title: Women's fertility after laparoscopic cystectomy of endometrioma and other benign ovarian tumors - a 24-month follow-up retrospective study.
abstract: OBJECTIVE
  The golden standard in treatment benign ovarian cysts is laparoscopic cystectomy, but it may also influence women's fertility. The aim of the study was to compare women's fertility after laparoscopic cystectomy of endometrioma versus other benign ovarian tumors.
  
  
  METHODS
  Out of the 123 patients operated because of benign ovarian tumor (OT), 66 underwent laparoscopic cystectomy of endometrioma (endometrioma group) and 57 underwent laparoscopic cystectomy of other benign ovarian tumor like: functional cyst, hemorrhagic cyst, yellow body cyst or mature teratoma (reference group). OT-related data were obtained from medical documentation (diagnostic tests, medical reproductive and surgical history, clinical status during OT surgery). Follow-up data were collected by means of a telephone interview. The survey included questions focused on women's fertility during a 24-month period following the surgical treatment of OT (conception, subsequent pregnancies, recurrence of OT).
  
  
  RESULTS
  A 24-month follow-up period revealed that the cumulative pregnancy rate was significantly higher in reference group (RG) as compared to endometrioma group (EG), i.e. 52.6% vs. 32.3%. Lower pregnancy risk was demonstrated in a EG group vs. other benign ovarian tumors, HR=0.57 (CI 0.33-0.99; p=0.049), log-rank test p=0.045. Benign OT returned in 19.3% vs. EG 36.3%, HR= 2.5 (CI 1.16-5.55 ; p=0.019) log-rank test: p=0.0136. The EG was divided on two subgroups: women with solitary endometrioma and women with endometrioma and coexistent peritoneal endometriosis. The study showed insignificantly lower risk of pregnancy in a group of advanced endometriosis vs. solitary endometrioma group (HR= 0.79 (CI 0.34-1.83; log-rank test p=0.57; pregnancy rate 29.3% vs. 40.0%). Statistically nonsignificant higher pregnancy rate occurred in a group of women with tumor ≤50mm in size among patients with benign ovarian tumor and solitary endometrioma vs. group of women with tumor >50mm (30% vs. 61%; p=0.09).
  
  
  CONCLUSIONS
  There is a low pregnancy rate after laparoscopic cystectomy of benign OT. Moreover, pregnancy rate after cystectomy of endometrioma is significantly lower and the percentage of reccurence of endometrioma is significantly higher. That is why, the decision about surgical treatment among childbearing women must be well-considered because of the risk of subsequent surgery in the future.
authors.affiliation: Department of Gynecology and Oncological Gynecology, Polish Mother's Memorial Hospital Research Institute in Lodz, Poland.
authors.forename: Marta
authors.initials: M
authors.lastname: Kostrzewa
authors.affiliation: Department of Gynecology and Oncological Gynecology, Polish Mother's Memorial Hospital Research Institute in Lodz, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Stachowiak
authors.affiliation: Department of Gynecology and Oncological Gynecology, Polish Mother's Memorial Hospital Research Institute in Lodz, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Zyła
authors.affiliation: Medical University of Lodz, Lodz, Poland.
authors.forename: Dorota
authors.initials: D
authors.lastname: Kolasa-Zwierzchowska
authors.affiliation: Department of Gynecology and Oncological Gynecology, Polish Mother's Memorial Hospital Research Institute in Lodz, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Szpakowski
authors.affiliation: Department of Gynecology and Oncological Gynecology, Polish Mother's Memorial Hospital Research Institute in Lodz, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Nowak
authors.affiliation: Department of Gynecology and Oncological Gynecology, Polish Mother's Memorial Hospital Research Institute in Lodz, Poland.
authors.forename: Jacek R
authors.initials: JR
authors.lastname: Wilczynski
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D005298:Fertility; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D010048:Ovarian Cysts / Q000601:surgery*; D010049:Ovarian Diseases / Q000150:complications / Q000601:surgery; D010051:Ovarian Neoplasms / Q000601:surgery*; D010532:Peritoneal Diseases / Q000150:complications / Q000601:surgery*; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D013724:Teratoma / Q000601:surgery*; D055815:Young Adult