Abstract
BackgroundOvarian endometriomas affect a substantial proportion of women of reproductive age who may have a potential risk of diminished ovarian reserve (DOR) after ovarian cystectomy. Here, we investigated the risk factors for pre-surgical DOR in patients with ovarian endometriomas and for DOR after laparoscopic ovarian cystectomy for endometriomas and evaluated the feasibility of the pre-surgical prediction of post-surgical DOR based on the Bologna criteria.MethodsA total of 143 patients with ovarian endometriomas who underwent laparoscopic cystectomy from January 2009 to May 2015 at our hospital were prospectively enrolled and evaluated. Serum anti-Müllerian hormone (AMH) concentrations were measured pre-surgically and at 3 and 6 months after surgery. In accordance with the Bologna criteria, the patients whose AMH concentrations were <1.1 ng/mL before surgery and 3 or 6 months after surgery were classified into pre- and post-surgical adverse DOR (aDOR) groups, respectively.ResultsThirty-one (21.7 %) of 143 patients were classified as pre-surgical aDOR. Patient age and serum follicle-stimulating hormone level were significantly positively correlated with pre-surgical aDOR [odds ratios (ORs), 1.26 and 1.16; p < 0.001 and p = 0.003, respectively]. Among the remaining 112 patients, 38 patients (33.9 %) had post-surgical aDOR 3 and 6 months after surgery. Bilateral cystectomy was positively correlated with post-surgical aDOR (at 3 months: OR, 4.7; p = 0.001; at 6 months: OR, 3.71; p = 0.006); conversely, pre-surgical serum AMH concentrations were negatively correlated with post-surgical aDOR (at 3 months: OR, 0.65; p = 0.005; at 6 months: OR, 0.43; p < 0.001). The optimal cut-off point of pre-surgical AMH concentrations for predicting aDOR at 3 and 6 months in the patients undergoing unilateral cystectomy was 2.1 ng/mL. In contrast, the optimal cut-off points at 3 and 6 months in the patients undergoing bilateral cystectomy were 3.0 and 3.5 ng/mL, respectively.ConclusionsOur data suggest that the pre-surgical serum AMH concentrations and bilateral cystectomy are significant factors for the risk of aDOR following surgery and that predicting post-surgical aDOR according to the Bologna criteria could be feasible using pre-operative measurements of serum AMH concentrations.
Highlights
Ovarian endometriomas affect a substantial proportion of women of reproductive age who may have a potential risk of diminished ovarian reserve (DOR) after ovarian cystectomy
The aims of the present study were to investigate the factors associated with DOR and the potential risk of becoming a poor ovarian responder (POR) before and after laparoscopic cystectomy of ovarian endometriomas, and to evaluate the feasibility of pre-surgical prediction of post-surgical DOR according to the Bologna criteria
The following analyses were conducted: 1) analysis I, to evaluate influencing factors associated with pre-surgical adverse DOR (aDOR) among 143 patients who underwent laparoscopic cystectomy for endometriomas; 2) analysis II, to evaluate influencing factors associated with post-surgical aDOR at 3 and 6 months after surgery in 112 patients without pre-surgical aDOR and optimal cut-off points of the pre-surgical antiMüllerian hormone (AMH) concentration to predict post-surgical aDOR at 3 and 6 months after surgery by Receiver operating characteristic (ROC) curve analysis and 3) analysis III, to evaluate cumulative spontaneous pregnancy rates at 24 months after surgery in the aDOR and non-aDOR groups classified according to serum AMH concentrations at 6 months after surgery in 35 patents who tried to achieve spontaneous pregnancy after surgery
Summary
Ovarian endometriomas affect a substantial proportion of women of reproductive age who may have a potential risk of diminished ovarian reserve (DOR) after ovarian cystectomy. According to the European Society of Human Reproduction and Embryology (ESHRE) guidelines, ovarian cystectomy is preferred for the secondary prevention of endometriosisassociated symptoms and for increasing the spontaneous pregnancy rate [3]. Both the guidelines and previous studies suggested a possible post-surgical reduction in the ovarian reserve, which indicates that follicles are inadvertently removed by the stripping of the cyst wall [4,5,6,7]. The potential incidence and the risk factors have not yet been adequately investigated
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
