#265 : Oocyte Outcome After Laparoscopy Cyst Drainage Procedure Before IVF Stimulation in Endometriosis Patients

Abstract

Background: Endometriosis is the presence of endometrial-like tissue outside the uterine cavity. In late years, in order to control endometriosis, we often performed cystectomy either laparoscopy or laparotomy. However, cystectomy done in endometriosis patient undergoing IVF can decrease the AMH also the quality of the oocytes, thus cyst drainage procedures (with the insertion of hemostate agent) was considered as a replacement for cystectomy in endometriosis patients before they begin the IVF stimulations. Aims: To see the effect of laparoscopic cyst drainage with the insertion of an absorbable hemostate towards the quality of the oocytes in endometriosis patient Method: A retrospective cohort study took place at Center of Reproductive Medicine and Andrology Bocah Indonesia in Primaya Hospital, Tangerang between January 2021 and December 2022. Patients with endometriosis cysts before IVF stimulations were all included. Excluded were those declining to participate and with incomplete case notes. All of the subjects used ultra-long GnRH agonist protocols. A medical committee approved the study and all women provided written informed consent. Results: 18 patients were included in the analysis (11 undergoing laparoscopy cyst drainage and insertion absorbable hemostatic agent’s vs 7 undergoing only cystectomy). There was a statistically significant difference in AMH values in patients with cystectomy vs drainage with an absorbable hemostatic agent in AMH values 1.002 ± 0.76 to 0.77 ± 0.76 vs 1 (0.30 – 3.31) to 1 (0.30 – 4.00) (p=0.003 vs p =0.678). Among those, there was no significant difference between cystectomy and drainage with the maturation of oocyte (p=0.231 vs p=0.381). On the other side, there was a significant difference between cyst drainage and cystectomy resulting in good embryos in cleavage (p=0.038). One of the patients has a naturally conceive pregnancy after a cyst drainage procedure. Conclusion: Endometriosis with laparoscopic cyst drainage procedure can maintain AMH level, reduce inflammation, and proliferation of lesions so it can maintain better quality of oocytes.