Effects of laparoscopic ovarian endometriosis cystectomy combined with postoperative GnRH-a therapy on ovarian reserve, pregnancy, and outcome recurrence

Abstract

The aim of this study was to investigate the impacts of laparoscopic ovarian endometriosis cystectomy combined with postoperative GnRH-a therapy on ovarian reserve, pregnancy outcome and recurrence. Materials and Methods: This was a prospective control study. The experimental group: 63 patients with combinations of laparoscopic bilateral ovarian endometrial cystectomies and gonadotropin-releasing hormone agonist (GnRH-a) treatment for three months. Control group: 62 patients with laparoscopic bilateral ovarian endometrial cystectomies. Benchmarks: the changes of follicle stimulating hormone (FSH) and FSH / luteinizing hormone (LH), etradiol (E2) in preoperative and postoperative three months or menstrual two to three days, menstrual two to three days after surgery, natural pregnancy, and cyst recurrence in 18 th month during postoperative follow-up. Results: In experimental group after six months, the percentage of returned FSH accounted for 95.3% of normal range, in the control group it was 82.2%, and the difference was significant (p < 0.05). The natural pregnancy rate of preoperative infertility patients (57.1%) was higher than the control (36.8%) (p < 0.05). The recurrence rate of preoperative infertility patients (12.7%) was lower than the control (27.4%) (p < 0.05). Conclusion: After bilateral laparoscopic ovarian endometrial cystectomy, an implement of GnRH-a therapy can improve the postoperative pregnancy rate, which changes with clinical stage and patient age, reduces ovarian recurrence, and its influence on ovarian reserve is lesser.

Effect of Postoperative Hormonal Suppression on Fertility in Patients With Endometriosis After Conservative Surgery

“…agonists in 14 trials 14,15,[26][27][28][30][31][32][33][34][35]39,41,42 (1,721 patients) was associated with increased chances of pregnancy compared with control (RR 1.20; 95% CI 1.03-1.41; I 2 525%, Fig. 1).…”

“…The strength of the evidence for the main outcome (pregnancy) was moderate according to the GRADE tool (Table 3). Overall strength of evidence was downgraded once because indirectness was a concern in seven trials 14,29,30,32,36,39,42 in which not all patients sought pregnancy. The funnel plot does not suggest any publication bias (Fig.…”

“…36,38 Surgical approach was by laparoscopy (n=13), 15,26–33,39–42 laparotomy (n=3), 34,36,38 or either one (n=3). 14,35,37 Four trials 28,31,40,41 included only patients with American Society for Reproductive Medicine Revised Classification of Endometriosis 21 stage 1 or 2, seven trials 15,29,30,32,34,37,38 included only patients with stage 3 or 4, and eight trials 14,26,27,33,35,36,39,42 included all stages. In seven trials, 14,29,30,32,36,39,42 only a subgroup of patients attempted pregnancy after surgery and were included in the analyses.…”

Effect of Mirena intrauterine device combined with GNRH-A on endometriosis, sex hormone level and carbohydrate antigen 125

“…Therefore, conservative surgical treatment can remove the lesions visible to the naked eye to a certain extent. However, the residual lesions after surgery may lead to the recurrence of the disease under the influence of the body's relevant hormones due to the characteristics of diffusion, infiltration and hyperplasia (14,15). Therefore, adjuvant drug therapy is needed after conservative surgery to enhance clinical efficacy and prevent disease recurrence.…”

“…For some patients, the treatment effect is not ideal after simple application of GnRH-A, and adjusting the dosage and changing the frequency of medication is easy to affect the safety of the medication, so the auxiliary application of other drugs is needed. Mirena placed in the uterine cavity of patients, intrauterine endometrial intervention, without affecting the level of estrogen, can reduce the endometrial E2, progesterone receptors, make the endometrial gland atrophy, inhibit the endometrial growth, reduce the endometrial reaction activity, effectively relieve symptoms (20,21).…”