Ozaki Rie, Kumakiri Jun, Tinelli Andrea, Grimbizis Grigoris F, Kitade Mari, Takeda Satoru
Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Obstetrics and Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology, and Minimally Invasive Therapy, Vito Fazzi Hospital, Ospedale Vito Fazzi, 73100, Lecce, Italy.
J Ovarian Res. 2016 Jun 21;9(1):37. doi: 10.1186/s13048-016-0241-z.
Ovarian endometriomas affect a substantial proportion of women of reproductive age who may have a potential risk of diminished ovarian reserve (DOR) after ovarian cystectomy. Here, we investigated the risk factors for pre-surgical DOR in patients with ovarian endometriomas and for DOR after laparoscopic ovarian cystectomy for endometriomas and evaluated the feasibility of the pre-surgical prediction of post-surgical DOR based on the Bologna criteria.
A total of 143 patients with ovarian endometriomas who underwent laparoscopic cystectomy from January 2009 to May 2015 at our hospital were prospectively enrolled and evaluated. Serum anti-Müllerian hormone (AMH) concentrations were measured pre-surgically and at 3 and 6 months after surgery. In accordance with the Bologna criteria, the patients whose AMH concentrations were <1.1 ng/mL before surgery and 3 or 6 months after surgery were classified into pre- and post-surgical adverse DOR (aDOR) groups, respectively.
Thirty-one (21.7 %) of 143 patients were classified as pre-surgical aDOR. Patient age and serum follicle-stimulating hormone level were significantly positively correlated with pre-surgical aDOR [odds ratios (ORs), 1.26 and 1.16; p < 0.001 and p = 0.003, respectively]. Among the remaining 112 patients, 38 patients (33.9 %) had post-surgical aDOR 3 and 6 months after surgery. Bilateral cystectomy was positively correlated with post-surgical aDOR (at 3 months: OR, 4.7; p = 0.001; at 6 months: OR, 3.71; p = 0.006); conversely, pre-surgical serum AMH concentrations were negatively correlated with post-surgical aDOR (at 3 months: OR, 0.65; p = 0.005; at 6 months: OR, 0.43; p < 0.001). The optimal cut-off point of pre-surgical AMH concentrations for predicting aDOR at 3 and 6 months in the patients undergoing unilateral cystectomy was 2.1 ng/mL. In contrast, the optimal cut-off points at 3 and 6 months in the patients undergoing bilateral cystectomy were 3.0 and 3.5 ng/mL, respectively.
Our data suggest that the pre-surgical serum AMH concentrations and bilateral cystectomy are significant factors for the risk of aDOR following surgery and that predicting post-surgical aDOR according to the Bologna criteria could be feasible using pre-operative measurements of serum AMH concentrations.
卵巢子宫内膜异位囊肿影响着相当一部分育龄女性，这些女性在卵巢囊肿切除术后可能存在卵巢储备功能下降（DOR）的潜在风险。在此，我们研究了卵巢子宫内膜异位囊肿患者术前DOR的危险因素以及子宫内膜异位囊肿腹腔镜卵巢囊肿切除术后DOR的危险因素，并评估了基于博洛尼亚标准术前预测术后DOR的可行性。
前瞻性纳入并评估了2009年1月至2015年5月在我院接受腹腔镜囊肿切除术的143例卵巢子宫内膜异位囊肿患者。术前及术后3个月和6个月测量血清抗苗勒管激素（AMH）浓度。根据博洛尼亚标准，术前及术后3个月或6个月AMH浓度<1.1 ng/mL的患者分别被归入术前和术后不良DOR（aDOR）组。
143例患者中有31例（21.7%）被归类为术前aDOR。患者年龄和血清促卵泡生成素水平与术前aDOR显著正相关[优势比（OR）分别为1.26和1.16；p<0.001和p=0.003]。在其余112例患者中，38例（33.9%）在术后3个月和6个月出现术后aDOR。双侧囊肿切除术与术后aDOR正相关（3个月时：OR，4.7；p=0.001；6个月时：OR，3.71；p=0.006）；相反，术前血清AMH浓度与术后aDOR负相关（3个月时：OR，0.65；p=0.005；6个月时：OR，0.43；p<0.001）。单侧囊肿切除患者术前AMH浓度预测3个月和6个月aDOR的最佳截断点为2.1 ng/mL。相比之下，双侧囊肿切除患者3个月和6个月时的最佳截断点分别为3.0和3.5 ng/mL。
我们的数据表明，术前血清AMH浓度和双侧囊肿切除术是术后发生aDOR风险的重要因素，并且根据博洛尼亚标准通过术前测量血清AMH浓度预测术后aDOR可能是可行的。
