Characteristics of the reproductive potential of women with ovarian endometrioma
Authors: Dyndar O.A. , Dymarska O.Z. , Oleshko V.F. 
Published: July 2024

Endometriosis is one of the most studied hormone-dependent pathological conditions in modern gynecological practice, which is diagnosed in 300 million women of reproductive age worldwide. The frequency of endometriosis in the general population of women is 10–15%, its rate is 46% among the patients with infertility and 80% – among the patients with pelvic pain syndrome. Ovarian endometriomas in the structure of external genital endometriosis account for 64%.The objective: to determine the state of the ovarian reserve in women of reproductive age with ovarian endometriomas depending on the surgical treatment method.Materials and methods. The study involved 120 women of reproductive age with ovarian endometriomas, who were surgically treated by laparoscopic access, and 30 women of the control group, who were included in the examination for the purpose of evaluating the physiological parameters of the ovarian reserve, who applied for the solution of contraception issues.Group I included 60 women who underwent intraoperative bipolar coagulation (BC) of the ovarian medulla for the purpose of hemostasis, 30 persons of them underwent inversion cystectomy (Subgroup IA) and 30 patients underwent traditional cystectomy (Subgroup IB).Group II included 60 patients who underwent intraoperative BC of the medullary and cortical layers, of which 30 underwent inversion cystectomy (Subgroup IIA) and 30 underwent traditional cystectomy (Subgroup IIB).For the assessment the functional state of the ovaries echographic examination, Doppler study and hormonal examination were carried out (determination of the concentration of anti-Mullerian hormone (AMH), basal level of follicle-stimulating hormone (FSH), inhibin B in blood plasma) before and 3 months after surgical treatment.Results. The indicators of the ovarian reserve of the patients of the studied groups before the surgical treatment were significantly different from the indicators of the women of the control group, which was manifested by a decreased number of antral follicles (AF) by 1.6 times, a decreased volume of ovarian tissue by 1.5 times, a decreased vascularization index (IV) by 2.4 times and the blood flow index (IC) by 1.2 times, an increase in the FSH index by 1.3 times, a decreased AMH level by 1.3 times and a decreased inhibin B concentration by 2.3 times (p<0, 05).After the surgical intervention, even more pronounced pathological changes in the reproductive potential were found, which were associated with deep neurovascular disorders in the ovaries and the death of part of the generative cells as a result of the cystectomy and hemostasis with the use of high-frequency energy.Conclusions. When using BC of the medullary and cortical layers of the ovaries a decreased number of AF by 48.8% and the decreased volume of the tissue of the operated ovary by 41.3% were found compared to the preoperative period, which is 4.1 and 3.1 times more than with BC of the medullary layer (p<0.05). Hormonal homeostasis disorders were manifested by a compensatory increased level of FSH by 46.8% and a decreased AMH concentration by 23.5% (p<0.05).In the case of the use of BC of the medulla of the ovary with inversion cystectomy, the decrease in the ovarian reserve is expressed at least. The use of BC of the medullary and cortical layers of the ovary with inversion cystectomy leads to a decreased ovarian reserve to a low level 2.2 times less often than when using a classic cystectomy (p<0.05).