Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons

REPRODUCTIVE BIOMEDICINE ONLINE

卷:23

Article

Biacchiardi, Chiara Perono²  Delle Piane, Luisa¹  Camanni, Marco²  Deltetto, Francesco²  Delpiano, Elena Maria²  Marchino, Gian Luigi¹  Gennarelli, Gianluca¹  Revelli, Alberto^1,3 

[1] Univ Turin, Reprod Med & IVF Unit, Dept Obstet & Gynecol Sci, OIRM S Anna Hosp, Turin, Italy

[2] GINTEAM Unit Minimally Invas Gynaecol, Turin, Italy

[3] Univ Turin, Physiopathol Reprod & IVF Unit, S Anna Hosp, Turin, Italy

关键词: endometriotic cyst;    laparoscopic cystectomy;    ovarian endometriosis;    ovarian reserve;   

DOI  :  10.1016/j.rbmo.2011.07.014

来源: Elsevier

【 摘 要 】

In order to estimate the impact of laparoscopic stripping of endometriomas on the ovarian follicular reserve, 43 normo-ovulatory women were studied by endocrine (anti-Mullerian hormone (AMH), FSH, LH, inhibin B, oestradiol) and ultrasonographic (antral follicle count (AFC)) methods before surgery, and 3 and 9 months after surgery. The operation was performed by experienced laparoscopists, particularly aware of the need to avoid damaging the healthy part of the ovary. Serum AMH concentrations significantly decreased after the operation (1.4 +/- 0.2 ng/ml after 3 months and 1.3 +/- 0.3 ng/ml after 9 months versus 3.0 +/- 0.4 ng/ml before surgery; P < 0.0001), whereas basal FSH, LH, oestradiol and inhibin B concentrations remained unchanged. The volume of the operated ovary significantly diminished after surgery (P < 0.0001), whereas the AFC was not significantly altered. Overall, the data show that laparoscopic stripping of endometriomas reduces ovarian reserve. The significant decrease of AMH after surgery confirms that part of the healthy ovarian pericapsular tissue, containing primordial and preantral follicles, is removed or damaged despite all the surgical efforts to be atraumatic. This must be carefully considered when laparoscopic cystectomy surgery is scheduled for patients with no relevant symptoms besides infertility or with already small ovarian reserve. (C) 2011, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

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