Comprehensive Assessment of the Impact of Laparoscopic Ovarian Cystectomy on Ovarian Reserve.

Abstract

To evaluate the effects of laparoscopic cystectomy of endometrioma and nonendometrioma ovarian cyst on ovarian reserve. Prospective follow-up study of patients after laparoscopic ovarian cystectomy (Canadian Task Force II-2). Academic hospital. Seventy patients underwent laparoscopic ovarian cystectomy, with bilateral endometrioma (n = 21), unilateral endometrioma (n = 29), and unilateral other benign ovarian cyst (n = 20) from February 2011 and May 2012. The control group (n = 20) comprised patients treated with laparoscopic myomectomy or laparoscopic hydrotubation and fimbrioplasty at the same time period. All laparoscopic operations were applied by suture homeostasis. Ovarian reserve was assessed by serum levels of anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) and by antral follicle count (AFC), ovarian volume, ovarian stromal pulsatility index, and resistance index on the third day of menstruation preoperatively and in postoperative months 1.6 and 12. FSH levels increased significantly but the AMH and AFC levels declined significantly in the bilateral endometrioma group at 1 month postoperatively compared with preoperative levels (p < .05) but did not differ significantly at 6 and 12 months postoperatively. The ovarian stromal pulsatility and resistance indices in the ipsilateral ovaries decreased significantly in all patients with unilateral ovarian cysts at 6 and 12 months postoperatively compared with preoperative levels (p < .05), although the mean ipsilateral ovarian volume was significant smaller than the unaffected side. There was no detectable difference on ovarian reserve marker levels between 4 groups and from baseline values at 6 and 12 months after laparoscopic ovarian cystectomy of endometrioma, although these levels significantly declined in the first month postoperatively.