reserve (AMH level higher than 2.0 ng/ml, FSH less than 8 IU/l). Before and after surgery, 2D- and 3D-transvaginal ultrasound was used in grey-scale, colour and power Doppler modes. 3D-angiography was used to assess vascularisation of ovarian tissue. Results. In the group of patients with low ovarian reserve, in case of cyst location in the area of the infundibulopelvic and proper ovarian ligament vascularisation and perfusion of normal ovarian tissue were significantly lower as compared to «marginal» location of the cyst in the same group (VI – 0.62 ± 0.16%, FI – 18.11 ± 2.53, PI – 1.77 ± 0.14, RI – 0.72 ± 0.05 and VI – 0.81 ± 0.57%, FI – 25.7 ± 2.53%, PI – 1.56 ± 0.11, RI – 0.65 ± 0.04, respectively). In patients with normal ovarian reserve, intraovarian blood flow in the affected ovary was damaged insignificantly. Conclusion. The presence of an endometrioid cyst is not always associated with damage to ovarian reserve: if the cyst size is more than 5 cm the possibility of damage to ovarian reserve increases by 3.5 times; if cyst sizes are 3–5 cm ovarian reserve might be both low and high. Influence of endometrioid cysts on ovarian reserve is conditioned by their size, location, characteristics of the capsule and spread of extragenital endometriosis. Key words: infertility, doppler ultrasound, laparoscopy, ovarian reserve, endometrioid ovarian cysts. For citation: Dubinskaya E.D., Gasparov A.S., Dutov A.A., Lapteva N.V., Pyatykh N.S. Ovarian reserve and endometrioid ovarian cysts: clinical and ultrasound aspects. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2017; 16(4): 27–34. (In Russian). DOI: 10.20953/1726-1678-2017-4-27-34

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