Study Objective: To assess, based on 3D-ultrasonography data, endometrial receptivity to implantation in women who have undergone conservative surgery for ovarian endometriomas (OE). Study Design: This was a prospective, comparative, clinical study. Materials and Methods: One hundred and seventy-two women who had undergone excision of OE were examined in the study: 114 patients with anti-Müllerian hormone (AMH) levels below 1.2 ng/mL (Group I, including subgroup A made up of 44 women younger than 35 and subgroup B made up of 70 women aged 35 to 40) and 58 patients with AMH ≥1.2 ng/mL (Group II). 3D-ultrasonography was performed at six and 12 months after cyst removal (between days 6 and 8 after ovulation). The VOCAL software was used to assess endometrial volume and volumetric blood flow indices, such as vascularization index (VI), flow index (FI), and vascularizationflow index (VFI). Study Results: One year after the surgery, endometrial volume in women from subgroup IA and Group II and volumetric blood flow indices in women from Group II did not significantly differ from population mean values. In subgroup IB endometrial gland volume remained reduced throughout the observation period; hemodynamics did not improve in either the endometrium (VI: 2.39 ± 1.57% after six months and 2.32 ± 1.44% after 12 months) or the subendometrial layer (VI: 10.96 ± 5.68% and 11.86 ± 4.59%, respectively). Conclusion: The structural and hemodynamic abnormalities revealed in the endometrium in the postoperative period should be viewed as factors worsening endometrial receptivity to implantation. Keywords: ovarian endometriosis, endometrial disorders, 3D-ultrasonography, volumetric blood flow indices.
Objective. To analyze the significance of the ovarian reserve (OR) in the assessment of endometrial receptivity in patients after cystectomy for ovarian endometriotic cysts (OECs). Patients and methods. We examined 172 patients after organ-sparing surgeries for OECs. The mean patient age was 28.7 ± 4.8 years. Group I included 114 women with low OR. Group II comprised 58 patients with unchanged OR. All study participants underwent pelvic ultrasonography in the middle luteal phase 6 and 12 months postoperatively. We evaluated endometrial thickness and its echostructure, as well as Doppler-angle-independent flow indices, including resistance index, pulsatility index, and systolic/diastolic ratio. Reduced OR was diagnosed according to the ESHRE recommendations (2011 Anti-Müllerian hormone ≤ 0.5–1.1 ng/mL and ≤5–7 antral follicles in one ultrasound section. Results. Impairments in the morphological and functional state of the ovaries were associated with changes of the endometrial thickness, its ultrasonic structure, and hemodynamic parameters in the terminal branches of the uterine arteries (hypovascularization, increased flow indices). Simultaneous use of various methods for the assessment of ovarian tissue and endometrium allowed the detection of a decreased reproductive potential. Patients with a reduced OR after surgeries for OECs demonstrated improvement of both morphological/functional characteristics of ovarian tissue and endometrial receptivity, which allows pregnancy planning. Patients with extremely thin endometrium (3.0–5.0 mm) that does not improve are recommended to resort to assisted reproductive technologies. Key words: ovarian reserve, endometrium, ovarian endometriotic cysts
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