Influence of Laparoscopic Cystectomy on Ovarian Reserve Function and Pregnantic Outcome in Women with Ovarian Endometriotic Cyst

  Objective  To investigate the influence of laparoscopic ovarian cystectomy on ovarian reserve function and pregnantic outcome in women with ovarian endometriotic cyst.

  Methods  A total of 176 women with ovarian cyst undergoing laparoscopic cystectomy were divided into six groups:40 patients with uni-lateral teratoma(con1), 10 patients with bilateral teratoma(con2), 40 patients with unilateral ovarian endometriotic cyst less than 35y(A), 26 patients with unilateral ovarian endometriotic cyst no less than 35y(B), 41 patients with bilateral ovarian endometriotic cyst less than 35y(C), and 19 patients with bilateral ovarian endometriotic cyst no less than 35y(D).Blood samples were obtained from patients before operation, 24 hours after operation and on the second and third day of the menstrual cycle 6 months after operation.Mean ovarian diameter were evaluated by ultrasound 6 months after operation and pregnancy outcome was recorded in the following 18 months after the operation.

  Results  In the bilateral groups(C and D), the serum level of follicle stimulating hormone(FSH)increased significantly after the operation(P < 0.05), while estradiol decreased significantly(P < 0.05).No significant difference between pre-and post-operational hormone levels were observed in the unilateral groups(A and B)and control group Serum basal FSH recovered to normal 6 months after the operation in 77.8% of patients in group C and 53.3% in group D(P < 0.05).The reduction of mean ovarian diameter six months after operation was significantly different between the affected and contralateral ovaries(P < 0.05).During the follow-up, the pregnancy rate was 92.9% in controlled group, compared to 45.2% in the endometriosis group(P < 0.05)and 60%, 37.5%, 46.2%, and 16.7%, respectively, for group A, B, C, and D.

  Conclusion  The ovarian reserve function decreases after laparoscopic ovarian cystectomy in women with ovarian endometriotic cyst.However, most young patients recover after 6 months.Peri-operative ovarian function assessment and ovarian protection should be carefully designed and performed for women who intend to get pregnant.