Impact of pre and post laparoscopic ovarian treatment on ovarian reserve with infertile women : prospective study

Abstract

We used laparoscopy to treat endometriosis and other causes of infertility in women to help improve chances for pregnancy. In 2013, we conducted a retrospective analysis using anti- müllerian hormone (AMH) serum to investigate the effects of laparoscopic treatment on ovaries. The aim of this new study was to determine the impact of laparoscopic ovarian treatment on ovarian reserve as measured by AMH in a prospective analysis. Prospective study This study involved 357 infertile women who received laparoscopic examination and treatment of ovaries prior to in-vitro fertilization (IVF) treatment at St. Luke Clinic, between March 2013 and October 2016. The patients were divided into four groups according to the kind of laparoscopy treatment conducted: 1) Ovarian drilling for polycystic ovary syndrome (LOD) (n=48); 2) Ethanol Sclerotherapy for chocolate cyst of the ovary (ES) (n=32); 3) Removal of ovarian endometriosis with electrocautery (EC) (n=213); and 4) No treatment to ovaries(some had laparoscopic procedures on areas other than ovaries) (Control) (n=64). From the previous study, we found that AMH levels were higher during the follicle phase than the luteal phase. Therefore, we measured AMH levels immediately prior to laparoscopic procedures, and during the follicle phase 2 days, 1 month, 3months, 6months post procedure. The AMH levels in the serums among the four groups were compared pre and post laparoscopy. The decreased ratio of AMH levels was evaluated [pre-operative AMH level]-[post-operative AMH level] / pre-operative AMH level, and compared among the four groups. In all four groups, the mean AMH levels after laparoscopy were significantly lower than before the laparoscopy (the mean AMH level prior to laparoscopy, and 2 days, 1, 3, and 6 months post laparoscopy, AMH levels: LOD: pre 9.4ng/ml and 7.1ng/ml, 5.6ng/ml, 5.4ng/ml, 6.1ng/ml; ES: pre 4.2ng/ml and 3.6ng/ml, 2.9ng/ml, 2.8ng/ml, 2.2ng/ml; EC: pre 3.4ng/ml and 2.9ng/ml, 2.5ng/ml, 2.8ng/ml, 2.7ng/ml; Control: pre 4.1ng/ml and 3.8ng/ml, 3.1ng/ml, 3.3ng/ml, 2.7ng/ml). The mean decrease ratio of the AMH levels 2 days post laparoscopy were significantly different between LOD and Control, and EC and Control (LOD: 23.5%, EC: 15.4%, Control 5%; there was no significant difference between ES:16.1% and Control). There was no significant difference between the mean decrease ratio of AMH levels at 1, 3, and 6 months post laparoscopy (1month; LOD: 38%, ES: 21.1%, EC: 13.5%, Control: 8%, 3month; LOD:34.6%, ES: 36.3%, EC: 8.9%, Control: 7.5%, 6month; LOD: 32.6%, ES:34.8%, EC: 6.2%, Control: 10.4%). This study suggests that ovarian reserve may be reduced after laparoscopy regardless of whether the laparoscopic treatment is to the ovaries or only to the uterus. LOD, ES, EC appears to have little influence on ovarian reserve.