title: Removal of unilateral endometriomas is associated with immediate and sustained reduction in ovarian reserve.
abstract: Endometrioma surgery by stripping the cyst capsule has been associated with a reduction in ovarian reserve. It is still not clear whether the inflicted damage is immediate, sustained over time or associated with the use of electrocautery, nor which marker is more accurately reflects the post-operative reduction in ovarian reserve. This observational study assessed the damage inflicted by endometrioma removal with anti-Müllerian hormone (AMH) concentration and antral follicle count (AFC) pre and post-operatively. Twenty-five women with unilateral endometrioma underwent laparoscopic stripping of the endometrioma cyst capsule. There was a significant decrease both in AMH concentration (24%) and in AFC (11%) 1 month following surgery (P<0.01). At 6months post-operatively, the respective values were 24% and 15% less than preoperatively. AMH concentration and AFC showed no correlation with the use of bipolar electrocautery during surgery. Primordial follicles embedded adjacent to the cyst capsule were found in 61.5% of the specimens. Endometrioma surgery by stripping of the cyst capsule is associated with a significant reduction in ovarian reserve. The reduction is immediate and sustained over time. AMH appears to be a better indicator for post-operative quantification of the ovarian reserve.
authors.affiliation: Department of Obstetrics and Gynecology and Assisted Reproduction Unit, American Hospital, Istanbul, Turkey. burman@superonline.com
authors.forename: Bulent
authors.initials: B
authors.lastname: Urman
authors.forename: Ebru
authors.initials: E
authors.lastname: Alper
authors.forename: Kayhan
authors.initials: K
authors.lastname: Yakin
authors.forename: Ozgur
authors.initials: O
authors.lastname: Oktem
authors.forename: Senai
authors.initials: S
authors.lastname: Aksoy
authors.forename: Cengiz
authors.initials: C
authors.lastname: Alatas
authors.forename: Ramazan
authors.initials: R
authors.lastname: Mercan
authors.forename: Baris
authors.initials: B
authors.lastname: Ata
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D015415:Biomarkers / Q000097:blood; D004715:Endometriosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005498:Follicular Phase; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D059351:Organ Sparing Treatments; D010048:Ovarian Cysts / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006080:Ovarian Follicle / Q000000981:diagnostic imaging; D010053:Ovary / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016649:Primary Ovarian Insufficiency / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D012720:Severity of Illness Index; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D015415:Biomarkers; D054304:Anti-Mullerian Hormone
keywords: anti-Müllerian hormone; antral follicle count; cyst stripping; endometrioma; laparoscopy; ovarian reserve