One‐year follow‐up of ovarian reserve by three methods in women after laparoscopic cystectomy for endometrioma and benign ovarian cysts

Abstract

Objective:To determine the long-term impact of laparoscopic cystectomy for endometriomas and benign cysts on ovarian reserve and selection of the most effective method of assessment. Methods:The present study was carried out between November 2013 and December 2016. Participants were assigned to laparoscopic cystectomy for diagnosed unilateral benign ovarian cysts and divided into groups: the endometrioma group (EG) (n=35) and the other benign ovarian tumor group (OG) (n=35). Before and at 3 and 12 months after the procedure, transvaginal ultrasonography was performed to assess antral follicle count (AFC) and ovarian volume (OvVol); laboratory tests were ordered for anti-Műllerian hormone (AMH) serum concentration assays. Pregnancy rates were counted in a 12-month follow-up. Statistica12 software was used for analysis. Results:The present study included 70 women aged 18-40 years. AMH serum concentration decreased significantly 3 months after laparoscopic cystectomy (4.89 ± 3.66 ng/mL to 3.45 ± 3.37 ng/mL; P<0.001). A greater decrease of AMH concentrations was observed in the EG (45.39% vs 14.87%; P=0.021). Twelve months of observation revealed a suppression in the drop of the AMH concentration, while AFC and OvVol remained unaffected. The likelihood of spontaneous pregnancy was three times higher in the OG (hazard ratio [HR] 3.57, 95% confidence interval [CI] 1.08-12.5). Conclusion:There was a significant decline in AMH levels in the EG 3 months after cystectomy. No further fall in AMH concentration was observed in the 12-month follow-up. The serum AMH concentration could be considered a valuable marker for ovarian reserve assessment after laparoscopic cystectomy. K E Y W O R D S

Antral follicle count is reduced in the presence of endometriosis: a systematic review and meta-analysis

“…The average age of all participants in the included articles was between 28 and 37 years old. The BMI of the participants could not be obtained for five articles (Almog et al, 2010(Almog et al, , 2011Candiani et al, 2019;Kostrzewa et al, 2019;Uncu et al, 2013) and participants in two of the remaining 10 articles had BMI >24 kg/m 2 (Ashrafi et al, 2019;Wahd et al, 2014); the remaining eight had BMI <24 kg/m 2 . The quality assessment is presented in Supplementary Table X and Figure X and the quality of seven studies is at a medium level (Almog et al, 2010;Biacchiardi et al, 2011;Candiani et al, 2019;Ercan et al, 2011;Kostrzewa et al, 2019;Uncu et al, 2013;Wahd et al, 2014), while the remaining nine studies are at a high level.…”

“…Finally, 15 studies (Almog et al, 2010(Almog et al, , 2011Ashrafi et al, 2019;Benaglia et al, 2013;Biacchiardi et al, 2011;Bourdon et al, 2018;Cagnacci et al, 2016;Campos et al, 2010;Candiani et al, 2019;Ercan et al, 2011; Q5 FIGURE 1 Flow chart depicting the literature search. Inal et al, 2019;Kostrzewa et al, 2019;Lima et al, 2015;Uncu et al, 2013;Wahd et al, 2014) were selected for inclusion in quantitative synthesis.…”

“…Relevant studies were reviewed and qualified independently by the two reviewers. Ten articles (Almog et al, 2011;Ashrafi et al, 2019;Benaglia et al, 2013;Bourdon et al, 2018;Campos et al, 2010;Ding et al, 2015;Inal et al, 2019;Kostrzewa et al, 2019;Uncu et al, 2013;Wahd et al, 2014) compared AFC between patients with and without endometriosis and one of these was excluded by influence analysis (Almog et al, 2011) (Supplementary Figure 2A); six articles (Almog et al, 2010(Almog et al, , 2011Biacchiardi et al, 2011;Candiani et al, 2019;Ercan et al, 2011;Lima et al, 2015) detected the difference in AFC between affected and unaffected ovaries in patients with unilateral ovarian endometriosis (Supplementary Figure 2B) and one of these was also excluded by influence analysis (Almog et al, 2010).…”

“…Of the 15 included studies, three studies were carried out in Turkey (Ercan et al, 2011;Inal et al, 2019;Uncu et al, 2013), two in Canada (Almog et al, 2010(Almog et al, , 2011, two in Brazil (Campos et al, 2010;Lima et al, 2015), two in Poland (Candiani et al, 2019;Kostrzewa et al, 2019) and the other six articles were from Iran, China, Italy, Iraq, France and Spain, respectively. Apart from two articles that were retrospective case-control studies (Almog et al, 2010(Almog et al, , 2011, the remaining 13 articles were prospective studies, of which one was a case-control and one a randomized clinical trial, six were cross-sectional studies and the remaining five were cohort studies.…”

“…The quality assessment is presented in Supplementary Table X and Figure X and the quality of seven studies is at a medium level (Almog et al, 2010;Biacchiardi et al, 2011;Candiani et al, 2019;Ercan et al, 2011;Kostrzewa et al, 2019;Uncu et al, 2013;Wahd et al, 2014), while the remaining nine studies are at a high level. Seven studies counted follicles with diameters of 2-10 mm (Almog et al, 2010;Cagnacci et al, 2016;Candiani et al, 2019;Inal et al, 2019;Kostrzewa et al, 2019;Lima et al, 2015;Wahd et al, 2014) and three studies counted follicles with diameters of 2-9 mm (Uncu et al, 2013), ≥2 mm (Bourdon et al, 2018) and >3 mm (Biacchiardi et al, 2011), respectively; the remaining five studies did not mention this information (TABLES 1 and 2). All the ultrasonography examinations in each article were performed by the same person.…”