Somigliana Edgardo, Marchese Maria Antonietta, Frattaruolo Maria Pina, Berlanda Nicola, Fedele Luigi, Vercellini Paolo
Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
Eur J Obstet Gynecol Reprod Biol. 2014 Sep;180:142-7. doi: 10.1016/j.ejogrb.2014.06.009. Epub 2014 Jun 25.
There is consistent evidence demonstrating that laparoscopic removal of benign ovarian cysts significantly damages the ovarian reserve. In contrast, the pre-operative impact of these cysts on the ovarian reserve is yet controversial. To elucidate this aspect, we set up a cross-sectional study in reproductive age women with and without benign ovarian cysts.
Inclusion criteria were as follow: (1) Age 18-40 years, (2) regular menstrual cycles, (3) Indication to laparoscopic surgery. Eligible women donated a blood sample for anti-Mullerian hormone (AMH) testing. Women who were diagnosed at surgery with concomitant endometriotic and non-endometriotic ovarian cysts, deep infiltrating peritoneal endometriosis or malignancies were subsequently excluded.
Diagnoses of the included women were as follows: ovarian endometriomas (n=122), non-endometriotic ovarian cysts (n=50) and non-ovarian diagnoses (n=113). Serum AMH in the three groups did not significantly differ. The median (Interquartile range-IQR) was 1.8 (0.8-3.1), 2.0 (0.8-3.9) and 1.9 (0.9-3.3) ng/ml, respectively (p=0.60). The analyses were repeated grouping women into those with bilateral cysts (n=54), unilateral cysts (n=118) and intact gonads (n=113). Women with bilateral lesions were found to have significantly lower levels of serum AMH. The median (IQR) serum AMH in the three groups was 1.3 (0.5-2.5), 2.0 (1.1-3.6) and 1.9 (0.9-3.3) ng/ml, respectively (p=0.019). We failed to demonstrate any correlation between serum AMH and the dimension of the ovarian cysts.
Serum AMH is lower in women with bilateral ovarian cysts and this does not appear to be related to the histology or dimension of the lesions.
有一致的证据表明，腹腔镜切除良性卵巢囊肿会显著损害卵巢储备功能。相比之下，这些囊肿对卵巢储备功能的术前影响仍存在争议。为阐明这一方面，我们对有和没有良性卵巢囊肿的育龄妇女进行了一项横断面研究。
纳入标准如下：（1）年龄18 - 40岁，（2）月经周期规律，（3）有腹腔镜手术指征。符合条件的女性捐献血样进行抗苗勒管激素（AMH）检测。随后排除手术中诊断为合并子宫内膜异位性和非子宫内膜异位性卵巢囊肿、深部浸润性腹膜子宫内膜异位症或恶性肿瘤的女性。
纳入女性的诊断情况如下：卵巢子宫内膜异位囊肿（n = 122）、非子宫内膜异位性卵巢囊肿（n = 50）和非卵巢疾病诊断（n = 113）。三组的血清AMH无显著差异。中位数（四分位间距 - IQR）分别为1.8（0.8 - 3.1）、2.0（0.8 - 3.9）和1.9（0.9 - 3.3）ng/ml（p = 0.60）。将女性分为双侧囊肿组（n = 54）、单侧囊肿组（n = 118）和性腺完整组（n = 113）重复进行分析。发现双侧病变女性的血清AMH水平显著较低。三组的血清AMH中位数（IQR）分别为1.3（0.5 - 2.5）、2.0（1.1 - 3.6）和1.9（0.9 - 3.3）ng/ml（p = 0.019）。我们未能证明血清AMH与卵巢囊肿大小之间存在任何相关性。
双侧卵巢囊肿女性的血清AMH较低，这似乎与病变的组织学或大小无关。
