ENDmetriosis and Reserve Ovarienne
Condition: Deep Endometriosis Stage III; Deep Endometriosis Stage IV
MeSH terms: Endometriosis
Study type: Observational [Patient Registry]

Summary: 
      Endometriosis is the ectopic implantation of endometrial glands and stroma, and can be
      ovarian and peritoneal (superficial or deep). There are 4 stages in endometriosis according
      to severity, and the stage is established on the basis of intra-operative observations. The
      AFSr classification is currently most used (I-IV,minimal, mild, moderate, severe). Most
      associated with endometriosis are subfertility and pelvic pain.

      In the surgical management of deep endometriosis, the issue of fertility is pivotal. There is
      a higher rate of infertility in a population of women with endometriosis as compared to the
      general population, even though the mechanisms are not yet elucidated. Patients with deep
      endometriosis can be referred to the surgeon for subfertility, but even when they are
      referred for chronic pain, future fertility considerations are taken into account in the
      planning of the surgery, as the patients are often young.

      It is now well documented that ovarian cystectomy is deleterious with regards to the ovarian
      reserve, and more so in endometriomas than in any other type of benign cysts. The ovarian
      reserve is the functional potential of the ovaries, reflecting the quantity and quality of
      remaining follicles. Studies have also relied greatly on the measure of serum anti-mullerian
      hormone (AMH) to evaluate the effect of cystectomy on ovarian reserve, as AMH is currently
      the most reliable marker to assess ovarian reserve. A significant difference was found
      between AMH before and following cystectomy in several studies. The deleterious effect of
      deep endometriosis surgery which comprises a wide dissection and adhesiolysis of the pelvis
      in many cases, even when no cystectomy has been performed, is therefore not entirely ruled
      out. To the best of our knowledge, there are no studies on the effect of deep endometriosis
      surgery, apart from ovarian surgery, on ovarian reserve.

      Our center is very active in the laparoscopic surgical treatment of deep endometriosis, with
      more than 200 cases every year. The objective of this trial is to assess the effect of deep
      endometriosis surgery on the ovarian reserve, whether a cystectomy is performed or not, by
      measuring serum AMH before and after surgery, at 6 months and 1 year post-operatively.
    


Intervention name(s): blood samples
Intervention type(s): Biological
Intervention description(s): Evolution of AMH before and after deep endometriosis surgery
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Female between 18 and 38 years old Deep endometriosis stage III or IV endometriosis of AFSr
        classification who undergo laparoscopy
      
Biospecimen description: 
      3 times blood sample retrieval and use serum to measure AMH the primary end point but also
      FSH, LH, estradiol which are study usually.
    
Keywords: AFSr classification; laparoscopy