Ovarian reserve in women with endometriosis under total cystectomy compared to partial cystectomy: A randomized clinical trial

Abstract

Background: The standard procedure for ovarian endometriosis is laparoscopic excision of ovarian cysts and complete removal of the cyst capsule using the striping technique. Owing to the possibility of reducing ovarian reserve, and in some cases, the premature ovarian failure, the safety remains to be known.
 Objective: To compare the ovarian reserve in women with endometriosis who underwent total cystectomy with partial cystectomy.
 Materials and Methods: In this randomized clinical trial, 56 women with endometriosis who were referred to the Research and Clinical Center for Infertility and Shahid Sadoughi Hospital, Yazd, Iran between January and February 2020 were randomly assigned into two groups (n = 25/each); group I (total cystectomy) and group II (partial cystectomy). To assess the ovarian reserves, the anti-Müllerian hormone (AMH) level before and three months after surgery was measured and compared between the two groups.
 Results: No significant difference was observed in the AMH levels before and after surgery (p = 0.52, p = 0.32, respectively). However, the mean reduction of AMH in total cystectomy group was significantly higher than the partial cystectomy (p = 0.001).
 Conclusion: Cystectomy in women with endometriosis reduces ovarian reserve and can help maintain some ovarian reserve by performing partial instead of total cystectomy.
 Key words: Anti-Müllerian hormone, Endometriosis, Cystectomy, Ovarian reserve.

The treatment of endometriosis-associated infertility

“…The effect of surgery for ovarian endometriosis on markers of ovarian reserve has been previously discussed in this article. The results of those studies [17][18][19][20][21][22]24] reinforce the ESHRE recommendation to avoid surgery for ovarian endometrioma unless required to improve endometriosis-associated pain or accessibility of follicles [2]. A study looking at the surgical treatment of endometrioma >3 cm prior to IVF found a similar CPR and LBR as in women with unexplained infertility, however this was a prospective case-control study despite identifying itself as an RCT [40].…”

“…Many studies evaluated these surrogate markers and consistently found a reduction in AFC [17,18] and AMH [17,[19][20][21], and an increase in FSH [17]. Bilateral endometrioma surgery had a greater effect on these surrogate markers than unilateral [19] and total cystectomy reduced AMH more than partial cystectomy [22].…”