Procjena učinaka dviju metoda laparoskopskog liječenja endometrioma na pričuve jajnika pomoću biokemijskih i ultrazvučnih parametara [Two laparoscopical methods in the treatment of ovarian endometriomas and its effect on the ovarian reserve assessed by known biochemical and ulstrasonographic parameters]

Fertility of patients with endometriosis is seriously compromised due to decrease in the follicle ovarian reserve even before any ovarian surgery. Antral follicle count (AFC) , anti Mullerian hormon (AMH), inhibin B and FSH were used in the ovarian reserve assessment. \nHundred twenty one (121) patients were randomized. In group A 61 patients- ovarian haemostasis was obtained by suturing and group B 60 patients- ovarian haemostasis was obtained by bipolar electrocoagulation. A prospective study was designed to assess whether the laparoscopic suturing for haemostasis had less adverse effect on the ovarian reserve compared to bipolar electrocoagulation. \nAge, parity and the size of endometriomas were comparable between both groups. The sum of AFC in three postoperative cycles of whole 121 intact ovaries in both groups was significantly lower than the AFC of whole 121 operated ovaries (18,57± 4,34 vrs. 8,50±4,35; p<0,001). There was a significantly higher AFC in ovaries that had been sutured (A) than in ovaries that had been electrocoagulated (B) (12,18±2,37 vrs. 4,75±2,13; p<0,001). In addition, there was a significantly higher AMH serum level in group A than in group B (22,11±8,15 vrs. 18,70±9,03; p<0,05). \nBy the method of standard linear regression it was noted significant predictive \neffect of postoperative serum levels of AMH (p=0,025) and its preoperative and postoperative difference (P<0,001) on the postoperative AFC. After the adjusment for chronological age serum levels of AMH (p=0,009) and serum levels of inhibin B (p=0,035) were statistically significant predictors of AFC. \nLaparoscopic operation on ovarian endometrioma could reduce ovarian reserve. That adverse effect could be less if the haemostasis is achieved by suturing of the rest ovarian tissue. Biochemical markers - FSH, inhibin B and AMH - could be used in the assessment of the ovarian reserve after laparoscopic treatment of ovarian endometriomas. AMH has significant predictive effect on the ovarian AFC.