Ovarian reserve after Laparoscopic Treatment of Ovarian Endometriomas with Two Techniques: Stripping and Ablation

Abstract

Ovarian endometriomas are cystic manifestation of ovarian endometriosis and very frequent adnexal masses in women of reproductive age. Operative laparoscopy is considered to be gold standard for treatment of patients with ovarian endometriomas regarding the benefits of such treatment. There are many laparoscopic techniques, but stripping and ablation of endometriomas are the most frequently used. The Aim: To evaluate the effects of two laparoscopic techniques for treatment of ovarian endometriomas on ovarian reserve. Materials and Methods: In a prospective randomized study, a hundred patients in reproductive age (20-40 years) with unilateral ovarian endometriomas were operated laparoscopically on University Clinic for gynecology and obstetrics in Skopje in period between 15.3.2012 and15.3.2015. Randomization was made depending of intraoperative findings. Patients were divided in two groups: group 1 with 50 patients operated with stripping techniques and group 2 with 50 patients operated with ablation. Several markers for ovarian reserve were evaluated before operation, three and six months after laparoscopy: ultrasonographic markers (ovarian volume-OV and antral follicle count-AFC), biochemical markers (follicle stimulating hormone - FSH and estradiol - E2) and markers for ovarian vascularization (pulsatility index - PI and resistance index - RI). Results: In our study statistical analysis has shown a significant reduction in ovarian volume in both groups three and six months after laparoscopy, but this decrease in OV was higher in the first three months after surgery in group 1 (p≤0.01). There was a significant increase in AFC in both groups three and six months after laparoscopy (p≤0.01), with higher increase in group 2. Statistical analysis has shown a decrease in PI and RI in both groups after surgery, with higher decrease of RI in group 1 postoperatively. Serum levels of FSH significantly decreased after laparoscopy in both groups (p≤0.01), while E2 levels significantly increased in both groups after surgery (p≤0.01). Conclusions: Ovarian reserve decreases after laparoscopic operation of ovarian endometriomas using both techniques: stripping and ablation. Laparoscopic stripping of endometriomas reduces ovarian reserve more than ablation.