Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Surgical Management of Ovarian Endometrioma: Impact on Ovarian Reserve Parameters and Reproductive Outcomes

Angelos Danilidis
ORCID logo ,
Georgios Grigoriadis
ORCID logo ,
Dimitrios Rafail Kalaitzopoulos
,
Stefano Angioni
ORCID logo ,
Üzeyir Kalkan
,
Adrien Crestani
ORCID logo ,
Benjamin Merlot
,
Horace Roman
* ORCID logo
Version 1 : Received: 24 July 2023 / Approved: 24 July 2023 / Online: 25 July 2023 (10:19:04 CEST)

A peer-reviewed article of this Preprint also exists.

Daniilidis, A.; Grigoriadis, G.; Kalaitzopoulos, D.R.; Angioni, S.; Kalkan, Ü.; Crestani, A.; Merlot, B.; Roman, H. Surgical Management of Ovarian Endometrioma: Impact on Ovarian Reserve Parameters and Reproductive Outcomes. J. Clin. Med. 2023, 12, 5324. Daniilidis, A.; Grigoriadis, G.; Kalaitzopoulos, D.R.; Angioni, S.; Kalkan, Ü.; Crestani, A.; Merlot, B.; Roman, H. Surgical Management of Ovarian Endometrioma: Impact on Ovarian Reserve Parameters and Reproductive Outcomes. J. Clin. Med. 2023, 12, 5324.

Abstract

Ovarian endometriomas have a negative impact on a patient’s reproductive potential and likely cause a reduction in ovarian reserve. The most commonly employed ovarian reserve parameters are anti-mullerian hormone (AMH) and antral follicular count (AFC). Surgical management options of endometrioma include cystectomy, ablative methods, ethanol sclerotherapy and combined techniques. The optimal surgical approach remains a matter of debate. Our review aimed to summarize the literature on the impact of surgical management of endometrioma on AMH, AFC and fertility outcomes. Cystectomy may reduce recurrence rates and increase chances of spontaneous conception. However, a post-operative reduction in AMH is to be anticipated, albeit there is evidence of recovery during follow-up. The reduction in ovarian reserve is likely multi-factorial. Cystectomy does not appear to significantly reduce, and may even increase, AFC. Ablative methods achieve an ovarian tissue-sparing effect and improved ovarian reserve, compared to cystectomy, has been demonstrated. A single study reported on AMH and AFC post- sclerotherapy and both were significantly reduced. AMH levels may be useful in predicting the chances of conception post-operatively. None of the aforementioned approaches has clearly demonstrated a superiority in terms of overall chances of conception. Surgical management of endometrioma may, overall, improve probability of pregnancy. Evidence on its value before medically-assisted reproduction (MAR) is conflicting, however, a combination of surgery followed by MAR may achieve the optimal fertility outcome. In view of the complexity of available evidence, individualisation of care, combined with optimal surgical technique, is highly recommended.

Keywords

endometrioma; endometriosis; cystectomy; laser; sclerotherapy; fertility; pregnancy

Subject

Medicine and Pharmacology, Obstetrics and Gynaecology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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