title: Endometriomas as a possible cause of reduced ovarian reserve in women with endometriosis.
abstract: OBJECTIVE
  To evaluate the adverse effects of endometriomas on ovarian reserve.
  
  
  METHODS
  Analysis of prospectively collected biopsy samples.
  
  
  METHODS
  Gynecology research unit in a university hospital.
  
  
  METHODS
  Women younger than age 35 years with endometriomas.
  
  
  METHODS
  Biopsy of normal cortex from ovaries affected by endometriomas (≤4 cm) and contralateral ovaries without cysts.
  
  
  METHODS
  Presence of cortex-specific stroma, observation of superficial endometriosis, follicular density, and presence of fibrosis.
  
  
  RESULTS
  Twenty samples of cortical tissue from ovaries with endometriomas and 11 from contralateral ovaries without cysts were analyzed. Follicular density was significantly lower in cortex from ovaries with endometriomas than in cortex from contralateral ovaries without cysts (mean ± SD = 6.3 ± 4.1/mm(3) vs 25.1 ± 15.0/mm(3)). Eleven (55%) cortical samples from ovaries with endometriomas showed fibrosis and concomitant loss of cortex-specific stroma, not observed in contralateral normal ovaries. Multivariate analysis revealed that the presence of endometrioma and fibrosis were significantly and independently associated with follicular density.
  
  
  CONCLUSIONS
  Endometriotic cyst formation and associated structural tissue alterations in apparently normal ovarian cortex may be a cause of reduced ovarian reserve. Early diagnosis and intervention may be beneficial in women with endometriomas to protect their ovarian function.
authors.affiliation: Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Department of Gynecology, Brussels, Belgium.
authors.forename: Michio
authors.initials: M
authors.lastname: Kitajima
authors.forename: Sylvie
authors.initials: S
authors.lastname: Defrère
authors.forename: Marie-Madeleine
authors.initials: MM
authors.lastname: Dolmans
authors.forename: Sebastien
authors.initials: S
authors.lastname: Colette
authors.forename: Jean
authors.initials: J
authors.lastname: Squifflet
authors.forename: Anne
authors.initials: A
authors.lastname: Van Langendonckt
authors.forename: Jacques
authors.initials: J
authors.lastname: Donnez
mesh_terms: D000328:Adult; D001706:Biopsy; D002452:Cell Count / Q000379:methods; D004715:Endometriosis / Q000150:complications* / Q000473:pathology*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology* / Q000473:pathology*; D008222:Lymphokines; D008954:Models, Biological; D010048:Ovarian Cysts / Q000209:etiology / Q000473:pathology; D010053:Ovary / Q000473:pathology*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D008222:Lymphokines; C092591:fibrosin