Experience in intraoperative use of hemostatic matrices to preserve the ovarian reserve in patients with endometriomas

Close metadata

Recommended articles:

Efficiency of using dienogest at the stage of pregravid preparation on the course of pregnancy and the outcome of childbirth in patients with endometriosis. Russian Journal of Human Reproduction. 2024;(5):118-125

Gonadotropin-releasing hormone agonists as a chance for motherhood in the future. Russian Bulletin of Obstetrician-Gynecologist. 2024;(2):30-36

Experience of combined treatment of patients with infertility operated for external genital endometriosis. Russian Bulletin of Obstetrician-Gynecologist. 2024;(3):77-81

Objective — to give a comparative assessment of the state of the ovarian reserve in patients after laparoscopic removal of endometrioid ovarian cysts with the use of bipolar coagulation and without using surgical energies, using hemostatic matrices. Material and methods. The study included 133 patients with infertility and the presence of an ovarian endometrium who underwent laparoscopic cystectomy using two methods of intraoperative hemostasis: group 1 — 75 patients underwent bipolar coagulation, 2nd group — 58 patients using hemostatic matrices. All patients underwent a study of the main parameters of the ovarian reserve before and after the operation: AMG, FSH and the number of antral follicles. Results. To compare the groups by the quantitative parameters after the operation, a nonparametric Mann—Whitney test was used. When studying the effect of the operation type on the studied parameters, it was revealed that the groups differ in the level of AMH (p=0.029), FSH level (p=0.049), and in the number of follicles in the operated ovary (p=0.0008). According to the number of follicles in the ovary in the study, the groups were not statistically significantly different (p=0.15). Median level of AMG when using hemostatic matrices is 1.72 (0.6; 2.7) ng/ml, and when using coagulation –1.2 (0.4; 2.0) ng/ml. Significant differences were also revealed after the operation and FSH levels in the blood serum: in group 1 of FSH — 7.4 (5.3; 11.2) IU/l, in the second group of FSH — 7.1 (4.6; 8.4) IU/l. Conclusion. The use of modern hemostatic matrices for the purpose of hemostasis during surgical treatment of the ovarian endometrioma has a smaller negative effect on the main indicators of the ovarian reserve than classical operational techniques using bipolar coagulation.

Keywords:

external genital endometriosis

hemostatic matrices

bipolar coagulation

surgical energies

antimuller hormone

Authors:

Kuzmina N.S.

The Federal Almazov North-West Medical Research Centre, Sainkt-Petersburg, Russia,197341

Bezhenar' V.F.

NII akusherstva i ginekologii im. D.O. Otta RAMN, Sankt-Peterburg

Kalugina A.S.

Department of Obstetrics, Gynecology, and Neonatology, Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg, Russia;
Ava-Peter Clinic, Saint Petersburg, Russia

List of references:

Adamian LV, Serov VN, Suhih GT, Fillipov OS. Clinical recommendations. Obstetrics and Gynecology. Endometriosis: diagnostics, treatment and rehabilitation. Problemy reproduktsii (spetsial’nyi vypusk). 2017;6:553-605. (In Russ.)
Baskakov VP, Cvelev YuV, Kira EF. Endometrioidnaya bolezn’. SPb.: NL; 2002. (In Russ.)
Bulun SE. Endometriosis. New England Journal of Medicine. 2009;360(3):268-279. https://doi.org/10.1056/nejmra0804690
Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447):1789-1799. https://doi.org/10.1016/s0140-6736(04)17403-5
Wheeler JM. Epidemiology of endometriosis-assotiated infertility. Journal of Reproductive Medicine. 1989;34(1):41-46.
Cramer DW, Missmer SA. The epidemiology of endometriosis. Annals of the New York Academy of Sciences. 2002;955:11-12. https://doi.org/10.1111/j.1749-6632.2002.tb02761.x
Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis. Fertility and Sterility. 2008;90(5 Suppl):260-269. https://doi.org/10.1016/j.fertnstert.2008.08.057
Bezhenar VF, Yarmolinskaya MI. The comparison of the efficacy of different regimens of postoperative hormonal therapy in infertile women with endometriosis. Problemy reproduktsii. 2015;4:89-98. (In Russ.) https://doi.org/10.17116/repro201521489-98
Yoo JH, Cha SH, Park CW, Kim JY, Yang KM, Song IO, Koong MK, Kang IS, Kim HO, Kim HO. Serum anti-müllerian hormone is a better predictor of ovarian response than FSH and age in IVF patients with endometriosis. Clinical and Experimental Reproductive Medicine. 2011;38(4):222-227. https://doi.org/10.1080/01443615.2016.1239071
Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and metaanalysis. Journal of Clinical Endocrinology and Metabolism. 2012; 97(9):3146-3154. https://doi.org/10.1210/jc.2012-1558
Toner JP, Seifer DB. Why we may abandon basal follicle-stimulating hormone testing: a sea change in determining ovarian reserve using antimullerian hormone. Fertility and Sterility. 2013; 99(7):1825-1830. https://doi.org/10.1016/j.fertnstert.2013.03.001
Kwon SK, Kim SH, Yun SC, Kim DY, Chae HD, Kim CH, Kang BM. Decline of serum antimullerian hormone levels after laparoscopic ovarian cystectomy in endometrioma and other benign cyst: a prospective cohort study. Fertility and Sterility. 2014;101(2):435-441. https://doi.org/10.1016/j.fertnstert.2013.10.043
Iwase A, Hirokawa W, Goto M, Takikawa S, Nagatomo Y, Nakahara T, Manabe S, Kikkawa F. Serum anti-müllerian hormone level is a useful marker for evaluating the impact of laparoscopic cystectomy on ovarian reserve. Fertility and Sterility. 2010;94(7) :2846-2849. https://doi.org/10.1016/j.fertnstert.2010.06.010
Hirokawa W, Iwase A, Goto M, Takikawa S, Nagatomo Y, Nakahara T, Bayasula B, Nakamura T, Manabe S, Kikkawa F. The post-operative decline in serum anti-Mullerian hormone correlates with the bilaterality and severity of endometriosis. Human Reproduction. 2011;26(4):904-910. https://doi.org/10.1093/humrep/der006
Donnez J, Lousse JC, Jadoul P, Donnez O, Squifflet J. Laparoscopic management of endometriomas using a combined technique of excisional (cystectomy) and ablative surgery. Fertility and Sterility.2010;94(1):28-32. https://doi.org/10.1016/j.fertnstert.2009.02.065
Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W; European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Human Reproduction. 2014;29(3):400-412. https://doi.org/10.1093/humrep/det457
Alborzi S, Foroughinia L, Kumar PV, Asad N, Alborzi S. A comparison of histopathologic findings of ovarian tissue in advententy excised with endometrioma and other kinds of benign ovarian cyst in patients undergoing laparoscopy versus laparatomy. Fertility and Sterility. 2009;92(6):2004-2007. https://doi.org/10.1016/j.fertnstert.2008.09.014
Seyhan A, Ata B, Uncu G. The impact of endometriosis and its treatment on ovarian reserve. Seminars in Reproductive Medicine. 2015;33(6):422-428. https://doi.org/10.1055/s-0035-1567820
Donnez J, Nisole M, Gillet N, Smets M, Bassil S, Casanas-Roux F. Large ovarian endomrtriomas. Human Reproduction. 1996;11(3): 641-646. https://doi.org/10.1093/humrep/11.3.641
Donnez J, Wyns C, Nissole M. Does ovarian surgery for edometriomas impair the ovarian response to gonadotropin? Fertility and Sterility. 2001;76(4):662-665. https://doi.org/10.1016/s0015-0282(01)02011-8
Alborzi S, Mortahan M, Parsanezhad ME, S. Zolghadri J. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patient whith endometriomas. Fertility and Sterility. 2004;82(6):1633-1637. https://doi.org/10.1016/j.fertnstert.2004.04.067
Donnez J, Lousse JC, Jadoul P, Donnez O, Squifflet J. Laparoscopic management of endometriomas using a combined technique of excisional (cystectomy) and ablative surgery. Fertility and Sterility. 2010;94(1):28-32. https://doi.org/10.1016/j.fertnstert.2009.02.065
Мarcous S, Maheux R, Berube S. Canadian Collaborative Group on Endometiosis. Laparoscopic surgery in infertile women with minimal or mild endometriosis. New England Journal of Medicine. 1997;337(4):217-222. https://doi.org/10.3109/09513599609116219
Parazzini F. Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Gruppo Italiano per lo Studio dell Endometriosis. Human Reproduction. 1999;14(5):1332-1334. https://doi.org/10.1093/humrep/14.5.1332
Moini A, Bahar L, Ashrafinia M, Eslami B, Hosseini R, Ashrafinia N. Fertility outcome after operative laparoscopy versus no treatment in infertile women with minimal or mild endometriosis. International Journal of Fertility and Sterility. 2012;5(4):235-240.
Сhapron C, Versellini P, Baracat H, Vieira M, Dubuisson JB. Management of ovarian endometriomas. Human Reproduction Update. 2002;8(6):591-597. https://doi.org/10.1093/humupd/8.6.591
Сrosignani PG, Versellini P, Biffignandi F, Costantini W, Cortesi I, Imparato E. Laparoscopy versus laparotomy in conservative surgical treatment for severe endometriosis. Fertility and Sterility. 1996;66(5):706-711. https://doi.org/10.1016/s0015-0282(16)58622-1
Shenken RS. Modern concepts of endometriosis. Classification and its consequences for therapy. Journal of Reproductive Medicine. 1998;43(3):269-275.
Vercellini P, Chapron C, De Giorgi O, Consonni D, Frontino G. Coagulation or excision of ovarian endometriomas? American Journal of Obstetrics and Gynecology. 2003;188(3):606-610. https://doi.org/10.1067/mob.2003.7
Hart RJ, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database of Systematic Reviews. 2008;(2):СD004992. https://doi.org/10.1002/14651858.cd004992

Close metadata