Comparison of Ovarian Reserves Before and After Laparoscopic Cystectomy "Fertility Sparing" in Endometriosis Cyst Patients
(1) Resident of Obstetrics and Gynecology, Faculty of Medicine, Andalas University, Dr. M. Djamil Central General Hospital Padang
(2) Sub Division of Reproductive Endocrinology, Obstetrics and Gynecology Department, Faculty of Medicine, Andalas University, Dr. M. Djamil Central General Hospital Padang
(*) Corresponding Author
DOI: https://doi.org/10.25077/aoj.4.1.95-109.2020
Abstract
Laparoscopy Cystectomy still remains the first line as the treatment of endometriosis cyst. A “fertility sparing” laparoscopy is a procedure that preserve uterus and ovaries of endometrioma patient.
Objective: was to compare the ovarian reserve before and after laparoscopic cystectomy “fertility sparing” using three marker of ovarian reserve which are AMH, FSH and Estradiol on 2nd or 3rd day of menstrual period and counting the AFC by Transvaginal Ultrasound.
Methods: This study is an experimental study on 25 endometrioma patient. Ovarian reserve values was taken before and after laparoscopy using three markers which are AMH, FSH and Estradiol and AFC. All patient included to group performed laparoscopy cyctectomy with several techniques which are no or less use of electrocoagulation, using vassopresin injected to the cyst wall, using stripping of the membrane technique on cyst, without suturing, using compression to control bleeding, avoiding hillus cut. Statistical Analysis was using paired t test method.
Result: There was average differences on AMH value before 1,77 ± 0,39 ng/ml and after laparoscopy 1,54 ± 0,38 ng/ml. FSH value before was 6,91 ± 4,59 mlU/ml and after was 10,13 ± 6,51 mlU/ml, for estradiol before was 99,65 ± 77,18 mlU/ml and after was 63,67 ± 35,22 mlU/ml. There were 15 samples before laparoscopy has AFC <4, 10 samples has AFC 4-6, after laparoscopiy there was 8 samples has 8 AFC, 8 samples has 4-6 AFC, and 9 samples has 7-10 AFC. There was a statistical significance on the reduce of ovarian reserve before and after laparoscopic cystectomy “fertility sparing” (p=0,001).
Conclusion: There was the affect of laparoscopy cystectomy to the decrease of ovarian reserve which sre 13% decreaed of AMH (p+0,001), 31,6% increased of FSH (p=0,001), estradiol was 47,8% decreaed (p=0,001) and AFC has increased 47.9% (p=0,003).
Keywords: Laparoscopic Cystectomy, Endometriosis, Anti Mullerian Hormone, Antral FollicleFull Text:
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O.Burney R, C.Giudice L. Pathogenesis And Pathophysiology Of Endometriosis. Fertil Steril 2012; 98:511-9.
Hoffman B, Schorge J, Schaffer J, Halvorson L, Bradshaw K, Cunningham F. Williams Gynecology 2th edition. McGraw-Hill. USA; 2012.
Hirsch M, Begum MR, Paniz E ,Barker C, Davis CJ, Dufffy J. Diagnosis and management of endometriosis: a systematic review of international and national guidelines. BJOG. 2018;125:556–564
Kuznetsov L, Dworzynski K, Davies M, Overton C. Diagnosis and management of endometriosis: summary of NICE guidance. BMJ. 2017;358 :3935.
Falcone T, Flyckt R. Clinical Management of Endometriosis. Obstet Gynecol. 2018;131:557–71.
Eisenberg V, Weil C, Chodick G, Shalev. Epidemiology of endometriosis: a large population-based database study from a healthcare provider with 2 million members. BJOG. 2018;125:55.
Hendry D, TH Madjid, R Anwar, A Rachmawati. 2017. Korelasi ekspresi VEGF dan PGP 9.5 Didalam Darah Haid Penderita Endometriosis. Andalas Obstetric and Ginecology Journal vol.1 issues 1.
Khine Y, Taniguchi, Harada T. Clinical management of endometriosis-associated infertility. Reprod Med Biol. 2016;15:217–225.
Parasar P, Ozcan P, Terry K. Endometriosis: Epidemiology Diagnosis and Clinical Management. Curr Obstet Gynecol Rep. 2017; 6(1): 34–41.
Soave D. Caserta D, Wenger J, Dessole S, Perino A, Marco. Environment and Endometriosis: a toxic relationship. European Review for Medical and Pharmacological Sciences. 2015; 19: 1964-1972.
Sourial S, Tempest N, Hapangama D. Theories on the Pathogenesis of Endometriosis. International Journal of Reproductive Medicine . 2014; Article ID 179515, 9 pages.
Patel B,Rudnicki M, Yu J, Shu Y, Taylor R. Progesterone resistance in endometriosis: origins,consequences and interventions. Acta Obstet Gynecol Scand. 2017; 96:623–632.
Tanbo T, Fedorcsak P. Endometriosis-associated infertility: aspects of pathophysiological mechanisms and treatment options. Acta Obstet Gynecol Scand. 2017; 96:659–667.
Zhang C, Wu L, Quanli P. Clinical study of the impact on ovarian reserve by different hemostasis methods in laparoscopic cystectomy for ovarian endometrioma. Taiwanese Journal of Obstetrics & Gynecology 55. 2016 ;507-511
Owczarek D, Malinowski A, Wilczynski M. Ovarian reserve evaluation after laparoscopic cyst enucleation, depending on applied haemostasis technique and with particular consideration of endometrial cysts. Menopause Rev. 2018; 17(1): 22-27.
Bhat R., Dhulked S, Ramachandran A, Bhaktie R., Vasudeva A, dkk. Laparoscopic cystectomy of endometrioma: Goodsurgical technique does not adversely affect ovarian. Journal of Human Reproductive Sciences. 2014; 7 (2)
Keyhan S, Hughe C, Price T, Muasher S. An Update on Surgical versus Expectant Management of Ovarian Endometriomas in Infertile Women. BioMed Research International.2015; Article ID 204792, 9 pages.
Tanos V, Akhras S. The Effect of Hemostatic Method on Ovarian Reserve following Endometrioma Excision. Glob J Reprod Med. 2017;1(3).
Sahin C, Akdemir A, Ergenoglu A, Ozgurel B, Yeniel A, Taskiran D, dkk. Which Should Be the Preferred Technique During Laparoscopic Ovarian Cystectomy; 2016
Choi C, Kim W, Lee D, Lee S. Usefulness of hemostatic sealants for minimizing ovarian damage during laparoscopic cystectomy for endometriosis. J. Obstet. Gynaecol. Res. 2017.
Deckers P, Riberio S, Simoes R, Miyahara C, Baracat E. Systematic review and meta-analysis of the effect of bipolar electrocoagulation during laparoscopic ovarian endometrioma stripping on ovarian reserve. Int J Gynecol Obstet.2018; 140: 11–17
Xiong W, Zhang L, Yu L, Xie W, Man Y, Xiong Y. Estradiol promotes cells invasion by activating b-catenin signaling pathway in endometriosis. Reproduction .2015; 150: 507–516.
Mohamed D,Abdel-Maksoud, Nervana Samy, Maha Hashim, Abeer Elkhayal.Assesment of Ovarian Reserve After Ovarian Cystectomy by Laparotomy versus Laparoscopy.International Journal of Pharmaceutical and Clinical Research 2015 ; 7(1) ; 23-28.2015
Saeed Alborzy, Pegah Keramati, Masoomeh Younesi,Alamtaj Samsami.The Impact of Laparoscopic Cystectomy on Ovarian Reserve in Patients with unilateral and bilateral endometriomas.Fertility and sterility vol 101 no.2.American Society for Reproductive Medicine.2014
Miller J, AhM S, Monsanto S, Khalaj K, Koti M, Tayade C. Implications of immune dysfunction on endometriosis associated infertility. Oncotarget. 2017;8(4) :7138-7147.
Becker C, Mittal M. The Effect of Surgery for Endometriomas on Fertility. RCOG Scientific Impact Paper. 2017; No. 55.
Rafique S, Decherney A. Medical Managementof Endometriosis. Clinical Obstetric and Gynecology.2017; 00 (00) ;000–000.
Buggio L, Barbara G, Facchin F, Frattaruolo M, Aimi G. Self-management and psychological-sexological interventions in patients with endometriosis: strategies, outcomes, and integration into clinical care. Journal of Women’s Health. 2017;9: 281–293.
Jeong J.In Search of Molecular Mechanisms in Endometriosis. Endocrinology.2014; 155(4):1178–1180.
Kralickova M, Vetvicka V. Immunological aspects of endometriosis: a review. Ann Transl Med .2015;3(11):153.
Cho Y, Lee S, Park J, Han M., Park M, Han S. Dysfunctional Signaling Underlying Endometriosis: Current 1 State of Knowledge. Society for Endocrinology.2018.
Izumi G, Koga K, Takamura M, Makabe T, Satake E, Takeuchi A. Involvement of immune cells in the pathogenesis of endometriosis J. Obstet. Gynaecol. Res.2018;44 (2): 191–198.
Brosens I, Benagiano. Endometrioma in adolescents and future reproductiveHealth. J Endometr Pelvic Pain Disord. 2017; 9(1): 9-16.
ESHRE. Management of women with endometriosis. Guideline of the European Society of Human Reproduction and Embryology; 2013.
Leon Speroff, MD, Marc A. Fritz, MD.Clinical Gynecology endocrinology and Infertility. 2011; Chapter 3 : 46-49
Hall J.E. Guyton and Hall Textbook of Medical Physiology 13thedition. Elsavier.USA; 2016.
Melmed S, Polonsky K, Larsen PR, Kronenberg H. Williams Textbook of Endokrinology 13thedition. Elsavier. USA;2016.
Fritz M, Sperrof L. Clinical Gynecologi endocrinoloy and Infertility 8 th edition. Lippicort WiliiamWillims. USA; 2011.
Geordaki K, Khoury N, Spandidos D, Zoumpourlis V. The molecular basis of fertilization (Review). INTERNATIONAL JOURNAL OF MOLECULAR MEDICINE. 2016; 38: 979-986.
Sherwood L. Human Physiology 8 th edition. Cengange learning. USA. 2016.
Castro F, Cruz M, Leal C. Role of Growth Differentiation Factor 9 and Bone Morphogenetic Protein 15 in Ovarian Function and Their Importance in Mammalian Female Fertility — A Review. Asian Australas. J. Anim.2016. 29; (8): 1065-1074.
Cunningham F, Leveno K, Bloom S, Spong C,Dashe J, Hoffan B. Williams obstetric 24th edition. McGraw-Hill. USA; 2014.
Islam Y, Aboulghar M, Alebrashy A, Aziz O. The value of different ovarian reserve tests in the prediction of ovarian response in patients with unexplained infertility. Middle East Fertility Society Journal. 2016; 21, 69–74.
Smith V, Osianlis T, Vollen hoven B. A review of luteinizing hormone and its role in ovarian reserve testing. Smith V et al. Int J Reprod Contracept Obstet Gynecol. 2014;3(1):11-18.
Rasool,S. Shah,D. 2017. Fertility with early reduction of ovarian reserve: the last straw that breaks the Camel’s back. Rasool and Shah Fertility Research and Practice (2017) 3:15.
Jirge PR. Poor ovarian reserve. Journal of Human Reproductive Sciences. 2016; 9 (2)
Jamil, Z, Fatima SS, Ahmed K, Malik R. Anti-Mullerian Hormone: Above and Beyond Conventional Ovarian Reserve Markers. Hindawi Publishing CorporationDisease Markers .2016 ; Article ID 5246217, 9 pages.
Kaur M., Arora M. Diminished Ovarian Reserved, Cause, Aseddment and Manangement. International journals of infertility and fetal medicine. 2013; 4 ( 2).
Haydardedeoglu B. The impact of endometriosis on fertility. Womens Health (2015) 11(5), 619–623.Hemostatic Sutures or Bipolar Electrocoagulation? A Randomized Controlled Prospective Study of Long-Term Ovarian Reserve. Reproductive Sciences 1-7.2015.
Saridogan E, Becker C, Feki A, Grimbizis G, Hummelshoj L, Keckstein J. Recommendations for the Surgical Treatment of Endometriosis. Part 1: Ovarian Endometrioma. Human Reproduction Open. 2017:1–6.
Arora A, Falcone T. Surgical Management of Endometriomas: The Link between Pathophysiology and Technique. Arora A and Falcone T. J Surg. 2018: JSUR-1132.
Afors K, Murtada R., Centini G, Fernandes R., Meza C, Castellano J, dkk. Employing laparoscopic surgery for Endometriosis. Women’s Health. 2014;10(4);431–443.
Gentaro Izumi, Kaori Koga, Masashi Takamura, dkk. Involvement of Immune Cells in the pathogenesis of Endometriosis. The Journal Of Obstetrics and Gynecology Research.2018;Vol 44 No.2 191-198
Ramazan Amanvermez, Migraci Tosun. An Update On Ovarian Aging and Ovarian Reserve Test. 2013. Review Article of International Journal Of Fertility and Sterility. Vol 9: No.4 411-415
Chen Y, Pei H, Chang Y, Chen M, Wang H, Xie H, et al. The impact of endometrioma and laparoscopic cystectomy on ovarian reserve and the exploration of related factors assessed by serum anti-Mullerian hormone: a prospective cohort study. Journal of Ovarian Research. 2014;7:108
Zhang CH, Wu L, Li PQ. Clinical study of the impact on ovarian reserve by different hemostasis methods in laparoscopic cystectomy for ovarian endometrioma. Taiwanese Journal of Obstetrics & Gynecology. 2016;55:507-511
Georgievska J, Sapunov S, Cekovska S, Vasilevska K. Ovarian reserve after laparoscopic treatment of unilateral ovarian endometrioma. Acta Inform Med. 2014;22(6):371-373
Alborzi S, Keramati P, Younesi M, Samsami A, Dadras N. The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometriomas. Fertility and Sterility. 2014;101(2):427-34
Chang HJ, Han SH, Lee JR, Jee BC, Lee BI, Suh CS, et al. Impact of laparoscopic cystectomy on ovarian reserve: serial change of serum anti-Mullerian hormone levels. Fertil Steril. 2010;94(1):343-9
Revelli A, Biacchiardi CP, Piane LD, Camanni M, Deltetto F, Delpiano EM, et al. Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experoenced surgeons. Reproductive Biomedicine Online. 2011;23:740-6
Ercan CM, Duru NK, Karasahin KE, Coksuer H, Dede M, Baser I. Ultrasonographic evalution and anti-mullerian hormone levels after laparoscopic stripping of unilateral endometriomas. Eur J Obstet Gynecol Reprod Biol. 2011;158(2):280-4
Adnyana IBP, Impacts of endometrioma type and two-different techniques of laparoscopic cystectomy on ovarian reserve by measuring anti-mullerian hormone concentration. Bali Med J. 2018;7(2):530-4
Muzii L, Bianchi A, Groce C, Manci N, Panici PB. Laparoscopic excision of ovarian cysts: is the stripping technique a tissue-sparing procedure?. Fertil Steril. 2002;77(3):609-14
Stilley JA, Birt JA, Sharpe-Timms KL. Cellular and molecular basis for endometriosis-associated infertility. Cell Tissue Res. 2012;349(3):849-62
Nargund G, Parsons J. Infected endometriosis cyst secondary to oocyte aspiration for in-vitro fertilization. Hum Reprod. 1995;10(6):1555
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