|
|
Received: 25 February 2016 Revised: 9 August 2016 Accepted: 4 November 2016 DOI: 10.1002/ijgo.12046
CLINICAL ARTICLE Gynecology
The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometrioma Abolfazl Mehdizadeh Kashi1 | Shahla Chaichian2 | Shideh Ariana1 | Masoumeh Fazaeli1 | Yousef Moradi3 | Mandana Rashidi4 | Zahra Najmi5* 1 Endometriosis and Gynecologic Disorder Research Center, Iran University of Medical Sciences, Tehran, Iran 2
Abstract Objective: To evaluate the effects of laparoscopic cystectomy on serum anti-Müllerian
Minimally Invasive Techniques Research Center in Women, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
hormone (AMH) level as a marker of ovarian reserve in patients with endometrioma.
3
Pars Advanced and Minimally Invasive Manners Research Center, Pars General Hospital Tehran, Iran University of Medical Sciences, Tehran, Iran
40 years who were referred to a tertiary center in Tehran, Iran, between January 1,
4
dysmenorrhea, dyspareunia, or dyschezia. Baseline and 6-month post-operative AMH
Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Tehran, Iran 5 Department of Obstetrics and Gynecology, Zanjan University of Medical Sciences, Zanjan, Iran
*Correspondence Zahra Najmi, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Gavazang Highway, Zanjan, Iran. Email: [email protected] Funding Information Iran University of Medical Sciences
Methods: A prospective observational study enrolled patients aged younger than 2013 and December 31, 2014 to undergo laparoscopic cystectomy for ovarian endometriomas at least 30 mm in diameter, or regardless of size for patients with infertility, levels were compared. Results: Data from 70 patients were included in the analyses. Among patients with unilateral endometriomas, lower pre-operative AMH levels were observed in patients with endometriomas at least 50 mm in diameter (P=0.027), whereas cyst size was not associated with differences in pre-operative AMH level in patients with bilateral endometriomas (P=0.227). Across the entire study population, post-operative AMH levels were lower than the baseline (P=0.008). Greater post-operative decreases in AMH were associated with bilateral cysts compared with unilateral cysts (P=0.046), cysts being at least 50 mm in diameter among patients with unilateral cysts (P=0.028), and both cysts being at least 50 mm in diameter among patients with bilateral cysts (P=0.025). Conclusion: Laparoscopic cystectomy was associated with post-operative decreases in serum AMH, particularly with bilateral involvement and endometriomas at least 50 mm in diameter. KEYWORDS
Anti-Müllerian hormone; Endometrioma; Laparoscopic cystectomy; Ovarian reserve
1 | INTRODUCTION
Laparoscopic ovarian cystectomy is the optimal treatment modality for endometrioma owing to the low recurrence reported with this
Endometriomas are present in 17%–44% of patients with endometri-
approach.5 Despite improvements in techniques and the management
osis1 and are often associated with infertility, dysmenorrhea, chronic
of symptomatic patients with endometriomas, concerns have been
pelvic pain, and dyspareunia. Decreases in the rate of spontaneous
raised regarding potential negative effects of laparoscopic cystec-
ovulation,2 and reductions in follicular number and activity in adjacent
tomy on ovarian reserve due to inadvertent removal or destruction of
ovarian tissues3,4 have been associated with endometriomas.
healthy ovarian tissue adjacent to the pseudo-capsule of the cyst.6,7
Int J Gynecol Obstet 2016; 1–5
wileyonlinelibrary.com/journal/ijgo
© 2016 International Federation of | 1 Gynecology and Obstetrics
|
Mehdizadeh KashiET AL.
2
Repeated surgeries have been associated with severe decreases in
were excluded from the study, as were patients with pathologic exam-
ovarian reserve and it has been demonstrated that considerable sur-
inations not confirming endometriosis.
gical expertise is necessary to maintain the ovarian reserve following endometrioma surgery.8
Post-operative blood tests were performed 6 months after surgery during the same phase of the menstrual cycle as for the first evaluation
Anti-Müllerian hormone (AMH) has been demonstrated to be a superior marker of ovarian reserve than using age alone or other mark-
(first follicular phase). Baseline and 6-month serum AMH levels were compared.
ers described in the literature, including basal follicle-stimulating hor-
Baseline and 6-month serum AMH levels were measured in the
mone, estradiol, and inhibin B.3,9 Additionally, serum AMH presents
outpatient department of the study institution using a commer-
a stable value that is accessible throughout the menstrual cycle, an
cial enzyme-linked immunosorbent assay kit (Diagnostic Systems
10
important advantage for an ovarian-reserve marker.
Consequently, AMH could be a useful marker for monitoring potential
Laboratories, Webster, TX, USA) that could detect serum AMH levels as low as 0.006 ng/mL.
decreases in ovarian reserve due to endometriomas or ovarian cystectomy.
SPSS version 18 (SPSS, Chicago, IL, USA) was used to analyze the
However, data evaluating ovarian-reserve damage resulting from ovarian
study data. Continuous variables were expressed as mean±SD and were
endometriomas or cystectomy using serum AMH levels are sparse, de-
compared using the Student t test; categorical variables were expressed
spite authors11,12 recommending that AMH be used for diagnosing the
as numbers and were compared between baseline and 6 months with
extent of post-operative ovarian damage to predict future fertility.
the χ2 test. P
|
Received: 25 February 2016 Revised: 9 August 2016 Accepted: 4 November 2016 DOI: 10.1002/ijgo.12046
CLINICAL ARTICLE Gynecology
The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometrioma Abolfazl Mehdizadeh Kashi1 | Shahla Chaichian2 | Shideh Ariana1 | Masoumeh Fazaeli1 | Yousef Moradi3 | Mandana Rashidi4 | Zahra Najmi5* 1 Endometriosis and Gynecologic Disorder Research Center, Iran University of Medical Sciences, Tehran, Iran 2
Abstract Objective: To evaluate the effects of laparoscopic cystectomy on serum anti-Müllerian
Minimally Invasive Techniques Research Center in Women, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
hormone (AMH) level as a marker of ovarian reserve in patients with endometrioma.
3
Pars Advanced and Minimally Invasive Manners Research Center, Pars General Hospital Tehran, Iran University of Medical Sciences, Tehran, Iran
40 years who were referred to a tertiary center in Tehran, Iran, between January 1,
4
dysmenorrhea, dyspareunia, or dyschezia. Baseline and 6-month post-operative AMH
Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Tehran, Iran 5 Department of Obstetrics and Gynecology, Zanjan University of Medical Sciences, Zanjan, Iran
*Correspondence Zahra Najmi, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Gavazang Highway, Zanjan, Iran. Email: [email protected] Funding Information Iran University of Medical Sciences
Methods: A prospective observational study enrolled patients aged younger than 2013 and December 31, 2014 to undergo laparoscopic cystectomy for ovarian endometriomas at least 30 mm in diameter, or regardless of size for patients with infertility, levels were compared. Results: Data from 70 patients were included in the analyses. Among patients with unilateral endometriomas, lower pre-operative AMH levels were observed in patients with endometriomas at least 50 mm in diameter (P=0.027), whereas cyst size was not associated with differences in pre-operative AMH level in patients with bilateral endometriomas (P=0.227). Across the entire study population, post-operative AMH levels were lower than the baseline (P=0.008). Greater post-operative decreases in AMH were associated with bilateral cysts compared with unilateral cysts (P=0.046), cysts being at least 50 mm in diameter among patients with unilateral cysts (P=0.028), and both cysts being at least 50 mm in diameter among patients with bilateral cysts (P=0.025). Conclusion: Laparoscopic cystectomy was associated with post-operative decreases in serum AMH, particularly with bilateral involvement and endometriomas at least 50 mm in diameter. KEYWORDS
Anti-Müllerian hormone; Endometrioma; Laparoscopic cystectomy; Ovarian reserve
1 | INTRODUCTION
Laparoscopic ovarian cystectomy is the optimal treatment modality for endometrioma owing to the low recurrence reported with this
Endometriomas are present in 17%–44% of patients with endometri-
approach.5 Despite improvements in techniques and the management
osis1 and are often associated with infertility, dysmenorrhea, chronic
of symptomatic patients with endometriomas, concerns have been
pelvic pain, and dyspareunia. Decreases in the rate of spontaneous
raised regarding potential negative effects of laparoscopic cystec-
ovulation,2 and reductions in follicular number and activity in adjacent
tomy on ovarian reserve due to inadvertent removal or destruction of
ovarian tissues3,4 have been associated with endometriomas.
healthy ovarian tissue adjacent to the pseudo-capsule of the cyst.6,7
Int J Gynecol Obstet 2016; 1–5
wileyonlinelibrary.com/journal/ijgo
© 2016 International Federation of | 1 Gynecology and Obstetrics
|
Mehdizadeh KashiET AL.
2
Repeated surgeries have been associated with severe decreases in
were excluded from the study, as were patients with pathologic exam-
ovarian reserve and it has been demonstrated that considerable sur-
inations not confirming endometriosis.
gical expertise is necessary to maintain the ovarian reserve following endometrioma surgery.8
Post-operative blood tests were performed 6 months after surgery during the same phase of the menstrual cycle as for the first evaluation
Anti-Müllerian hormone (AMH) has been demonstrated to be a superior marker of ovarian reserve than using age alone or other mark-
(first follicular phase). Baseline and 6-month serum AMH levels were compared.
ers described in the literature, including basal follicle-stimulating hor-
Baseline and 6-month serum AMH levels were measured in the
mone, estradiol, and inhibin B.3,9 Additionally, serum AMH presents
outpatient department of the study institution using a commer-
a stable value that is accessible throughout the menstrual cycle, an
cial enzyme-linked immunosorbent assay kit (Diagnostic Systems
10
important advantage for an ovarian-reserve marker.
Consequently, AMH could be a useful marker for monitoring potential
Laboratories, Webster, TX, USA) that could detect serum AMH levels as low as 0.006 ng/mL.
decreases in ovarian reserve due to endometriomas or ovarian cystectomy.
SPSS version 18 (SPSS, Chicago, IL, USA) was used to analyze the
However, data evaluating ovarian-reserve damage resulting from ovarian
study data. Continuous variables were expressed as mean±SD and were
endometriomas or cystectomy using serum AMH levels are sparse, de-
compared using the Student t test; categorical variables were expressed
spite authors11,12 recommending that AMH be used for diagnosing the
as numbers and were compared between baseline and 6 months with
extent of post-operative ovarian damage to predict future fertility.
the χ2 test. P
