Changes In Ovarian Reserve Research Articles

Comparing ovarian reserve parameters after laparoscopic endometrioma resection in the follicular vs. luteal phase: a prospective cohort study.

To evaluate whether performing laparoscopic endometrioma surgery in the follicular or luteal phase affects changes in ovarian reserve. This prospective cohort study was conducted in a university-affiliated hospital. A total of 55 women who underwent unilateral laparoscopic endometrioma removal were included in the study. Of these, 28 were in the follicular phase of the menstrual cycle (follicular group), and 27 were in the luteal phase (luteal group). The primary outcomes were the rates of decreased anti-Mullerian hormone (AMH) levels and antral follicle counts (AFC) 6 months after the surgery, which were compared between the groups. The groups were similar in patient characteristics and endometrioma sizes. AMH levels and AFCs were significantly lower in the post-operative 6th month compared with their pre-operative values (p < 0.05 for both groups). The rate of decrease in AMH levels 6 months after the surgery was not significantly different between the follicular and luteal groups (24.5 and 19.5%, respectively, p > 0.05). Similarly, the rate of decrease in AFCs 6 months after the surgery did not differ between the groups (13.4 and 14.3%, respectively, p > 0.05). Performing laparoscopic endometrioma surgery, whether in the follicular or luteal phase, does not seem to affect the changes in the ovarian reserve. https://clinicaltrials.gov/study/NCT03484546, identifier NCT034845.

Impact of ultrasound-guided high-intensity focused ultrasound for the treatment of uterine fibroids on ovarian reserve and quality of life: a single-center prospective cohort study

BackgroundWe aimed to evaluate changes in ovarian reserve and quality of life in women treated with ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids.MethodsIn this single-center prospective study, a total of 69 patients with uterine fibroids treated with USgHIFU from October 2018 to November 2021 were enrolled. Fibroid volume, anti-Müllerian hormone (AMH) levels, uterine fibroid symptom scores, and uterine fibroid symptoms and quality of life (UFS-QOL) questionnaire scores before and 1, 3, and 6 months after USgHIFU treatment were analyzed. Correlations between AMH levels and age, fibroid type, and fibroid location were assessed.ResultsData from 54 of the 69 patients included in the present study were analyzed. The UFS-QOL scores at baseline and at 1 month and 6 months after USgHIFU treatment were 70 (50.75–87.50), 57 (44.75–80.00), and 52 (40.75–69.00) points, respectively (p < 0.001). The rate of fibroid volume reduction increased significantly at the 3-month follow-up compared with the 1-month follow-up (p < 0.001), and no significant change was observed between the 3-month and 6-month follow-ups (p > 0.99). The median AMH levels before and at 1, 3 and 6 months after treatment were 1.22 (0.16–3.28) ng/ml, 1.12 (0.18–2.52) ng/ml, 1.15 (0.19–2.08) ng/ml and 1.18 (0.36–2.43) ng/ml, respectively (p = 0.2). Multivariate linear regression analyses revealed that age was independently associated with AMH levels.ConclusionsUSgHIFU treatment for uterine fibroids can significantly improve quality of life with minimal adverse effects on ovarian function.

Ovarian Reserve Changes After Tubal Surgery

Ovarian Reserve Changes After Tubal Surgery

Correlation between ovarian follicular development and Hippo pathway in polycystic ovary syndrome

BackgroundFor women of childbearing age, the biggest problem caused by polycystic ovary syndrome (PCOS) is infertility, which is mainly caused by anovulation, abnormal follicular development, proliferation of small antral follicles, and cystic follicles. The mechanism underlying its occurrence is not clear. The abnormal proliferation and development of follicles in PCOS patients is a complex process, which is affected by many factors. The objective of this study was to investigate the relationship between the Hippo pathway and follicular development in PCOS, and to further explore this relationship by using the YAP inhibitor verteporfin (VP).Method30 3-week-old BALB/C female rats were randomly divided into control group (n = 10), DHEA group (n = 10) and DHEA + VP group (n = 10). The morphology of ovary and the degree of follicular development were observed by HE staining, and the expression and location of AMH in ovarian follicles were observed by immunofluorescence. The ovarian reserve function index AMH, cell proliferation index PCNA and the ratio of Hippo pathway related proteins MST, LATS, YAP, P-YAP and P-YAP/YAP were detected by Western blot.ResultsAfter dividing 30 3-week-old female mice into control, dehydroepiandrosterone (DHEA; model of PCOS), and DHEA + VP groups, we found that the number of small follicles increased in the DHEA group compared to the control group. Additionally, in the DHEA group compared to the control group, anti-müllerian hormone (AMH; ovarian reserve index) increased, proliferating cell nuclear antigen (PCNA; cell proliferation index) decreased, and upstream (MST and LATS) and downstream (YAP and p-YAP) proteins in the Hippo pathway increased, though the p-YAP/YAP ratio decreased. VP ameliorated the increases in AMH, MST, LATS, YAP and p-YAP, but did not ameliorate the decrease in the p-YAP/YAP ratio.ConclusionsThis study indicates that the increased small follicles in the ovaries and changes in ovarian reserve and cell proliferation may be closely related to Hippo pathway activation. This suggests that the Hippo pathway may be an important pathway affecting the proliferation and development of follicles and the occurrence of PCOS.

Effect of catheter-directed ethanol sclerotherapy on ovarian reserve in patients with recurrent endometrioma: comparative analysis with primary endometriosis.

Catheter-directed ethanol sclerotherapy (CDS) is known to less affect the ovarian function, with comparable efficacy. This study aims to investigate the change in ovarian reserve after catheter-directed ethanol sclerotherapy in patients with recurrent endometrioma, as compared to primary endometrioma. Retrospective, observational study. Electronic medical records and images of patients with endometrioma who underwent CDS from August 2014 to April 2022 at a single institution were obtained. Patients aged > 18years old and with anti-Müllerian hormone (AMH) level between 0.8 and 10.0 with regular menstruation were enrolled. Cyst diameter, laterality, AMH level, and CA-125 level before and after 1month, 6months, 1year, 2years, and 3years of sclerotherapy were obtained. A total of 180 patients were fit for analysis. There was no statistical difference in age and cyst size between the two groups. Mean values of AMH in each group were 3.35 in the primary group and 3.00 in the recurrent group prior to the procedure (p = 0.347). There was no significant difference in delta value of AMH after sclerotherapy in both groups at each follow-up period. Also, this result was consistent when stratified by laterality, preprocedural AMH level, and initial size of endometrioma. No case of recurrence was reported in both groups. The effect of CDS on ovarian reserve is not inferior in recurrent endometrioma compared to primary endometrioma. Since sclerotherapy is known to less deteriorate the ovarian function than surgical removal of endometrioma, clinician could consider this as the first-line therapy in patients with recurrent endometrioma. Catheter-directed ethanol sclerotherapy for patients with recurrent endometrioma has similar effect on ovarian reserve compared to patients with primary endometrioma. • Secondary surgery for endometrioma has significant deleterious effect on ovarian function. • Catheter-directed sclerotherapy (CDS) for endometrioma had equally minimal adverse effect on ovarian reserve, represented as anti-Müllerian hormone (AMH), in both primary and recurrent groups. • Physicians should consider CDS for patients with recurrent endometrioma who desire to preserve ovarian function.

Effect of Bilateral Salpingectomy versus Bilateral Tubal Ligation on Ovarian Reserve for Patients Seeking Permanent Sterilisation: A Prospective Cohort Study

Introduction: Ovarian cancer is a common malignancy in women with a high mortality rate, necessitating effective preventive measures. The American Cancer Society and the American College of Obstetricians and Gynaecologists, in their newer guidelines, suggest that patients undergoing tubectomy have an opportunity for the prevention of ovarian carcinoma by undergoing Prophylactic Bilateral Salpingectomy (PBS) instead of tubectomy in average-risk women. However, salpingectomy is not widely accepted as a method of sterilisation over tubectomy during caesarean section due to concerns about its potentially detrimental effect on ovarian reserve. Aim: To determine the effect of Bilateral Salpingectomy (BLS) and Bilateral Tubectomy (BLT) on ovarian reserve over a period of six months from surgery and to compare salpingectomy and tubectomy for their intraoperative and postoperative complications. Materials and Methods: The study is a hospital-based prospective cohort study conducted in the Department of Obstetrics and Gynaecology, Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta, Assam, India, from Sept 2020 to Aug 2021, over a period of one year, involving women between 32-35 years undergoing sterilisation during caesarean section. Mean Antimullerian Hormone estimation was done preoperatively, at the 3rd month, and at the 6th month to assess changes in ovarian reserve following salpingectomy and tubectomy. Intraoperative blood loss, surgery time, surgical complications, postoperative complications, recovery period, histopathological study of the fallopian tube, etc., were analysed and compared between the two groups. All data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0. A p-value &lt;0.05 was considered statistically significant at a 5% confidence level. Results: A total of 114 patients were enrolled in the study, of which 9.64% dropped out midway, while the remaining 103 (90.36%) patients were part of the study until its completion. The mean age of the participants was 33 years and six months. There was no significant intergroup variation in preoperative, 3rd month, and 6th month mean Antimullerian Hormone (AMH) values (p&gt;0.05). However, in each group, the preoperative mean AMH was lower than its 3rd month and 6th month values, which were in the normal range. This was attributed to ovarian suppression during pregnancy, which normalised following delivery and showed an increasing trend thereafter. However, on average, salpingectomy required approximately 10 minutes more than tubectomy. Conclusion: Salpingectomy does not affect ovarian reserve in the short-term of six months. Other than being more timeconsuming compared to tubectomy, salpingectomy is on par with traditional tubectomy. Therefore, it may be adopted as a routine sterilisation method considering its role in the prevention of ovarian cancers.

LONGITUDINAL FOLLOW UP OF PATIENTS DIAGNOSED WITH COVID-19 DEMONSTRATES NO DECREASE IN OVARIAN RESERVE AS DEMONSTRATED BY SERUM ANTI-MÜLLERIAN HORMONE (AMH) AT 3 AND 6 MONTHS: A PILOT STUDY

To assess the impact of COVID-19 infection on ovarian reserve as measured by serum AMH in reproductive age females at 3 and 6 months post diagnosis of COVID-19 infection. An institutional COVID-19 biorepository was used to identify female patients between the age of 18 and 41 years with serum samples collected at time of COVID-19 diagnosis, 3 months post diagnosis, and/or 6 months post diagnosis. After IRB approval, serum samples were analyzed for AMH level at each time point. A power analysis demonstrated a sample size of 22 unique participants provides 80% power to detect a 0.85 ng/mL difference in AMH level, with an alpha of 0.05. The paired Wilcoxon signed rank test was used to determine significant difference in serum AMH levels over two time points and the Friedman test was used to determine significant difference in serum AMH levels over three time points. P<0.05 was considered significant. 22 unique participants had serum samples over at least two separate time points, including either time of diagnosis (0-13 days post diagnosis), 3 months (84-111 days) post diagnosis, and/or 6 months (180-190 days) post diagnosis. Mean age was 32.67±7.0 years and mean BMI was 32.65±9.1 kg/m2. The majority of participants were Caucasian (68.2%) or African American (31.8%). One participant was Hispanic (4.55%) and the remainder were Non-Hispanic (95.45%). 50% of participants had received at least one dose of COVID-19 vaccine by the time of diagnosis, 45.45% were unvaccinated, and vaccination status was unknown for 1 participant. 4 of the participants (18.18%) were on oral contraceptive pills (OCPs) during at least one time point over which serum samples were obtained, and 45.45% had history of prior OCP use. Overall, there was no difference in paired serum AMH levels between baseline and the follow up values at 3 or 6 months (n=22, median difference -0.41 ng/mL, p=0.08). Median values at baseline and follow up were: 3.04 ng/mL [3.71] and 4.05 ng/mL [3.93]. Similarly, there were no differences in serum AMH when 3 and 6 month follow up was assessed separately: 3 months: n=17, median difference -0.69, p=0.08; 6 months: n=14, median difference -0.52, p=0.12. When AMH at three time points was assessed for patients with both 3 and 6 month samples (n = 10), no significant differences were noted (p=0.44). In this limited sample, there was a significant difference in baseline median AMH values between patients that were vaccinated compared to unvaccinated (2.0 ng/mL vs. 5.1 ng/mL); however, in a regression analysis controlling for age, race, and BMI, this difference was not significant (p=0.053). This study does not demonstrate an association between a COVID-19 diagnosis and a change in ovarian reserve as assessed by serum AMH at 3 and 6 months follow up. The findings are presented as a pilot study as the overall sample size was small, and additional data collection is ongoing.

Ovarian reserve in premenopausal women with breast cancer

BackgroundAs a special reproductive hormone and ovarian reserve indicator, the role of anti-Müllerian hormone (AMH) in premenopausal women with breast cancer deserves further study. MethodsWe conducted an in-depth analysis of the data from the EGOFACT study (NCT02518191), a phase Ⅲ, randomized, controlled trial involving premenopausal female breast cancer patients in two parallel groups: chemotherapy with or without gonadotropin-releasing hormone analogs (GnRHa). Three hundred thirty premenopausal women aged 25–49 years with operable stage I to III breast cancer were included in this study. The characteristics of ovarian reserve changes marked by AMH in the EGOFACT study and the factors affecting ovarian function in premenopausal women with breast cancer were analyzed. ResultsThe AMH level of the chemotherapy alone group decreased gradually within one year, while the AMH level of the GnRHa group was significantly higher as early as 6 months after chemotherapy and recovered to close to the baseline level 12 months after chemotherapy (F = 34.991, P < 0.001). Correlation analysis showed that the factors affecting AMH levels mainly included age, menarche age, body mass index (BMI), reproductive history, baseline follicle stimulating hormone (FSH) level, pathological stage and GnRHa application, but they had different effects on the incidence of premature ovarian insufficiency (POI) at different periods. Multivariate logistic regression analysis showed that menarche age younger than 14 years (OR 0.470 [0.259, 0.852], P = 0.013), baseline AMH level higher than 0.5 ng/mL (OR 9.590 [3.366, 27.320], P < 0.001), pathological stage Ⅰ(OR 0.315 [0.124, 0.798], P = 0.015) and GnRHa application (OR 0.090 [0.045, 0.183], P < 0.001) were independent factors conducive to protection of ovarian reserve, as well as to recovery of ovarian reserve. ConclusionsAge, menarche age, baseline AMH level, and GnRHa application are the most important influencing factors for ovarian reserve in premenopausal women with breast cancer. Trial registrationClinicalTrials.gov, NCT02518191, registered on Aug 5, 2015.

The Prediction of Ovarian Reserve Changes after Cystectomy in Patients with Endometrioma Using the Point Scale System

Background. Ovarian endometriosis has the most aggressive effect on the ovarian reserve compared to other types of benign ovarian neoplasms. Laparoscopic cystectomy with pathomorphological verification remains the gold standard for the diagnosis of endometriosis in clinical practice. It is the lack of clear criteria for predicting damage to the ovarian reserve after surgical treatment and the future reproductive potential of a woman, as well as the inability to personalize treatment, that determined the purpose and objectives of this study. Aims to develop a score scale for predicting changes in the ovarian reserve after cystectomy in ovarian endometriosis based on a comprehensive preoperative assessment of basic clinical, ultrasound, and molecular-biochemical parameters. Materials and methods. A single-center observational cohort prospective comparative study was conducted for 5 years. The study included 238 women aged 24.4 3.1 years with pathomorphologically verified ovarian endometriosis, who came to the clinic with complaints of pain of varying intensity. Results. The content of anti-Muller hormone (AMH) less than 1.5 ng / ml was significantly highly correlated with the unfavorable outcome of surgery (r=0.723). The largest diameter of the formation more than 5 cm (r=0.826) and its main localization (r=0.743) correlated most strongly with a decrease in HR and intraovarian blood flow after cystectomy. The ROC analysis (receiver operating characteristic) and the evaluation of the area under the curve the AUC indicator (area under ROC curve) revealed that the determining value of the cut off point for serum LDH was 107.35 U/l, for IL-8 94.55 pg/ml and IL-6 82.4 pg/ml, with an increase in which the probability of reducing AMH increases by more than 50%. Conclusions. The point scale system including preoperative assessment of ultrasound parameters (endometrioma size, localization, and bilaterality) and biochemical markers of toxicity in serum helps to predict changes of ovarian reserve after cystectomy (LDH, IL-6, IL-8).

Long-term antimüllerian hormone patterns differ by cancer treatment exposures in young breast cancer survivors

To compare antimüllerian hormone (AMH) patterns by cancer status and treatment exposures across 6 years after incident breast cancer using administrative data. In a cross-sectional design, AMH levels in patients who developed incident breast cancer between ages 15-39 years during 2005-2019 were matched 1:10 to levels in females without cancer in the OptumLabs Data Warehouse. Modeled AMH patterns were compared among cyclophosphamide-based chemotherapy, non-cyclophosphamide-based chemotherapy, no chemotherapy, and no breast cancer groups. Commercially insured females in the United States. Females with and without breast cancer. Breast cancer, cyclophosphamide- and non-cyclophosphamide-based chemotherapy. AMH levels. A total of 233 patients with breast cancer (mean age, 34 years; standard deviation, 3.7 years) contributed 278 AMH levels over a median of 2 years (range, 0-6.7 years) after diagnosis; 52% received cyclophosphamide-based chemotherapy, 17% received non-cyclophosphamide-based chemotherapy (80% platinum-based), and 31% received no chemotherapy. A total of 2,777 matched females without cancer contributed 2,780 AMH levels. The pattern of AMH levels differed among the 4 groups. Among females without cancer and breast cancer survivors who did not undergo chemotherapy, AMH declined linearly over time. In contrast, among those who received cyclophosphamide-based and noncyclophosphamide-based chemotherapy, a nonlinear pattern of AMH level of initial fall during chemotherapy, followed by an increase over 2-4 years, and then by a plateau over 1-2 years before a decline was observed. In breast cancer survivors, AMH levels from administrative data supported ovarian toxicity of non-cyclophosphamide-based chemotherapy in breast cancer and efficiently depicted the timing and duration of changes in ovarian reserve to reflect the residual reproductive lifespan.

How Ovarian Reserve Changes after Deep Infiltrative Endometriosis Surgery?

Study Objective To study the ovarian response to surgical treatment of deep infiltrative endometriosis (DIE) in women of reproductive age. Design Prospective cohort-controlled study. Setting Surgical treatment of patients was performed by laparoscopic access using a standard closed technique under conditions of endotracheal anesthesia. Patients or Participants The main cohort was 70 women of reproductive age who underwent surgery for DIE. The comparison group consisted of 50 fertile women who underwent plastic surgery on the uterus. Interventions Surgical treatment of the patients of the main group consisted in maximum excision of foci of DIE and enucleation of endometrioid ovarian cysts. Measurements and Main Results Before and 6 months after surgery underwent determination of the level of anti-Müllerian hormone (AMH), follicle-stimulating hormone and estradiol in the blood by enzyme immunoassay, as well as counting the number of antral follicles (AFC) in the ovaries by transvaginal ultrasound. The baseline AMH level was significantly lower in patients with DIE (2.4±2.1 ng/ml) than in the comparison group (3.8±3.2 ng/ml), p<0.05. Surgical treatment of DIE led to a significant decrease in the level of AMH, the average level of AMH in patients of the main group 6 months after surgery was 1.6±1.6 ng/ml compared with the initial level of 2.4 ng/ml, p<0,05. In the patients of the comparison group after surgery the AMH level remained at the initial level (3.8±3.2 ng/ml). The initial AFC according to transvaginal ultrasound was also significantly lower in the main group (8.3±4.5) than in the comparison group (11.8±4.1), p<0.001. After surgical treatment of DIE, there was a slight decrease in the AFC according to ultrasound (7.2±3.5), but the difference with the preoperative level did not reach statistical significance. Conclusion Surgical treatment of DIE leads to a decrease in the initially compromised ovarian reserve in patients of reproductive age. To study the ovarian response to surgical treatment of deep infiltrative endometriosis (DIE) in women of reproductive age. Prospective cohort-controlled study. Surgical treatment of patients was performed by laparoscopic access using a standard closed technique under conditions of endotracheal anesthesia. The main cohort was 70 women of reproductive age who underwent surgery for DIE. The comparison group consisted of 50 fertile women who underwent plastic surgery on the uterus. Surgical treatment of the patients of the main group consisted in maximum excision of foci of DIE and enucleation of endometrioid ovarian cysts. Before and 6 months after surgery underwent determination of the level of anti-Müllerian hormone (AMH), follicle-stimulating hormone and estradiol in the blood by enzyme immunoassay, as well as counting the number of antral follicles (AFC) in the ovaries by transvaginal ultrasound. The baseline AMH level was significantly lower in patients with DIE (2.4±2.1 ng/ml) than in the comparison group (3.8±3.2 ng/ml), p<0.05. Surgical treatment of DIE led to a significant decrease in the level of AMH, the average level of AMH in patients of the main group 6 months after surgery was 1.6±1.6 ng/ml compared with the initial level of 2.4 ng/ml, p<0,05. In the patients of the comparison group after surgery the AMH level remained at the initial level (3.8±3.2 ng/ml). The initial AFC according to transvaginal ultrasound was also significantly lower in the main group (8.3±4.5) than in the comparison group (11.8±4.1), p<0.001. After surgical treatment of DIE, there was a slight decrease in the AFC according to ultrasound (7.2±3.5), but the difference with the preoperative level did not reach statistical significance. Surgical treatment of DIE leads to a decrease in the initially compromised ovarian reserve in patients of reproductive age.

Üreme Döneminde Kadınlarda TSH Düzeyinin Yumurta Rezervine Etkisi

Objective: One of the most common endocrinological disorders in women of reproductive age is thyroid diseases. It is known that serum Anti-Mullerian hormone level is a good indicator in determining the ovarian reserve. In this study, we investigated the effect of serum thyroid-stimulating hormone level on Anti-Mullerian hormone.Material and Methods: The data of 198 patients aged between 20-45 years, who were consulted to the endocrinology clinic for fertility evaluation, were recorded and analyzed retrospectively. All patients were divided into 3 categories according to their thyroid-stimulating hormone level results; 1) ≤2.5 mIU/L, 2) 2.51-4.99 mIU/L, 3) ≥5 mIU/L. Serum Anti-Mullerian hormone, laboratory results and demographic characteristics were compared between all of the groups. In addition, the correlation between Anti-Mullerian hormone and thyroid-stimulating hormone was analyzed.Results: The mean age of the patients was 29.4 (±6.4). Variables such as age (p=0.384), BMI (p=0.407), FSH (p=0.178), LH (p=0.407), estradiol (p=0.424), and Anti-Mullerian hormone (p=0.814) were not different between the groups. There was no correlation between Anti-Mullerian hormone level and serum thyroid-stimulating hormone level or body mass index results. While a statistically significant positive correlation was found between Anti-Mullerian hormone and luteinizing hormone (r=0.258, p=0.001), a negative correlation was found between Anti-Mullerian hormone and follicle stimulating hormone (r=-0.207, p=0.007) and estradiol (r=-0.198, p=0.010).Conclusion: In conclusion, while mild thyroid-stimulating hormone changes do not appear to be effective on Anti-Mullerian hormone used in the assessment of ovarian reserve, more comprehensive studies are needed to show that ovarian reserve changes positively with thyroid hormone replacement therapy.

EVALUATION OF ENDOMETRIOMA PATHOPHYSIOLOGY AND RELATED OVARIAN DAMAGE BY PTEN / AKT APOPTOSIS SIGNALING PATHWAY

To investigate the role and significance of PTEN/AKT apoptosis signaling pathway in the occurrence and changes in ovarian reserve for patients with endometriosis in the manner of ovarian reserve markers.

Laparoscopic Stripping of Ovarian Endometriosis in Relation to Ovarian Response and Reserve

Objective: To evaluate the changes in ovarian reserve and response after laparoscopic stripping for ovarian endometrioma. Patients and Method: Forty infertile women in reproductive age were submitted to laparoscopic cystectomy and stripping for symptomatic ovarian endometrioma(s) of at least 30mm in diameter. The evaluated parameters were follicle-stimulating hormone (FSH), Estradiol (E2), serum anti-Müllerian hormone (AMH), as well as ovulation and pregnancy rates. Results: Three months after laparoscopy, preoperative antral follicle count (AFC) significantly increased (p&lt;0.001), with a significant reduction in ovarian volume (p&lt;0.001). The levels of AMH at 3 months reduced significantly (p=0.02), with non-significant changes in serum FSH and E2.AMH was significantly increased in bilateral lesions. There was a significant reverse correlation between preoperative AMH and age after laparoscopy. A significant positive correlation between AMH and AFC was detected preoperatively and after 3 months. The ovulation rate was 52.5% at 3 months, with a pregnancy rate of 42.5%. Conclusion: Laparoscopic stripping of ovarian endometriomas may be associated with worsen ovarian reserve.

Comparison of serum antimüllerian hormone levels after robotic-assisted vs. laparoscopic approach for ovarian cystectomy in endometrioma

ObjectiveSerum antimüllerian hormone (sAMH) is regarded as a useful marker in predicting for ovarian functional reserve. To evaluate whether postoperative change in ovarian reserve differs between robotic-assisted and laparoscopic single-site ovarian cystectomy in patients with ovarian endometrioma by comparing sAMH levels. Study designThe perioperative outcomes in 94 patients with ovarian endometrioma who underwent robotic assisted (n = 40) or laparoscopic (n = 54) cystectomy were compared retrospectively. The sAMH levels were measured by enzyme immunoassay preoperatively and at 3 months and 6 months after surgery. The difference and ratio of sAMH levels between preoperative and 3 months, 6 months after cystectomy were compared between robotic-assisted and laparoscopic approach for predicting which method is better for preservation of ovarian function. Result(s)The sAMH levels were obviously decreased after the surgery (ratio of sAMH levels between preoperative and 3 months, 0.49 ± 0.46 versus 0.52 ± 0.28 ng/mL, mean ± standard deviation) in both groups. There was no difference of the recovery sAMH level at 6 months (ratio of 6 months sAMH to preoperative sAMH level) after cystectomy in unilateral ovarian cystectomy. However, in patients with bilateral endometrioma, the recovery of sAMH level was higher in robotic assisted approach than those of laparoscopic surgery (0.40 ± 0.24 versus 0.21 ± 0.23, p = 0.009). In multivariate linear regression analysis, the coefficient of robot surgery was 0.442 (p = 0.028). Conclusion(s)In our study, robotic-assisted cystectomy had higher preservation of ovarian function than the laparoscopic approach for bilateral ovarian endometrioma, but not for unilateral endometrioma. The robotic-assisted approach could be considered for preserving ovarian function in patients with bilateral ovarian endometrioma.

Does Ovarian Reserve Change after Endometrioma Management? Comparison of Two Treatment Regimens

Background: The endometriosis-mediated damage to ovarian re- serve beyond the stretching of ovarian cortex that can lead to loss of primordial follicles is supported by many studies.Laparoscopy represents the first-line treatment in sub fertile women with endo- metriotic ovarian cysts. The primary benefit of surgical treatment of endometriosis is the relief o f pelvic pain. The effect of laparoscopic cystectomy of an endometrioma on the antral follicle count has been conflicting. Objective: is to estimate effects of laparoscopic ovarian cystectomy on ovarian reserve and ICSI outcome. Methodology: 100 patients with unilateral ovarian endometrioma (size from 2.5-5 cm) were selected for ICSI, divided into two equal groups, group1 (underwent laparoscopic cystectomy) and group2 (underwent ultrasound guided cyst aspiration). Both groups were compared regarding ICSI outcome (number of oocytes, number of embryos transferred, pregnancy rate) as well as change in AMH as a marker of ovarian reserve 6 months after the procedures. Outcome measures: the outcomes were the ovarian reserve changes after the two procedures as well as the Intracytoplasmic Sperm Injection out- comes. Results: There is a remarkable reduction in the level of AMH in group1(43% reduction) compared to group2 (5.7%) with no signifi- cance (P=0.393). Conclusion: In view of the hazardous effect of laparoscopic ovarian cystectomy on ovarian reserve, ultrasound guided aspiration may be a good alternative procedure for treatment of endometrioma in view of preserving the ovarian tissues without compromising ICSI outcomes

Impact of gonadotropin-releasing hormone agonist post-operative treatment on ovarian reserve changes after laparoscopic surgery of ovarian endometrioma

Impact of gonadotropin-releasing hormone agonist post-operative treatment on ovarian reserve changes after laparoscopic surgery of ovarian endometrioma

Investigation of treatment efficacy of 10% povidone–iodine sclerotherapy on ovarian cyst diameter: an experimental study

Background/aimThe purpose of this study was to investigate the effects of 10% povidone–iodine (PI) sclerotherapy on ovarian cyst diameter through an experimental study.Materials and methods To be able to create ovarian cysts, right unilateral salpingectomy was performed on 20 Wistar albino rats. One month after the operation, the abdomens of all rats were reopened. Sixteen rats with macroscopic ovarian cysts were divided randomly into 2 groups consisting of 8 rats. Group 1 (G1): the cyst content was only aspirated. Group 2 (G2): the ovarian cyst was aspirated and then the cystic cavity was irrigated with PI. Abdomens of all rats were closed and 1 month later they were reopened. Tissues of the right ovaries of the rats were embedded in paraffin blocks for histopathological examination. Follicle count, fibrosis, and congestion were evaluated under a light microscope.Results For G1, there was no difference in cyst diameters before and after aspiration. In G2, a decrease was observed in cyst diameter. There was no difference in ovarian reserve between the 2 groups. When compared with G1, an increase in fibrosis and congestion was determined in G2.ConclusionsSclerotherapy into the ovarian cyst for a 5-min period using 10% PI reduces cyst diameter without any change in ovarian reserve.

Five-year study assessing the clinical utility of anti-Müllerian hormone measurements in reproductive-age women with cancer.

An important discussion point before chemotherapy is ovarian toxicity, a side-effect that profoundly affects young women with cancer. Their quality of life after successful treatment, including the ability to conceive, is a major concern. We asked whether serum anti-Müllerian hormone (AMH) measurements before chemotherapy for two most common malignancies are predictive of long-term changes in ovarian reserve? A prospective cohort study measured serum AMH in 66 young women with lymphoma and breast cancer, before and at 1 year and 5 years after chemotherapy, compared with 124 healthy volunteers of the same age range (18-43 years). Contemporaneously, patients reported their menses and live births during 5-year follow-up. After adjustment for age, serum AMH was 1.4 times higher (95% CI 1.1 to 1.9; P < 0.02) in healthy volunteers than in cancer patients before chemotherapy. A strong correlation was observed between baseline and 5-year AMH in the breast cancer group (P < 0.001, regression coefficient = 0.58, 95% CI 0.29 to 0.89). No significant association was found between presence of menses at 5 years and serum AMH at baseline (likelihood ratio test from logistics regression analysis). Reproductive-age women with malignancy have lower serum AMH than healthy controls even before starting chemotherapy. Pre-chemotherapy AMH was significantly associated with long-term ovarian function in women with breast cancer. At key time points, AMH measurements could be used as a reproductive health advisory tool for young women with cancer. Our results highlight the unsuitability of return of menstruation as a clinical indicator of ovarian reserve after chemotherapy.

Changes in ovarian reserve and ovarian blood flow in patients with polycystic ovary syndrome following laparoscopic ovarian drilling

This prospective cohort study was conducted on 80 patients with clomiphene citrate (CC)-resistant polycystic ovary syndrome undergoing laparoscopic ovarian drilling (LOD). Pre- and post-LOD ovarian reserve parameters (anti-Mullerian hormone: AMH, ovarian volume: OV, and antral follicle count: AFC) and ovarian stromal blood flow indices (Vascularization index: VI, flow index: FI, and vascularization flow index: VFI) were measured to explore the effect of LOD and to find out the correlation between serum AMH and different clinical, hormonal, and ultrasonic variables. There was a highly significant reduction of the serum AMH (p < .001) after LOD with significant reduction in OV, AFC and vascular indices (VI, FI and VFI) of the right and left ovaries (p < .05). LOD significantly reduced ovarian reserve parameters (AMH, OV and AFC) and ovarian stromal blood flow indices (VI, FI and VFI) with no observed correlation between AMH levels and Doppler indices.