Abstract
Objective: To assess whether coagulation or suture for hemostasis during laparoscopic excision of unilateral endometrioma affects short-term ovarian reserve.
Methods: From April 2008 to March 2011, 48 women underwent laparoscopic excision of endometrioma. In 26 patients, bipolar electrocoagulation was used for hemostasis, while in 22, the ovary was sutured. We reviewed these cases retrospectively. Age, BMI, menstrual cycle day, tumor size, and American Society for Reproductive Medicine (rASRM) score at laparoscopy were observed as baseline clinical characteristics for each patient. Serum anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol levels were measured preoperatively and 1 month postoperatively and compared in both groups. The antral follicle count from the operated ovary and the intact ovary in each group were also analyzed 1 month postoperatively.
Results: Age, BMI, and menstrual cycle day were similar in the 2 groups. There was no significant difference between the 2 groups in rASRM score or size of endometriomas. No significant differences in preoperative and post-operative serum FSH and Estradiol levels were found in either group. Serum AMH levels were significantly decreased postoperatively in both groups. In the suture group, the mean number of AFC was significantly reduced in the operated ovary compared with the contralateral intact ovary.
Conclusions: Laparoscopic excision of unilateral endometrioma appears to adversely affect AMH hormonal values 1 month after operation. Our results suggest that suturing of the ovarian parenchyma after laparoscopic excision of endometrioma adversely affects ovarian reserve in the short-term. We suggest that these findings might be of particular interest when treating women with risk factors of postoperative ovarian reserve impairment.
