Effect Of Three Different Types Of Laparoscopic Surgical Treatment On Ovarian Reserve Function In Infertile Women With Ovarian Endometriomas

ObjectiveTo investigate the effect of three different types of laparoscopic surgical treatment on ovarian reserve function in infertile women with ovarian endometriomas. Three laparoscopic surgical techniques of endometriomas includes: fenestration, fenestration and bipolar coagulation, cystectomy.MethodsThe medical records of83consecutive infertile patients with ovarian endometriomas treated from May2011to September2013were retrospectively reviewed. The patients were divided into3groups according to different types of laparoscopic surgical technique.32patients in group A underwent laparoscopic endometriomas fenestration;25patients in group B underwent laparoscopic endometriomas fenestration and bipolar coagulation;26patients in group C underwent laparoscopic endometriomas cystectomy. Base follicle stimulating hormone (bFSH) and base estradiol (bE2) level in2nd-3rd day of menstrual cycle of pre-operation, post-operation first cycle and third cycle were tested. Pre-and post-operation antral follicle count (AFC) and total AFC of operation side and health side were also evaluated through transvaginal ultrasound. These Data were collected to evaluate ovarian reserve function.ResultsGroup A: bFSH and bE2of post-operation first cycle had significant improvement (P<0.05) compared with that of pre-operation. Group B:bFSH of post-operation first cycle had significant improvement (P<0.05) compared with that of pre-operation. Post-operation tAFC increased significantly compared to pre-operation stage. Group C: bFSH of pre-and post-operation first cycle had no significant difference. Pre-operation bFSH and bE2had no significant difference between three groups. Pre-operation AFC of operation side and tAFC had no significant difference between group A and B, but both had significant difference compared with group C (P<0.05). Pre-operation AFC of operation side and tAFC in group C were significantly more than in group A and B. The difference between pre-operation and post-operation first cycle in group A and group B had significant difference compared with that in group C (P<0.05). The elevation of bFSH between post-operation first cycle and pre-operation in group A and B had more significant improvement than in group C. The tAFC difference of operation side between pre-operation and post-operation in group A and B had significant difference than in group C (P<0.05). The increased number of operation side AFC in group A and B were significantly more than in group C. The tAFC difference between pre-operation and post-operation in group B had significant difference (P<0.05) compared with that in group A and C. The increased number of tAFC post-operation in group B were significantly more than in group A and C. ConclusionIn infertile women with ovarian endometriomas, especially combined with decreased ovarian reserve function, laparoscopic endometriomas fenestration and fenestration and bipolar coagulation had better outcome compared with laparoscopic endometriomas cystectomy, which could significantly lower bFSH of post-operation first cycle, increase the number of AFC, and contribute to improve ovarian reserve function, which might improve pregnancy rate. Compared with laparoscopic fenestration,laparoscopic, fenestration and bipolar coagulation, could be better in increasing tAFC, which may consequently improve oocyte retrieval rate and be an optimal surgical treatment.