title: Laparoscopic cystectomy of endometrioma: Good surgical technique does not adversely affect ovarian reserve.
abstract: BACKGROUND
  The damage to ovarian reserve inflicted by surgery for endometriosis represents a major concern in the balance between reproductive benefits and risks.
  
  
  OBJECTIVE
  To evaluate the ovarian reserve in sub fertile women after laparoscopic endometriotic cystectomy.
  
  
  METHODS
  Prospective study, done in Department of Obstetrics and Gynecology, tertiary care hospital between August 2010-2012.
  
  
  METHODS
  Laparoscopic cystectomy performed by stripping technique for endometriotic cysts. Endometriosis was staged according to revised American Society of Reproductive Medicine classification (rASRM). Ovarian reserve assessed by comparing FSH and LH levels, measurement of residual ovarian volume, antral follicle counts and stromal blood flow on second day of menses pre and postoperatively. Cyst wall was evaluated histologically to note the presence of normal ovarian tissue in resected tissue.
  
  
  METHODS
  SPSS for Windows version 16.0 (SPSS Inc., Chicago, IL) was used for statistical calculations. Wilcoxon signed test and Pearson Chi - Square test were applied. Significance level was P < 0.05.
  
  
  RESULTS
  Incidence of minimal, mild, moderate, and severe endometriosis was 4.1%, 21.9%, 28.7%, 45.3% respectively. Ovarian reserve was assessed both by ultrasound and biochemical parameters on day 2 of menses; pre and post-operatively. Preoperative and post-operative values; FSH (7.24 ± 1.21, 7.23 ± 1.51 m IU/ml), LH levels (6.37 ± 1.8, 6.6 ± 2.3 m IU/ml), residual ovarian volume (8.5 cm(3) ± 5.3, 7.4 cm(3) ± 5.8), antral follicle count(3.3 ± 1.9, 4.1 ± 1.5) and stromal blood flow (6.8 cm/sec ± 4.57, 7.1 cm/sec ± 3.55) were statistically not significant. Loss of follicle was seen in 27.2% cyst walls on histopathological examination while 72.73% had no loss.
  
  
  CONCLUSIONS
  Laparoscopic cystectomy when performed for endometriotic cysts with accurate surgical technique leads to no significant ovarian tissue removal.
authors.affiliation: Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
authors.forename: Rajeshwari G
authors.initials: RG
authors.lastname: Bhat
authors.affiliation: Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
authors.forename: Sushma
authors.initials: S
authors.lastname: Dhulked
authors.affiliation: Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
authors.forename: Amar
authors.initials: A
authors.lastname: Ramachandran
authors.affiliation: Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Bhaktha
authors.affiliation: Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
authors.forename: Akhila
authors.initials: A
authors.lastname: Vasudeva
authors.affiliation: Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
authors.forename: Pratap
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Department of Pathology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
authors.forename: Anuradha C K
authors.initials: AC
authors.lastname: Rao
keywords: Antral follicle count; laparoscopic endometriotic cystectomy; ovarian reserve; ovarian volume