title: Damage to ovarian reserve associated with laparoscopic excision of endometriomas: a quantitative rather than a qualitative injury.
abstract: OBJECTIVE
  Retrospective studies suggest that laparoscopic excision of endometriomas is associated with a reduced responsiveness to ovarian hyperstimulation. In this study, we prospectively evaluated ovarian response to hyperstimulation in women selected for in vitro fertilization and intracytoplasmic sperm injection cycles who previously underwent laparoscopic enucleation of a monolateral endometrioma.
  
  
  METHODS
  Operated and contralateral intact ovaries of the same patient were compared in terms of number of follicles, number of oocytes retrieved, fertilization rate, and rate of high-quality embryos.
  
  
  RESULTS
  Thirty-eight subjects were included. A reduced number of dominant follicles, oocytes, embryos, and high-quality embryos was observed in the operated gonad. The mean percentage of reduction was 60% (95% confidence interval 38-81%), 53% (95% confidence interval 30-75%), 55% (95% confidence interval 28-81%), and 52% (95% confidence interval 17-87%), respectively. Fertilization rate and rate of good-quality embryos were similar.
  
  
  CONCLUSIONS
  Laparoscopic excision of endometriomas is associated with a quantitative but not a qualitative damage to ovarian reserve.
authors.affiliation: Infertility Unit, Policlinico, Mangiagalli and Regina Elena Hospital, Università Degli Studi di Milano, Milan, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Ragni
authors.forename: Edgardo
authors.initials: E
authors.lastname: Somigliana
authors.forename: Francesca
authors.initials: F
authors.lastname: Benedetti
authors.forename: Alessio
authors.initials: A
authors.lastname: Paffoni
authors.forename: Walter
authors.initials: W
authors.lastname: Vegetti
authors.forename: Liliana
authors.initials: L
authors.lastname: Restelli
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Crosignani
mesh_terms: D000328:Adult; D004624:Embryo Transfer; D004715:Endometriosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy; D009865:Oocytes; D010048:Ovarian Cysts / Q000503:physiopathology / Q000601:surgery*; D006080:Ovarian Follicle; D010053:Ovary / Q000000981:diagnostic imaging / Q000187:drug effects / Q000293:injuries / Q000503:physiopathology*; D010062:Ovulation Induction; D011184:Postoperative Period; D011446:Prospective Studies; D014463:Ultrasonography