Comparison of the Effect on the Ovarian Reserve of Modern Methods of Treatment of Endometrioid Cysts

ObjectiveTo compare the efficacy and safety of autologous platelet-rich plasma (PRP) therapy in laparoscopy and transvaginal sclerotherapy for the treatment of endometrioid cysts for maintaining ovarian reserve.MethodsThe study included 71 women under age 35 years with primary and secondary infertility. Twenty women underwent sclerotherapy of endometrioid cysts followed by autologous PRP injection into ovarian tissue, and 21 underwent laparoscopic cyst removal by stripping followed by autologous PRP injection. The control group consisted of 30 women who underwent laparoscopic cystectomy by stripping without autologous PRP injection. We assessed ovarian reserve for all patients before surgery as well 3 and 6 months after surgery by measuring serum anti-Müllerian hormone (AMH) levels and calculating antral follicle count using ultrasound.ResultsIn the control group, AMH levels had decreased significantly at 3 and 6 months post-surgery, whereas levels in laparoscopy and PRP group remained almost unchanged from initial levels. In the sclerotherapy group, we observed a tendency towards increased AMH levels, but it was not statistically significant when compared with initial results. Follicle count changes were similar to AMH patterns.ConclusionIn this study, sclerotherapy in combination with PRP therapy for ovarian endometriomas was associated with improved measures of ovarian reserve, and the combination of laparoscopic excision of the endometrioma with PRP therapy facilitated ovarian reserve preservation.     

Argon beam coagulator versus cystectomy for endometrioma treatment in infertile women and the impact on ovarian reserve. A case control study

ObjectiveTo evaluate the impact of two different surgical modalities, traditional cystectomy and argon beam coagulator vaporization–ablation (ABC) of ovarian endometrioma on the ovarian reserve in terms of antimullerian hormone (AMH) and antral follicle count (AFC).Patients and methodsEighty infertile women with ovarian endometrioma were included in this case control study. Patients were selected to undergo either traditional cystectomy (Group I, n = 40) or argon coagulator beam vaporization (Group II, n = 40). Mean serum AMH changes and antral follicle counts (AFC) were the primary and secondary outcomes of this study.ResultsAt 2 weeks follow-up, postoperative mean serum AMH levels were markedly decreased, though not significantly different between both treatment groups and mean AFC was higher in both groups, though statistically significant in the ABC group.ConclusionOur study clearly demonstrated that the surgical management of endometrioma, with either ovarian cystectomy or argon beam coagulator vaporization causes a significant decrease in ovarian reserve in terms of AMH levels in women of reproductive age.     

Effect of salpingectomy,ovarian cystectomy and unilateral salpingo-oopherectomy on ovarian reserve

Pelvic surgery can affect ovarian reserve, but estimates of the potential effect of different surgical procedures are lacking. This study examines the markers of ovarian reserve after different procedures in order to help the provision of informed consent before surgery. Anti-Müllerian hormone (AMH), antral follicle count (AFC) and follicle-stimulating hormone (FSH) of women with a history of salpingectomy, ovarian cystectomy or unilateral salpingo-oophorectomy were compared to those without history of surgery using cross-sectional data adjusting for patient and clinical factors in multivariable regression model. There were 138 women who had had salpingectomy, 36 unilateral salpingo-oopherectomy, 41 cystectomy for ovarian cysts that are other than endometrioma and 40 women had had excision of endometrioma. There was no significant difference in AMH (9 %; p = 0.33), AFC (?2 %; p = 0.59) or FSH (?14 %; p = 0.21) in women with a history of salpingectomy compared to women without surgery. Women with a history of unilateral salpingo-oophorectomy were found to have significantly lower AMH (?54 %; p = 0.001). These women also had lower AFC (?28 %; p = 0.34) and higher FSH (14 %; p = 0.06), the effect of which did not reach statistical significance. The study did not find any significant associations between a history of cystectomy, for disease other than endometrioma and AMH (7 %; p = 0.62), AFC (13 %; p = 0.18) or FSH. (11 %; p = 0.16). Women with a history of cystectomy for ovarian endometrioma had 66 % lower AMH (p = 0.002). Surgery for endometrioma did not significantly affect AFC (14 %; p = 0.22) or FSH (10 %; p = 0.28). Salpingo-oopherectomy and cystectomy for endometrioma cause a significant reduction in AMH levels. Neither salpingectomy nor cystectomy for cysts other than endometrioma has appreciable effects on ovarian reserve.     

Removal of unilateral endometriomas is associated with immediate and sustained reduction in ovarian reserve

Endometrioma surgery by stripping the cyst capsule has been associated with a reduction in ovarian reserve. It is still not clear whether the inflicted damage is immediate, sustained over time or associated with the use of electrocautery, nor which marker is more accurately reflects the post-operative reduction in ovarian reserve. This observational study assessed the damage inflicted by endometrioma removal with anti-Müllerian hormone (AMH) concentration and antral follicle count (AFC) pre and post-operatively. Twenty-five women with unilateral endometrioma underwent laparoscopic stripping of the endometrioma cyst capsule. There was a significant decrease both in AMH concentration (24%) and in AFC (11%) 1 month following surgery (P < 0.01). At 6 months post-operatively, the respective values were 24% and 15% less than preoperatively. AMH concentration and AFC showed no correlation with the use of bipolar electrocautery during surgery. Primordial follicles embedded adjacent to the cyst capsule were found in 61.5% of the specimens. Endometrioma surgery by stripping of the cyst capsule is associated with a significant reduction in ovarian reserve. The reduction is immediate and sustained over time. AMH appears to be a better indicator for post-operative quantification of the ovarian reserve.Endometrioma surgery by stripping the cyst capsule has been associated with a reduction in ovarian reserve. It is still not clear whether the inflicted damage is immediate, sustained over time or associated with the use of electrocautery, nor which marker more accurately reflects the post-operative reduction in ovarian reserve. In this observative study, we assessed the damage inflicted by endometrioma removal with anti-Müllerian hormone (AMH) and antral follicle count (AFC) pre- and post-operatively. Twenty-five women underwent laparoscopic stripping of the endometrioma cyst capsule. There was a 24% decrease in AMH concentration and an 11% decrease in AFC compared with the preoperative values 1 month following surgery. The values did not change 6 months after surgery over those recorded at 1 month post-operatively (24 and 15% less than preoperative values. Primordial follicles embedded adjacent to the cyst capsule were found in 61.5% of the specimens. Endometrioma surgery by stripping of the cyst capsule is associated with a significant reduction in ovarian reserve. The reduction is immediate and sustained over time. AMH appears to be a better indicator for post-operative quantification of the ovarian reserve.     

Anti-Mullerian hormone trend evaluation after laparoscopic surgery of monolateral endometrioma using a new dual wavelengths laser system (DWLS) for hemostasis

Operative laparoscopy is the gold standard in the treatment of endometriotic ovarian cysts. Excisional surgery is the best technique to prevent recurrences and improve symptoms but it may result in ovarian reserve damage due to the removal of healthy ovarian cortex. The aim of this study was to assess the impact on ovarian reserve of the use of dual wavelengths laser system (DWLS) hemostasis after stripping technique of monolateral endometrioma, by dosing the anti-Mullerian hormone (AMH). This prospective study was conducted at the Institute of Obstetrics and Gynecology, University of Foggia, from December 2013 to January 2015. Forty-five women underwent excision of monolateral endometriotic ovarian cyst by stripping without using a bipolar coagulation and performing hemostasis with a DWLS. The AMH serum levels were estimated before the surgery (T0), 4–6 weeks (T1) and 6–9 months (T2) after surgery. Our results suggest that an appropriate surgical technique with the use of laser hemostasis does not determine a significant reduction of ovarian reserve. Laser hemostasis could prevent follicular reserve loss after ovarian endometrioma surgery.     

The impact of endometrioma and laparoscopic cystectomy on ovarian reserve and the exploration of related factors assessed by serum anti-Mullerian hormone: a prospective cohort study

Background

To evaluate the impact of the presence of endometrioma and laparoscopic cystectomy on ovarian reserve as assessed by serum anti-Müllerian hormone (AMH) level. In addition, factors related to the decline in ovarian reserve were analyzed.

Methods

From June 2013 to January 2014, we prospectively included 40 women with endometriomas as the study group (group A), 36 women with tubal factor infertilities as control group 1 (group B) and 22 women with the other benign ovarian cysts as control group 2 (group C). The women with ovarian cysts underwent laparoscopic cystectomy. Serum AMH levels were determined preoperatively and at 1 month after surgery.

Results

The endometrioma group had lower AMH levels (1.53?±?1.37 ng/ml) compared with the other benign ovarian cyst group (2.20?±?1.23 ng/ml) and the tubal factor infertility group (2.82?±?1.74 ng/ml). The rate of serum AMH decline 1 month after surgery in the endometrioma group (0.62?±?0.35) was larger than the decline in the other benign ovarian cyst group (0.32?±?0.30). The preoperative AMH level showed a significant correlation with patient age (group A, r?=??0.32; group B, r?=??0.54; group C, r?=??0.71); there was a statistically significant correlation between the rate of serum AMH decline and endometrioma diameter as well as with the preoperative serum AMH level. In addition, the rate of serum AMH decline was larger for bilateral endometriomas than for unilateral endometriomas, but there was no similar correlation in the other benign ovarian cyst group. The rate of AMH decline after surgery in the subgroup of >7 cm was significantly higher than in the subgroup of ≤7 cm.

Conclusions

Ovarian endometriomas per se may damage ovarian reserve, and cystectomy of endometriomas may cause greater damage to ovarian reserve compared with other benign ovarian cysts. The operation-related damage to the ovarian reserve was positively related to whether the endometriomas were bilateral, as well as cyst size (especially for cysts >7 cm), but was negatively related to the preoperative serum AMH level. Age was a negative factor that affected the ovarian reserve.

     

The long-term effects of endometrioma surgery on ovarian reserve: a prospective case–control study

The objective of this study was to evaluate the long-term effects of endometrioma excision on ovarian reserve. This study evaluated the long-term effects of endometrioma excision on ovarian reserve. A total of 63 women were enrolled in this prospective case–control study; 21 women had histories of endometrioma surgery (study group), 21 women had diagnoses of endometrioma, and 21 healthy age-matched women served as controls. Participants were recruited from the Department of Obstetrics and Gynecology, Inonu University Faculty of Medicine, between January 2007 and January 2016. The mean follow-up duration after endometrioma surgery was 30.4?±?18.0?months for the study group. The mean follicle-stimulating hormone, luteinizing hormone and estradiol levels were similar among groups, but the anti-Müllerian hormone (AMH) level was significantly lower in the surgery group than in the control group (p?p?=?.080 and p?=?.160, respectively). Endometrioma has a detrimental effect on ovarian reserve, and decreased ovarian reserve compared with that in healthy fertile subjects without endometrioma is evident shortly after endometrioma excision. However, the endometrioma excision procedure does not significantly decrease the ovarian reserve in the long term.     

Effect on ovarian reserve of laparoscopic bipolar electrocoagulation versus laparotomic hemostatic sutures during unilateral ovarian cystectomy

Objective

To compare the effects of laparoscopic bipolar electrocoagulation with laparotomic hemostatic suturing during unilateral ovarian cystectomy on the ovarian reserve.

Methods

A prospective randomized trial was conducted on 59 women with unilateral benign ovarian cysts who underwent laparoscopic ovarian cystectomy by a stripping technique (n = 30) or open laparotomy with hemostatic suturing (n = 29). Serum anti-Müllerian hormone (AMH), antral follicle count (AFC), and ovarian stromal peak systolic velocity (PSV) at the 1st, 3rd, and 6th postoperative cycle were used to assess the ovarian reserve.

Results

Preoperative AMH levels did not differ significantly (P = 0.18) between the laparoscopy and laparotomy groups. In the laparoscopy group, there was a significant decrease in AMH levels, AFC, and PSV at the 3rd and 6th postoperative cycles compared with the 1st postoperative cycle, with an insignificant decrease between the 3rd and 6th cycles. In the laparotomy group, nonsignificant decreases in AMH levels, AFC, and PSV were detected at the 1st, 3rd, and 6th postoperative cycle and between the 3rd and 6th cycles.

Conclusion

Laparoscopic ovarian cystectomy is associated with a significant reduction in ovarian reserve. This is a consequence of damage to the ovarian vascularity and the removal of an increased amount of ovarian tissue.     

Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons

In order to estimate the impact of laparoscopic stripping of endometriomas on the ovarian follicular reserve, 43 normo-ovulatory women were studied by endocrine (anti-Müllerian hormone (AMH), FSH, LH, inhibin B, oestradiol) and ultrasonographic (antral follicle count (AFC)) methods before surgery, and 3 and 9 months after surgery. The operation was performed by experienced laparoscopists, particularly aware of the need to avoid damaging the healthy part of the ovary. Serum AMH concentrations significantly decreased after the operation (1.4±0.2 ng/ml after 3 months and 1.3±0.3 ng/ml after 9 months versus 3.0±0.4 ng/ml before surgery; P<0.0001), whereas basal FSH, LH, oestradiol and inhibin B concentrations remained unchanged. The volume of the operated ovary significantly diminished after surgery (P<0.0001), whereas the AFC was not significantly altered. Overall, the data show that laparoscopic stripping of endometriomas reduces ovarian reserve. The significant decrease of AMH after surgery confirms that part of the healthy ovarian pericapsular tissue, containing primordial and preantral follicles, is removed or damaged despite all the surgical efforts to be atraumatic. This must be carefully considered when laparoscopic cystectomy surgery is scheduled for patients with no relevant symptoms besides infertility or with already small ovarian reserve.     

AMH after laparoscopic surgery of the ovaries: a review

Abstract

Operative laparoscopy compared with laparotomy has been established as the gold standard surgical approach in treating ovarian cysts. However, the safety of a laparoscopic cystectomy has been questioned in what has to do with the subsequent damage to the ovarian reserve of the operated ovary. One of the best available methods to determine ovarian reserve, due to its biochemical and pathological characteristics is anti-Mullerian hormone (AMH). With this study, we are reviewing currently available studies examining the effect laparoscopic operations have on AMH levels.     

Assessment of ovarian reserve after unilateral diathermy with thermal doses adjusted to ovarian volume

Women with polycystic ovary syndrome seem to have a larger ovarian reserve. However, regardless of a greater reserve, diminished ovarian reserve has been reported after laparoscopic diathermy. The aim of this article was to determine whether the doses adjusted unilateral laparoscopic ovarian drilling with diathermy (ULOD) diminishes ovarian reserve to compare with bilateral laparoscopic ovarian drilling with diathermy (BLOD). Ninety-six women were assigned in two groups. One group underwent ULOD receiving thermal doses (0–840?J per ovary) adjusted to volume one ovary. The other group underwent BLOD receiving fixed doses (600?J per ovary). Ovarian reserve markers [anti-Müllerian hormone (AMH); antral follicle count (AFC) and ovarian volume] were measured before and after surgery (1 and 6 months). Both groups showed a decrease in AMH after surgery, but it was significantly more distinct in the BLOD versus ULOD group (2.0?ng/mL versus 1.3?ng/mL; p?=?0.018) in the first follow-up month and remained significantly different through the sixth follow-up month (1.9?ng/mL versus 1.15?ng/mL; p?=?0.023). In contrast, in the sixth month, the ULOD versus BLOD showed a significantly greater increase AFC (p?p?=?0.013). Our findings evidenced that the dose-adjusted unilateral diathermy (60?J/cm³) does not have significant and long-term effects on ovarian reserve.     

Anti-Müllerian hormone trend after laparoscopic surgery in women with ovarian endometrioma

Abstract

Operative laparoscopy is the gold standard in the treatment of endometriotic ovarian cysts. Excisional surgery is the best technique to prevent recurrences and improve symptoms but it may result in ovarian reserve damage due to the removal of healthy ovarian cortex. The aim of this study was to investigate the extent of the ovarian reserve damage after stripping technique of unilateral endometriomas, by dosing the Anti-Müllerian Hormone (AMH). This prospective study was conducted at the Center of Minimally Invasive Pelvic Surgery of the Department of Health of Woman and Child, University of Padua, from October 2010 to June 2012. Twenty-five women underwent excision of monolateral endometriosis ovarian cyst by stripping without accessing a bipolar coagulation and performing an intracortical suture. The AMH serum levels were estimated in the early proliferative phase of the cycle, before surgery (time 0), 24?h after surgery (time 1), the first menstrual cycle after surgery (time 2) and the third menstrual cycle after surgery (time 3). We found a nonstatistically significant decreases in serum AMH levels after surgical excision of the cysts. Our results suggest that an appropriate surgical technique, without the use of the bipolar coagulation of ovarian border, does not determine a significant reduction of ovarian reserve.     

Impact of laparoscopic cystectomy on fecundity of infertility patients with ovarian endometrioma

AIM: To clarify the effect of laparoscopic cystectomy for ovarian endometrioma in infertility patients, the pregnancy outcome was evaluated. METHODS: This was a retrospective study. From August 2002 to February 2006, 33 infertility patients with ovarian endometrioma underwent laparoscopic cystectomy at our center. According to the laparoscopic findings 33 were divided into two groups; 10 were evaluated as the patients who need assisted reproductive technologies (ART) treatment (IVF subgroup) and 23 were evaluated as the patients who do not need ART treatment but conventional infertility treatment (non-IVF subgroup). During the same period, 70 patients who were age-matched and received ART treatment without laparoscopy were defined as control (control group). Following up to 12 months after laparoscopy, the cumulative pregnancy rate in the non-IVF subgroup was calculated. RESULTS: The patients age, duration of infertility and size of endometrioma were equal in the IVF and the non-IVF subgroups. The revised-American Society of Reproductive Medicine (r-ASRM) score in the IVF subgroup was significantly higher than that in the non-IVF group (P < 0.05). The pregnancy rates after laparoscopic cystectomy in IVF and non-IVF subgroups were 50.0% and 60.9%, respectively. These rates in the IVF and the non-IVF groups were slightly higher than that in control group (41.4%), but these differences were not significant. The cumulative pregnancy rate in the non-IVF group reached 52.2%, 12 months after laparoscopic surgery. CONCLUSIONS: Laparoscopic surgery should be performed prior to ART treatment not only for making a decision about the treatment course but also for establishing a good pelvic condition to induce a pregnancy during ART treatment in infertility treatment with ovarian endometrioma.     

Ovarian Reserve Following Laparoscopic Ovarian Cystectomy vs Cyst Deroofing for Endometriomas

Study ObjectiveBecause laparoscopic ovarian cystectomy of endometriomas is known to adversely impact patient ovarian reserve, the search for other techniques of surgical management is ongoing. The present study was undertaken to evaluate laparoscopic cyst deroofing as a feasible alternative.Study DesignProspective, randomized clinical trial (Canadian Task Force classification I).SettingUniversity maternity hospital.PatientsWomen diagnosed with unilateral or bilateral ovarian endometriomas.InterventionsPatients were managed with either laparoscopic ovarian cystectomy or cyst deroofing.Measurements and Main ResultsA total of 122 women with endometriomas were randomized to either laparoscopic cystectomy (group 1) or laparoscopic cyst deroofing (group 2). The primary endpoint was the effect on ovarian reserve based on changes in anti-Müllerian hormone (AMH) values. At 1 month postsurgery, anti-Müllerian hormone values were significantly decreased (p < .001) from preoperative values, from 4.25 ± 0.87 ng/mL to 1.66 ± 1.02 ng/mL in group 1 and from 4.2 ± 1.69 ng/mL to 2.15 ± 1.48 ng/mL in group 2. In addition, antral follicle count and ovarian volume decreased significantly (p < .001) in both groups by 1 month postsurgery. The decreases in these 3 parameters were more significant (p < .001) in group 1 than in group 2.ConclusionLaparoscopic cyst deroofing of endometriomas appears to be a promising alternative to laparoscopic cystectomy, with less postoperative decrease in ovarian reserve; however, the higher rate of endometrioma recurrence warrants future clinical research to determine the optimal surgical management of endometriomas.     

Hemostasis by Bipolar Coagulation Versus Suture After Surgical Stripping of Bilateral Ovarian Endometriomas: A Randomized Controlled Trial

Study objectiveTo estimate whether the suture of the ovary is superior to bipolar coagulation in preserving ovarian reserve in infertile women undergoing laparoscopic stripping of bilateral endometriomas.DesignRandomized controlled trial (Canadian Task Force classification I).SettingUniversity teaching hospital.Patients100 patients with bilateral endometriomas.InterventionsPatients underwent stripping of bilateral endometriomas and were randomized to undergo hemostasis by use of either laparoscopic suturing (LS group) or bipolar coagulation (BC group). Changes in ovarian reserve were investigated by measuring the levels of anti-Mullerian hormone (AMH) and basal follicle-stimulating hormone (FSH) before surgery and at 3, 6 and 12 months from surgery.Measurements and Main ResultsAt 3-month, 6-month, and 12-month follow-up, in both study groups, postsurgical AMH levels were significantly lower and basal FSH levels were significantly higher than before surgery. There was no significant difference in the mean percentage decrease of AMH levels in the BC group and LS group at 3-, 6-, and 12-month follow-up. The mean percentage increase in basal FSH was higher in the BC group than in the LS group at both 3-month (p = .023) and 6-month follow-up (p = .029), but not at 12-month follow-up. Pregnancy rate, time to conception, and rate of endometrioma recurrence was similar in the 2 study groups.ConclusionLaparoscopic stripping of ovarian endometriotic cyst significantly decreases serum AMH levels and increases basal FSH levels independent from the method used to obtain hemostasis on the ovarian tissue.     

子宫内膜异位症患者抗苗勒管激素基础水平研究进展

子宫内膜异位症(EMs)是育龄期妇女的常见病,包括腹膜型、深部结节型、卵巢型。EMs影响约2%的生殖期女性,约40%的EMs患者为卵巢型EMs,合并不孕者为40%~50%,并且具有易复发的特点。治疗方法包括药物保守治疗和手术治疗。近年来,有研究报道卵巢型EMs患者手术治疗后,卵巢功能下降,甚至出现卵巢功能早衰。而EMs本身,尤其是卵巢型EMs对卵巢储备功能的影响报道较少。抗苗勒管激素(AMH)是近年来评估卵巢储备功能的可靠标志物。通过分析3种不同类型EMs患者的AMH基础水平总结评价EMs对卵巢功能的影响,从而进一步指导临床工作。     

腹腔镜单侧卵巢子宫内膜异位囊肿剥除术对血清抗苗勒管激素水平变化的影响

目的:探讨腹腔镜下单侧卵巢子宫内膜异位囊肿剥除术对血清抗苗勒管激素(AMH)变化的影响。方法:测定128例单侧卵巢囊肿患者手术前及术后1周、3个月及6个月的AMH、FSH及E_2水平,并进行窦卵泡计数。结果:术后1周,AMH、FSH及E_2均发生改变,且差异有统计学意义(P0.05);术后3个月,血FSH和E_2水平已恢复正常,窦卵泡计数与术前无明显改变(P0.05),但AMH水平仍低于术前(P0.05);术后第6个月,AMH水平仍低于术前水平(P0.05),而FSH、E_2及窦卵泡数均较术前比较,差异无统计学意义(P0.05)。年龄35岁患者的术后AMH下降率显著高于年龄≤35岁者(P=0.001)。结论:单侧囊肿卵巢囊肿术后半年卵巢储备功能仍处于恢复阶段,AMH可作为敏感的卵巢储备标志物,优于基础FSH测定及窦卵泡计数。     

Effect of dienogest on serum anti-Mullerian hormone level after laparoscopic cystectomy of ovarian endometrioma

ObjectiveThis comparative study aimed to evaluate the effect of postoperative dienogest treatment on serum anti-Mullerian hormone (AMH) levels in patients undergoing laparoscopic cystectomy of ovarian endometriomas.Materials and methodsA total of 71 patients with ovarian endometriomas treated at our department were enrolled. After surgery, 54 patients received oral dienogest 2 mg daily continuously for 6 months (dienogest group). The other 17 patients did not receive postoperative medical treatment (control group). Serum AMH levels were measured before surgery, at 3-month period after surgery, and at the end of 6-month follow-up period. Serial changes of AMH levels were compared between the two groups.ResultsThe age, endometrioma size, and serum AMH level before surgery were comparable between the dienogest group and the control group. The AMH levels decreased significantly at 3-month period after surgery in the dienogest group (a decrease of 65.5%; p < 0.001) and the control group (a decrease of 64.8%; p = 0.018). The AMH levels increased gradually from the nadir at 3-month period after surgery and recovered partially at the end of 6-month follow-up period in both groups. There were no statistically significant differences in the rate of reduction of serum AMH levels between the two groups (p = 0.707).ConclusionLaparoscopic cystectomy of ovarian endometrioma causes a significant decrease in serum AMH levels. The rates of reduction of AMH levels are similar regardless of dienogest treatment. Postoperative dienogest treatment for 6 months has no rescue effect on serum AMH levels in these patients.     

Evaluation of ultrasonographic and Anti-Müllerian Hormone (AMH) changes as predictors for ovarian reserve after laparoscopic ovarian drilling for women with polycystic ovarian syndrome

Background and aim of the studyLaparoscopic ovarian drilling (LOD) is considered one of the effective tools for treatment of women with polycystic ovarian syndrome. The aim of this work was to evaluate the effects of laparoscopic ovarian drilling on ovarian reserve assessed by Anti-Müllerian hormone assay and ultrasonography.Study designThe current prospective controlled study included 70 (n = 70) primary anovulatory women with PCOS who are allocated to undergo LOD (n = 40), who are clomiphene citrate (CC) resistant, and another group receiving incremental doses (50–150 mg) of CC (n = 30) and 20 healthy age-matched women with a regular menstrual cycle and normal ovaries (confirmed with ultrasound examination) as the control group.Materials and methodsFor the LOD group, standard laparoscopy ovarian drilling was done just after the end of the menstruation using a monopolar electrocautery needle. For the CC group, clomiphene citrate was given in incremental doses (50–150 mg) for up to six cycles from days 2–6 of a menstrual cycle or after a progestin withdrawal bleeding. Evaluation for the ovarian reserve was done using the following tests: (1) AMH level in the third cycle day, (2) antral follicle count (AFC) by TVS, and (3) summed ovarian volume (SOV) by transvaginal ultrasound examination (TVS).ResultsIn the current study, among the (40) PCOS women having LOD, 30/40 (75%) had regular cycles in the 6-month period after LOD, while the ovulation rate was 24/40 (60%) and the pregnancy rate was 11/40 (27.5%) in the 6-month period after LOD. Those rates were not statistically different in the PCO women group treated with CC. There were statistically significant differences between AMH levels and antral follicle count before and after LOD (p = 0.001 and 0.009 respectively) and this might indicate a possible diminished ovarian reserve.ConclusionAMH and AFC are reliable markers for assessment of the ovarian reserve and measuring them for women with anovulatory PCOS undergoing LOD may provide a useful tool in evaluating the outcome of LOD.     

Ethanol Sclerotherapy versus Laparoscopic Surgery for Endometrioma Treatment: A Prospective,Multicenter, Cohort Pilot Study

Study ObjectiveTo compare the cost-effectiveness of ultrasound (US)-guided aspiration and ethanol sclerotherapy versus laparoscopic surgery for benign-appearing ovarian endometrioma.DesignProspective, cohort pilot study.SettingMultiple centers, Spain.PatientsForty patients with suspected ovarian endometrioma identified by US, with a maximum diameter of 35 to 100 mm, of whom 33 met inclusion criteria.InterventionsThe study group (n = 17) underwent US-guided aspiration plus sclerotherapy with ethanol, and the control group (n = 14) underwent laparoscopic cystectomy.Measurements and Main ResultsRecurrence, complications, and direct costs were compared. One of 17 sclerotherapy patients recurred (5.9%) compared with 4 of 14 laparoscopic surgery patients (28.6%) (odds ratio 0.18, 0.01–1.53). No serious adverse effects (Clavien-Dindo ≥ III) were observed in the sclerotherapy group; 1 patient in the surgery group had a Clavien-Dindo IIIb complication. Median hospital direct costs were significantly lower in the sclerotherapy group than those in the surgery group—266 euros versus 2189 euros.ConclusionEthanol sclerotherapy seems to be cost-effective for endometrioma and also appears to reduce complications. In this pilot study, recurrence was not higher than with conventional surgery.