Ovarian Endometrioma Clinical Trial
Official title:
The Impact of Electrocoagulation on Ovarian Reserve After Laparoscopic Excision of Ovarian Cysts: Randomization Clinical Trial
The aim of the study is to evaluate the effect of bipolar electrocoagulation on ovarian reserve.
Laparoscopic ovarian cystectomy is currently considered the treatment of choice in women with
benign ovarian cysts and has gained increasing acceptance among gynecologic sur¬geons .
However, the safety of this technique in terms of ovarian damage to the operated gonad has
recently been questioned. A great deal of evidence supports that the re¬moval of ovarian
cysts is associated with injury to the ovarian reserve . Many of these studies involved
patients who required assisted reproduction, and they found that the number both of follicles
and retrieved oocytes obtained in the operated gonad during ovarian hyperstimulation was
markedly reduced when compared with the contralateral intact ovary. However, most of these
studies applied ovarian response to gonadotropin hyperstimulation to measure the ovarian
reserve. It has been argued that these patients are not representative of all patients
undergoing laparoscopic ovarian cystectomy in terms of ovarian damage because these data were
acquired from aggressive gonadotropin stimulation which is thought to be different from a
natural menstrual cycle .
On the other hand, because ovarian reserve cannot be mea¬sured directly, the evaluation of
ovarian reserve is difficult to carry out. The induction of ovarian hyperstimulation in an
un¬selected population of surgical patients for the purpose of evaluating ovarian reserve is
obviously ethically untenable. The serum level of follicle-stimulating hormone (FSH) is a
predictor of functional ovarian reserve , but its usefulness is limited considering that the
vast majority of patients un¬dergo monolateral excision of a cyst and the contralateral
in¬tact gonad may completely substitute for reduced function of the operated ovary . Given
the well-established role of ul¬trasound scanning in the diagnosis and follow-up of ovarian
cysts, reported that basal antral follicle number and mean ovarian diameter could be used as
indicators of ovarian reserve. found that the value of ovarian stromal blood flow velocity
was an initial marker of ovarian reserve before the change of FSH level and ovarian volume.
With the combined use of serum hormonal evaluation and ultrasound examination, the
investigators prospectively investigated the ovarian reserve of patients after the excision
of benign ovarian cysts. The damage to ovarian reserve was evaluated during through a
12-month follow-up period after the application of bipolar, ultrasonic scalpel
electrocoagulation or suture for ovarian cystectomy .
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