Objective: To investigate the impact of laparoscopic endometrioma cystectomy on the ovarian reserve and to identify the most important factors that predict the ovarian reserve in patients with endometriomas. Design: Prospective study. Settings: Endoscopy unit of a general hospital. Patient(s): Fifty-four patients with unilateral (n ¼ 37) and bilateral endometriomas (n ¼ 17). Interventions(s): The serum antim€ ullerian hormone (AMH) concentration was assessed before surgery and at 6 and 12 months after surgery. Main Outcome Measure(s): The primary outcome was the damage to the ovarian reserve, as assessed by the serum AMH concentration. Secondary end points were the persistence or recovery of ovarian damage after 1 year. Result(s): AMH concentrations decreased after the laparoscopic excision of cystic ovarian endometriomas. Before surgery and at 6 and 12 months after surgery, the concentrations were, respectively 3.07, 1.29, and 1.46 ng/mL. In the unilateral group, the median AMH levels were 3.31, 1.43, and 1.72 ng/mL, and in the bilateral group the levels were 2.55, 0.98, and 0.89 ng/mL. The serum AMH concentrations thus decreased by 53.27 AE 38.2% and 49.43 AE 38.3% at 6 and 12 months after cystectomy, respectively. Conclusion(s): In patients with endometriomas, the decrease in ovarian reserve occurs immediately after the excision of the endometrioma. Significant predictors of AMH values at 6 and 12 months after surgery include the baseline AMH level, patient age, and bilateral endometriomas.
Kratak sadr`aj: Kod 2000 trudnica ura|en je u prvom trimestru trudno}e genetski skrining na hromozomopatije odre |ivanjem biomarkera Pregnancy associated plasma protein-A i free-beta-HCG u maternalnom serumu. Posle dobijanja normalnog kariotipa fetusa, patolo{ke vrednosti bio markera su korelisane sa drugim poreme}ajima trud no }e kako bi se ispitali mogu}i uzroci pozitivnog genetskog skrinin ga. Otkriveno je ukupno 340 la`no pozitivnih nalaza biomar kera (17%). Zna~ajan udeo imao je povi{eni free-beta--HCG (48,24%). Utvr|ena je zna~ajna povezanost (p>0,01) povi {enog free-beta-HCG i krvarenja u trudno}i. U 78,52% trudno}a sa patolo{kim biomarkerima nastale su kompli kacije: 13,82% MISSed, 10,88% spontani poba ~aj, 8,82% indu kovani prekid trudno}e zbog anomalija ploda i 45% poro |aja sa poreme}ajem fetalnog vitaliteta. Rezultati istra`i vanja su pokazali veoma zna~ajnu poveza nost (p>0,01) izme|u pove}ane vrednosti biomarkera free-beta-HCG i fetalne hipoksije. La`no pozitivan genetski skri ning uzrok o van povi{e nim free-beta-HCG mo`e da bude pokazatelj pla centarne disfunkcije i poreme}aja fetalnog vitaliteta.
The past decades have brought about numerous new methods in the treatment of the most frequent benign gynaecological tumour, the myoma, while at the same time, the indications of traditional surgical treatment have also been reassessed. The constant procrastination of pregnancy to older and older age, the frequency of myoma growing by age and the wider application of assisted reproduction techniques have created new conditions for the treatment of myoma. In our research, we analysed the data of 30 infertile patients out of a group of 99 who had hysteroscopic and laparoscopic myomectomy carried out in one session. In the course of 2 years, nine women got pregnant. Besides two miscarriages, the others could carry their pregnancy for at least 34 weeks. Out of the seven deliveries, five (71%) ended with caesarean section, for obstetrical reasons in all cases. In case of uterus with multiplex myoma, hysteroscopy and laparoscopy can safely be applied in parallel and it does not necessarily imply the termination of the occurring pregnancy by caesarean section.
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