Impact of laparoscopic cystectomy of endometriotic and non-endometriotic cysts on ovarian volume, antral follicle count (AFC) and ovarian doppler velocimetry.

OBJECTIVE

To evaluate the effect on ovarian reserve and blood flow of unilateral laparoscopic stripping of endometriotic versus non-endometriotic cysts.

DESIGN

Prospective observational study.

SETTING

Tertiary university gynecology unit.

PATIENTS

During the study period, 71 subjects underwent the first laparoscopic surgery for removal of a monolateral benign ovarian cyst.

INTERVENTIONS

Trans-vaginal ultrasound scans of the pelvis about six months after surgery.

MAIN OUTCOME MEASURES

Ovarian volume, Antral Follicle Count (AFC) and Resistance Index (RI) of ovarian artery of the operated and the contralateral ovary.

RESULTS

Among 71 cysts, 39.4% were endometriotic and 60.6% non-endometriotic benign cysts. All the procedures were performed by the same experienced surgeons with a standardized technique. No major complications were reported during surgery. The mean (±SD) age and BMI of women were 31.0 ± 6.8 years and 24.2 ± 3.3 kg/m(2), respectively. Mean diameter of the removed cysts was smaller for endometriotic than non-endometriotic cysts (4.35 ± 1.77 cm versus 6.33 ± 3.71 cm, p = 0.046). In comparison to non-operated, volume of the operated ovary was significantly lower and with a reduced AFC, with no difference between endometriotic and non-endometriotic cysts (-2.41 ± 2.35 versus -2.00 ± 2.23 cm(3), p = 0.496) (-3.45 ± 3.07 versus -2.43 ± 1.95, p = 0.11). Ovarian artery RI was higher in the operated ovary with no difference between endometriotic and non-endometriotic cysts (0.19 ± 0.14 versus 0.14 ± 0.10, p = 0.455). The difference in ovarian volume (r = 0.178), AFC (r = 0.094) and RI (r = 0.079) between operated and non-operated ovary was not dependent on the diameter of the removed cyst.

CONCLUSION

Ovarian surgery is associated with a decline of ovarian reserve, independently on the histological type and the diameter of the removed cyst.