Reproductive Aspects of the Problem of Conservative Surgical Treatment of Endometrioid Ovarian Cysts

Abstract

The aim is to clarify the timing of recurrence of endometriomas removed and the dependence of the ovarian reserve status on the number of ovarian resections performed, as well as to assess the awareness of patients about the impact of surgical treatment of endometrioid ovarian cysts (EOC) on reproductive function and therapeutic effectiveness of in vitro fertilization (IVF) technology. Material and methods. In 93 infertile patients with EOC and values of anti-muller hormone (AMH) < 1.2 ng/ml, the dependence of the degree of reduction of this hormone on the number of operations performed with relapses of endometrioma was analyzed. Using standard research methods in the same patients, the prevalence of infertility factors identified in the International Classification of Diseases of the 10th revision was studied in parallel, and women's awareness of the impact of surgical treatment of EOC on reproductive potential was clarified. Results. Other forms of endometriosis were found in 71% of women with EOC, and the observed infertility, which necessitated the appointment of IVF, was mainly associated with confirmed male and tubal factors. Among the patients operated on for EOC with a reduced level of AMH, the majority underwent repeated ovarian resections due to relapses of endometriomas that occurred within two and a half years after their removal. The degree of decrease in the level of AMH was directly dependent on the number of operations performed. During surgical treatment of EOC, only 7.5% of patients received relevant information about their frequent recurrence and possible consequences for the reproductive function of ovarian resection performed (especially multiple). Conclusions. Frequent recurrence of EOC, which forces repeated resections of the ovaries, is an obvious factor that, due to the reduction of the ovarian reserve, prevents the successful use of IVF technology with its own oocytes in situations where this method of infertility treatment is in demand. When planning the removal of EOC in women of reproductive age, surgeons should necessarily refer patients to reproductologists for advice on issues related to the implementation of reproductive plans both in the near and long term