Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons.
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-Müllerian 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.
GINTEAM Unit of Minimally Invasive Gynaecology, Turin, Italy.
Chiara Perono
CP
Biacchiardi
Luisa Delle
LD
Piane
Marco
M
Camanni
Francesco
F
Deltetto
Elena Maria
EM
Delpiano
Gian Luigi
GL
Marchino
Gianluca
G
Gennarelli
Alberto
A
Revelli
D000293:Adolescent; D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D004715:Endometriosis / Q000601:surgery*; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007265:Inhibins / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects*; D007986:Luteinizing Hormone / Q000097:blood; D006080:Ovarian Follicle / Q000000981:diagnostic imaging*; D010053:Ovary / Q000000981:diagnostic imaging / Q000502:physiology*; D014463:Ultrasonography
C422364:inhibin B; D004958:Estradiol; D007265:Inhibins; D054304:Anti-Mullerian Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone