Excision Of Endometrioma Research Articles

Reproductive outcomes in infertile women with endometriosis undergoing ART.

Background Endometriosis-related infertility and its treatment with assisted reproductive technologies (ART) have been broadly researched. Yet, underlying mechanisms of infertility, particularly in the absence of tubal dysfunction, remain unclear. While the impact of inflammatory milieu on the ovary and/or endometrium has been indicated as a contributing factor, recent evidence from euploid transfers and donor cycles questions the extent of these effects. Moreover, the frequent coexistence of other confounders, such as adenomyosis, further complicates the clinical picture, making it difficult to isolate the specific impact of endometriosis on ART outcomes. Objectives To evaluate the influence of endometriosis on various aspects of ART, including oocyte competence, ART success and whether surgical or medical treatments improve these. Methods We primarily focused on recent high-quality sources, including systematic reviews, large-scale observational studies, and meta-analyses, to ensure a robust and reliable synthesis of the available evidence. Outcome While oocyte yield can decrease in the presence of an endometrioma or history of endometrioma excision, oocyte quality, early embryo development indicators, aneuploidy rates, and clinical outcomes of endometriosis patients do not differ from other infertility diagnoses in ART settings. Surgical treatments and hormonal suppression before ART do not seem to improve outcomes. Ovarian stimulation for ART does not seem to exacerbate endometriosis. Conclusions and Outlook Endometriosis, despite its high prevalence among infertile patients, does not inherently impair ART success, except in cases where ovarian reserve is compromised due to ovarian disease or its surgical treatment. The causal link between endometriosis and infertility remains an enigma, and future studies should continue to explore this association with other confounding factors.

Ovarian endometrioma recurrence after laparoscopic surgery: First assessment of ACSAP predicting score.

We aimed to develop and validate a predictive score to estimate the post-operative recurrence risk after laparoscopic excision of ovarian endometrioma (OMA). The prediction score was developed using a training set comprising 431 patients with OMA who underwent laparoscopic surgery at our institution between January 2015 and September 2017. A follow-up period of at least 5 years was required. Clinical data were entered into least absolute shrinkage and selection operator (LASSO) regression to build a scoring system that predicted OMA recurrence. A testing set containing 185 patients from October 2017 to October 2018 was used to assess its performance. Based on LASSO regression, the final score (ACSAP score) included five clinical predictors (0-15 points): Age, cyst size, previous surgery for OMA, revised American Society for Reproductive Medicine stage and post-operative pregnancy. The area under the curve values of the score were 0.741 (0.765) and 0.727 (0.795) for predicting 3-year and 5-year OMA recurrence, respectively, in the training (testing) set. The score stratified patients into three risk groups in both sets, with significant differences in the 5-year recurrence rates (low-risk, 5.3% [0%]; intermediate-risk, 20.2% [16.5%] and high-risk, 48.0% [36.5%]; P < 0.001). Moreover, patients in the intermediate- and high-risk groups exhibited a significant reduction in the 5-year cumulative recurrence following a minimum of 15-month post-operative medical treatment (both P < 0.05). The ACSAP score may be a concise and useful tool for identifying patients with a higher risk of OMA recurrence after surgery who might receive long-term post-operative medical treatment.

Effect of vasopressin injection technique on ovarian reserve during laparoscopic cystectomy of ovarian endometriomas: a systematic review and meta-analysis of randomized controlled trials.

To evaluate the effect of injecting vasopressin during laparoscopic excision of ovarian endometriomas on ovarian reserve. Four different databases (PubMed, Cochrane Library, Scopus, and ISI Web of Science) were searched to identify relevant studies in March 2023. We selected randomized controlled trials (RCTs) that compared vasopressin injection in the intervention group versus no injection of vasopressin in the control group among women undergoing laparoscopic cystectomy of ovarian endometriomas. The main outcomes were the amount of bleeding, number of coagulation events, and levels of serum anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH). The available data were extracted and analyzed in a meta-analysis model using RevMan software. Seven RCTs, involving a total number of 478 patients, were included in our study. The vasopressin group had significantly reduced blood loss amount and number of coagulation events compared to the control group (P=0.004 and P=0.005). There was a significant improvement in the AMH levels within 6 months after surgery in the vasopressin group (MD=0.52, 95% CI: 0.11, 0.93, P=0.01). In addition, the FSH levels within 6 months after laparoscopic cystectomy were significantly reduced with vasopressin injection. Vasopressin injection during laparoscopic cystectomy of ovarian endometriomas is effective in reducing blood loss amount and frequency of coagulation, as well as protecting the ovarian reserve. More trials are encouraged to confirm our findings.

Management of Endometriosis: An Integrative Review of National and International Guidelines

Endometriosis is a disease characterized by the presence of endometrial tissue outside the uterus, affecting 2 to 22% of women worldwide, resulting in inferior quality of life as the condition often causes pain (dysmenorrhea, dyspareunia) and infertility. It is notable that clinical practice has changed in the last decade, with endometriosis receiving much more media attention and patients taking a more active role through different disease organizations. Considering these changes and identifying which practices are justified by medical evidence is essential. Using the descriptors: "Treatment", "Endometriosis" and "Guidelines" in the PUBMED, MEDLINE and SciELO databases, a total of 312 articles were found and, subsequently, eight articles were submitted to the selection criteria. Regarding pharmacological therapies associated with endometriosis, most of the guidelines included in this study suggest progestins, either in the form of dienogest or medroxyprogesterone acetate, and combined oral contraceptives as first-line therapy with considerable evidence. GNRH agonists and the levonorgestrel system are used as second-line treatment. Surgery also has a significant role in the treatment of endometriosis-related pain, with the excision of endometrial implants or endometriomas. Handling ovarian tissue as thoroughly as possible is recommended in order to limit the decrease in ovarian reserve. Despite very well-established guidelines, relevant diagnostic tests such as Magnetic Resonance Imaging (MRI) are inaccessible and expensive for most women, as is laparoscopic surgery, hindering the diagnosis and treatment of the disease, especially in underdeveloped countries.

Whole exome sequencing reveals novel candidate variants for endometriosis utilizing multiple affected members in a single family.

Endometriosis is an estrogen-dependent, chronic inflammatory disease that affects 10% of women during the reproductive ages. Despite the estimated 50% heritability for the condition, only 26% was associated with common genetic variants. Thus, necessity of identifying rare variants for the missing heritability is implicated in the literature. Therefore, our study aimed to identify novel rare genetic variants involved in the pathogenesis of endometriosis utilizing a family of multiple affected members. A family composed of four affected women along with their two unaffected mothers were recruited at a single gynecology and infertility clinic specialized in endometriosis. All patients presented with endometriomas, which was visualized by transvaginal ultrasonography. Two affected individuals had received laparoscopic endometrioma excision and therefore were diagnosed with recurrent disease. One mother had a history of endometrial serous adenocarcinoma (ESC) for which she underwent hysterectomy with bilateral oophorectomy. Three endometriosis cases were whole exome sequenced on Illumina NextSeq 550 platform with an average of 90% coverage. Candidate genes were confirmed by Sanger sequencing and followed-up with family segregation. Novel rare variants were identified in TNFRSF1B (NM_001066.3: c.1072G>A, p.(Ala358Thr)) and GEN1 (NM_001130009.3: c.1574C>T, p.(Ser525Leu)) as possible genetic causes of endometriosis. A third novel rare variant was identified in CRABP1 (NM_004378.3:c.54G>C, p.(Glu18Asp)) only on the mother with ESC history and her daughters. Novel candidate genetic variants that might contribute to endometriosis were suggested that need replication through independent cohorts or validation by functional studies. The family has also received genetic counseling and that the affected daughters are on clinical follow-up, accordingly.

Predictive Value of Serum Vascular Endothelial Growth Factor Level for Postoperative Endometriosis Recurrence in Patients with Ovarian Endometriosis

Background: Postoperative recurrence remains a problem for endometriosis. The study aimed to study whether baseline serum vascular endothelial growth factor (VEGF) levels can predict postoperative endometriosis recurrence. Methods: We included 147 patients with ovarian endometriosis who received laparoscopic endometrioma excision and postoperative gonadotropin-releasing hormone agonist treatment with hormonal add-back therapy between 2017 and 2019 in a tertiary hospital. According to endometriosis recurrence within 2 years, the patients were divided into two groups and baseline serum VEGF level measured before the surgery were compared. Logistic regression was used to examine the association between baseline serum VEGF level and endometriosis recurrence, and the area under the receiver operating characteristic curve (AUC) was calculated to examine its predictive performance. Results: The mean age of the patients was 30.1 ± 6.0 years with a duration of dysmenorrhea of 60.3 ± 35.0 months before surgery, and the majority (88.4%) were with revised American Fertility Society (rAFS) stage III or IV. Eight (5.44%) patients had endometriosis recurrence within 2 years. Compared with patients without recurrence, patients with recurrence were significantly younger (25.9 ± 4.3 vs. 30.3 ± 6.0 years, p = 0.040) and had higher baseline serum VEGF levels (689.67 ± 127.38 vs. 547.87 ± 171.31 pg/mL, p = 0.023), but there was no difference in other baseline characteristics. Serum VEGF levels were significantly associated with endometriosis recurrence (odds ratio 1.008 per pg/mL increase, 95% confidence interval 1.001–1.014) after adjusting for other baseline characteristics. The AUC of serum VEGF levels for predicting postoperative endometriosis recurrence was 0.741 (95% confidence interval 0.594–0.887). Conclusions: Baseline serum VEGF level is an independent risk factor of postoperative endometriosis recurrence and might be useful for predicting endometriosis recurrence.

Patient satisfaction and Quality of life after dienogest treatment versus surgical excision of ovarian endometrioma

Patient satisfaction and Quality of life after dienogest treatment versus surgical excision of ovarian endometrioma

Fertility Preservation in Women with Endometriosis.

Several mechanisms have been implicated in the pathogenesis of endometriosis-related infertility. For patients considering surgery, the risk of iatrogenic injury is among the most important factors in the context of fertility preservation, along with age and individual reproductive goals. In the case of endometrioma excision, evidence overwhelmingly demonstrates the negative impact of surgery on ovarian reserve, with significant reductions in antimullerian hormone (up to 30% in unilateral versus up to 44% in bilateral endometriomas). The surgical endometriosis patient should be thoroughly counseled regarding fertility preservation and discussion should include tissue, embryo, and oocyte cryopreservation options. For the latter, data support cryopreservation of 10-15 oocytes in women ≤35 years and over 20 for those >35 years for a realistic chance to achieve one or more live births. When performing surgical interventions for endometriosis, reproductive surgeons should employ fertility-conserving surgical methods to reduce the likelihood of postoperative iatrogenic diminished ovarian reserve.

The optimal time for laparoscopic excision of ovarian endometrioma: a prospective randomized controlled trial

ObjectiveThis study aimed to explore the optimal time of laparoscopic cystectomy for unilateral ovarian endometrioma patients and evaluate the influence on ovarian reserve.Materials and methodsThis prospective randomized controlled study included 88 women with unilateral ovarian endometrioma at a tertiary teaching hospital. All patients received their first identified diagnosis of ovarian endometrioma by ultrasound (> 4 cm and ≤ 10 cm) and were administered an oral contraceptive pill (OC) for one cycle before laparoscopy. They were randomly divided into two groups: laparoscopy at the late luteal phase (group LLP) (n = 44) (termination of OC for two days) and laparoscopy at the early follicular phase (group EFP) (n = 44) (day 3 after menstruation). Basic clinical characteristics were recorded. Serum Anti-Müllerian hormone (AMH) levels were measured at various times to predict ovarian reserve. Serum levels of Anti-Müllerian hormone (AMH) were measured at several time sites to predict the ovarian reserve; AMH and leukocyte esterase (LE) levels of the endometrioma wall were measured.ResultsBefore surgery, serum AMH levels decreased in both groups from preoperative to one week and six months postoperatively. In contrast, the difference values of group EFP were larger than those of group LLP at postoperative one week and postoperative six months (1.87 ± 0.97 vs. 1.31 ± 0.93, P = 0.07; 1.91 ± 1.06 vs. 1.54 ± 0.93, P = 0.001). The mean rates of postoperative serum AMH decline were 37.92% and 46.34% in group EFP, significantly higher than those in group LLP (25.83% vs. 31.43%, P < 0.001). Ovarian endometrioma wall AMH of group LLP was significantly lower than that of group EFP ([22.86 ± 3.74] vs. [31.02 ± 5.23], P < 0.001). Meanwhile, ovarian endometrioma LE concentration of group LLP was significantly higher than that of group EFP ([482.83 ± 115.88] vs. [371.68 ± 84.49], P<0.001). There was also a significant inverse correlation between leukocyte esterase and AMH concentration in an ovarian endometrioma cyst wall (r=-0.564, P<0.001).Conclusion(s)The optimal time for laparoscopic cystectomy for patients with first identified unilateral ovarian endometrioma is the late luteal phase, which reduces ovarian tissue loss and preserves ovarian reserve effectively and safely.

P-351 The impact of ovarian endometriosis on oocyte competence in IVF/ICSI cycles: A systematic review and meta-analysis

Abstract Study question Is oocyte competence affected in patients with ovarian endometriosis in IVF/ICSI cycles? Summary answer In IVF cycles ovarian endometrioma negatively impacts oocyte quality in terms of oocytes and mature (MII) oocytes retrieved but not the fertilization and blastulation rates. What is known already Is still controversial whether the presence of a non-surgically treated ovarian endometrioma alone may adversely affect the oocyte quality in IVF/ICSI treatments. As oocyte quality is well reflected by the ability to complete maturation and undergo successful fertilization, the best clinical markers of oocyte competence are represented by number of MII oocytes retrieved and fertilization rates. Even though women with endometriomas had fewer oocytes and MII oocytes retrieved than women without, no further differences in reproductive outcomes have been found. The most recent meta-analysis, however, has serious limitations, such as clinical heterogeneity of the studies and a small sample size. Study design, size, duration A systematic review and meta-analysis of studies evaluating clinical markers of oocyte competence in women with ovarian endometriosis were conducted. Electronic searches were performed in PubMed, Cochrane database, and ClinicalTrials.gov up to December 2022. Randomized controlled trials and observational studies were eligible for inclusion. The risk of bias was assessed using the Newcastle–Ottawa Quality Assessment Scale. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Participants/materials, setting, methods Studies reporting ART outcomes among women with endometrioma were included. The main outcomes were clinical markers of oocyte competence including the number of oocytes retrieved, MII oocytes retrieved, ovarian sensitivity index (OSI), fertilization and blastulation rates. Mean differences (MD) and odds ratios (ORs) with 95% confidence intervals (CI) were calculated using the random and fixed effects model. Main results and the role of chance Of 876 unique records identified, 30 studies met inclusion criteria, and 21 studies, totaling 5962 participants, were included in the meta-analysis. The results showed that significantly fewer oocytes retrieved (mean difference (MD) = -1.67; 95% confidence interval (CI), -2.46, -0.88; p = &amp;lt;0.0001; I2=92%; low quality) and MII oocytes (MD = -2.45; 95% CI, -3.23, -1.67; p = &amp;lt;0.0001; I2=86%; moderate quality) were observed in women with endometriomas compared with the control. However, the OSI (MD = -1.47; 95% CI, -3.74, 0.81; p = 0.21; I2=97%; very low quality), fertilization rate (Odds ratio (OR) = 1.04; 95% CI, 0.78, 1.39; p = 0.79; I2=93%; low quality) and blastulation rate (OR = 0.90; 95% CI, 0.66, 1.22; p = 0.51; I2=95%; low quality) were not significantly different between the groups. Limitations, reasons for caution Despite removing patients with previous surgeries and diverse stages of endometriosis, main outcomes showed significant heterogeneity. The unilaterality/bilaterality, size, and the general extent of endometriomas could cause this heterogeneity. The quality of evidence generated from our findings is low, mainly due to the factors mentioned above. Wider implications of the findings Our findings suggest that endometriomas do not hinder fertility chances, as fertilization and blastulation rates were not compromised. Due to the risk of ovarian damage, these results argue against endometrioma excision. Further clinical trials with adequately-powered sample sizes should focus on blastulation and euploidy rates to validate our findings. Trial registration number Not applicable

Anatomical and Surgical Considerations for Ileocolic Endometriosis

We aim to review the incidence, location, and management of bowel endometriosis and demonstrate relevant surgical principles while emphasizing anatomic considerations for minimally invasive resection of ileocolic lesions. This video briefly reviews the background of bowel endometriosis and indications for surgical excision. We present a case of a patient diagnosed with symptomatic terminal ileum endometriosis and review the preoperative imaging. We demonstrate the steps of a medial-to-lateral surgical approach for ileocolic resection and highlight the relevant surgical anatomy. Institutional review board approval was not required. This procedure was performed at a large academic institution with a multidisciplinary team of minimally invasive gynecologic and colorectal surgeons. The case presented is a 44-year-old female with a known history of stage IV endometriosis. She presented with acute abdominal pain and was found to have a small bowel obstruction from a 3-centimeter lesion thought to be an endometrioma. She failed conservative management and was thoroughly counseled about the need for surgical intervention. Pelvic magnetic resonance imaging was performed for preoperative planning. Laparoscopic ileocolic resection is performed using a medial-to-lateral approach for excision of a symptomatic 3-centimeter ileocecal endometrioma. The following techniques are highlighted: (1) Evaluation of the entire small bowel starting at the ligament of Treitz (2) Entry into the retroperitoneum below the ileum with cranial and caudal dissection (3) Mobilization of the ascending colon to the level of the falciform ligament (4) Extension of the umbilical incision to perform an extracorporeal ileocecal resection and anastomosis CONCLUSION: The bowel is the most common extragenital site for endometriosis to occur, with the highest rate of lesions located in the rectosigmoid colon [1]. Lesions can be either superficial or deeply infiltrative and can lead to a range of symptoms. A serious sequela of bowel endometriosis includes bowel obstruction requiring surgical intervention.

Expectant, Medical, and Surgical Management of Ovarian Endometriomas.

Management options for ovarian endometriomas include expectant management, medical treatment, surgical treatment, in vitro fertilization (IVF), or a combination of the above. The choice of management depends on many clinical parameters that should be taken into consideration, the first of which is the main presenting symptom. Most patients are today referred to medical therapy as a first option in the case of associated pain, and to IVF in the case of associated infertility. When both symptoms are present, usually surgery is the preferred approach. Recently, however, surgical excision of an ovarian endometrioma has been associated with a postoperative reduction in the ovarian reserve, and recent guidelines suggest that the clinician should caution the patient as to the possible damage to the ovarian reserve in the case of surgery. However, evidence has been published as to a possible detrimental effect of the ovarian endometrioma on the ovarian reserve even if expectant management is followed. In this review, the current evidence on the conservative management of ovarian endometriomas, with particular focus on the issue of the ovarian reserve, is evaluated, and the different surgical techniques for the treatment of ovarian endometriomas are discussed.

Comparison between Injection of Diluted Vasopressin and Saline Only in Laparoscopic Excision of Ovarian Endometrioma

Comparison between Injection of Diluted Vasopressin and Saline Only in Laparoscopic Excision of Ovarian Endometrioma

Impact of the hemostatic approach after laparoscopic endometrioma excision on ovarian reserve: Systematic review and network meta-analysis of randomized controlled trials.

Laparoscopic excision of endometrioma and subsequent hemostasis have detrimental effects on ovarian reserve. To evaluate which hemostatic approach after stripping cystectomy shows less damage on ovarian reserve. Embase, MEDLINE, Scopus, Scielo.br, LILACS, Cochrane Library at the CENTRAL Register of Controlled Trials, Clinicaltrials.gov, CINAHL, conference abstracts, and International Clinical Trials Registry Platform were searched from inception until April 2022. Randomized controlled trials of women undergoing laparoscopic endometrioma excision that compared at least two hemostatic approaches. Relevant data were extracted and tabulated. Network meta-analysis based on random-effects model for mixed multiple treatment to rank hemostatic strategies using the surface under the cumulative ranking curve area (SUCRA) was performed. Quality assessment was performed using Cochrane criteria. The primary outcome was serum antimullerian hormone levels 3months after surgery. Ten studies, including 748 women, were selected. Suturing the ovary with barbed suture (SUCRA, 82.80%) seem the most effective strategy to avoid antimullerian hormone reduction. Similarly, for ultrasonographic antral follicular count, barbed (SUCRA, 30.70%) and simple suture (SUCRA, 30.70%) were ranked the best choices. Ovarian suturing with simple suture demonstrated lower follicle-stimulating hormone levels (SUCRA, 88.70%). Suturing the ovary, with simple or barbed suture, seems the most effective approach to keep ovarian reserve higher.

Excision and reconstruction of port site umbilical endometrioma; practices of aesthetic gynaecology in a low resource setting

The presence of endometrial tissues outside the uterine cavity is known as endometriosis. Villar’s node, also known as umbilical endometriosis, is a rare condition that accounts for 0.5-1% of all extra-pelvic diseases. Electrocautery combined with surgical removal of the umbilical nodule and a recreation of an aesthetically appealing umbilicus is the treatment of choice. The surgical technique of local excision of umbilical endometrioma, neo umbilical reconstruction with four flap technique and post-operative management in low resource settings where plastic surgery facilities are not available have been discussed in the article.

Laparoscopic Endometrioma Excision Using Hydrodissection with Dilute Vasopressin

<h3>Study Objective</h3> To demonstrate the surgical technique of hydrodissection with dilute vasopressin for laparoscopic endometrioma excision. <h3>Design</h3> A narrated stepwise video demonstration of surgical technique. <h3>Setting</h3> Academic Hospital, demonstrated by an experienced surgeon trained in minimally invasive gynecologic surgery. <h3>Patients or Participants</h3> Two patients with infertility and stage 4 endometriosis. Both with large bilateral endometriomas. Desiring to preserve and improve fertility. <h3>Interventions</h3> We perform laparoscopic excision of large endometriomas using hydrodissection with dilute vasopressin (20 units in 100-200cc). Vasopressin is injected with a laparoscopic injection needle into the potential space between the endometrioma wall and ovarian capsule. This technique helps to develop the correct surgical plane while decreasing blood loss and tissue trauma. The ovarian capsule is dissected off the cyst using blunt dissection and traction-countertraction techniques, with a goal of minimal use of electrocautery and maximum preservation of healthy ovarian follicles. <h3>Measurements and Main Results</h3> Both cases resulted in complete excision of bilateral endometriomas with minimal blood loss and exceptional hemostasis at the conclusion of the procedure. <h3>Conclusion</h3> Hydrodissection with dilute vasopressin is a simple and effective method for decreasing blood loss during laparoscopic excision of endometriomas. This method helps decrease use of electrocautery and potential thermal spread to surrounding viable ovarian follicles.

EFFECT OF HEMOSTATIC METHODS USED IN LAPAROSCOPIC SURGERY FOR OVARIAN ENDOMETRIOMA ON OVARIAN RESERVE: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS OF RANDOMIZED TRIALS

Laparoscopic excision of ovarian endometriomas is associated with a decrease in ovarian reserve and the choice of hemostatic method following stripping has been implicated as a factor. We aimed to rank various hemostatic methods used following laparoscopic endometrioma excision.

The presence of living endometrial cells in ovarian endometriotic cyst fluid may contribute to the recurrence of endometriosis after surgical excision of endometriomas

BackgroundMany factors can affect the recurrence of endometriosis after surgery, however, whether endometriotic cyst fluid contributes to endometriosis recurrence after surgical excision of ovarian endometriomas remains unclear. The objective of this study was to determine the presence of endometrial cells in ovarian endometriosis cyst fluid and the potential differences between these cells and those in the cyst wall.MethodsSamples of cyst fluid (n = 39) and drainage fluid (n = 14) were collected from patients with ovarian endometriomas undergoing laparoscopic surgery. Drainage fluid from 14 patients without endometriosis was used as a control. The presence of endometrial cells in cyst fluid and drainage fluid was determined by cell culture in vitro and immunostaining. In addition, cyst fluid endometrial fragments and viscosity were analysed by transcriptome sequencing analysis and apparent diffusion coefficients, respectively. An animal model was used to confirm the ability of endometrial cells in cyst fluid to form new lesions.ResultsWe found endometrium-like tissues in 71.8% (28/39) of cyst fluid and 71.4% (10/14) of drainage fluid samples by histopathological examination, and the presence of endometrioid tissue in cyst fluid was related to the viscosity of the cyst fluid. The living endometrial cells in cyst fluid and drainage fluid were confirmed by cell culture in vitro and immunostaining. Moreover, the adhesion ability of endometrial fragments in cyst fluid was significantly higher than that of ectopic tissues in the cyst wall (P < 0.05). In addition, living endometrial cells in the cyst fluid were able to adhere and alive in the animal model.ConclusionsThe existence of living endometrial cells with high adhesion ability in ovarian endometriotic cyst fluid may contribute to the recurrence of endometriosis after surgical excision of endometriomas due to cyst fluid outflow during the surgical procedure.

Risk Factors for Anti Mullerian Hormone Decline after Laparoscopic Excision of Endometrioma: A Prospective Study.

Background:Laparoscopic excision of ovarian endometrioma is believed to decrease the ovarian reserve, but the risk factors of declining ovarian reserve are not well studied. This study aimed to determine the risk factors of anti mullerian hormone (AMH) decline after laparoscopic surgery of endometrioma.Materials and Methods:This prospective study was recruited in Yas and Arash Hospitals affiliated to Tehran University of Medical Sciences from 2020 to 2021. Women between 18-45 years with ovarian endometriomas with a diameter greater than 3 centimeters who were candidates for laparoscopy were included. AMH, luteinizing hormone (LH), and follicular stimulating hormone (FSH) as well as cancer antigen 125 (CA125) and cancer antigen 19-9 (CA19-9) were obtained and compared pre and postoperatively. Indeed, the relation of AMH decline rate and the demographic, symptoms and endometrioma characteristics were investigated either.Results:In this study, 100 women were recruited. The mean ± SD age of the participants was 29.08 ± 4.6. AMH (P<0.000) and LH (P=0.013) declined significantly postoperatively. Whereas, no significant difference was observed between pre and postoperative FSH (P=0.520). AMH decline rate was 30.07 ± 2.30% and didn’t have significant relation with the demographic characteristics, preoperative AMH, and the amount of CA125. Otherwise in the multivariate analysys, CA125 (P=0.160) and the grade of endometriosis (P=0.05) had significant correlation with AMH decline rate.Conclusion:Ovarian reserve decline after laparoscopic excision of endometrioma. Otherwise, there may no specific risk factor to predict the degree of ovarian reserve decline. Therefore, the selection of patients for laparoscopic excision of endometrioma should be taken more cautiously as the ovarian reserve diminishes even in the patients with the lowest risks.

Ovarian function following use of various hemostatic techniques during treatment for unilateral endometrioma: Arandomized controlled trial.

To compare the effect of hemostatic techniques (bipolar energy versus hemostatic sealants versus suture) on the ovarian reserve of patients submitted to laparoscopic cystectomy for the surgical excision of unilateral endometrioma. A randomized controlled trial conducted in a teaching hospital included 84 patients with unilateral endometrioma. The patients underwent laparoscopic stripping for excision of the unilateral endometrioma between March 2018 and February 2020. Three different hemostatic techniques-bipolar energy (Group 1), hemostatic sealants (Group 2), and suture (Group 3)-were compared. Anti-Müllerian hormone (AMH) levels were measured before, and 1 and 6months after surgery to determine changes in ovarian function. Following surgery, AMH levels decreased in all the groups; however, this decrease was not statistically significant. Comparison between groups showed no statistically significant differences in AMH levels between the three hemostatic techniques used. Six months after surgery, median AMH levels were: 1.65ng/mL (interquartile range [IQR] 0.62-2.08ng/mL) in Group 1, 1.87ng/mL (IQR 1.27-2.97ng/mL) in Group 2, and 1.53ng/mL (IQR 1.18-2.44ng/mL) in Group 3. The present study suggests that there is no difference between the different hemostatic techniques used in laparoscopic cystectomy for the treatment of unilateral endometriomas. Registered at ClinicalTrials.gov: NCT03430609. https://clinicaltrials.gov/ct2/show/NCT03430609.