Ovarian Reserve Following Laparoscopic Ovarian Cystectomy vs Cyst Deroofing for Endometriomas

Study Objective: Because laparoscopic ovarian cystectomy of endometriomas is known to adversely impact patient ovarian reserve, the search for other techniques of surgical management is ongoing. The present study was undertaken to evaluate laparoscopic cyst deroofing as a feasible alternative. Study Design: Prospective, randomized clinical trial (Canadian Task Force classification I). Setting: University maternity hospital. Patients: Women diagnosed with unilateral or bilateral ovarian endometriomas. Interventions: Patients were managed with either laparoscopic ovarian cystectomy or cyst deroofing. Measurements and Main Results: A total of 122 women with endometriomas were randomized to either laparoscopic cystectomy (group 1) or laparoscopic cyst deroofing (group 2). The primary endpoint was the effect on ovarian reserve based on changes in anti-Mullerian hormone (AMH) values. At 1 month postsurgery, anti-Mullerian hormone values were significantly decreased (p < .001) from preoperative values, from 4.25 +/- 0.87 ng/mL to 1.66 +/- 1.02 ng/mL in group 1 and from 4.2 +/- 1.69 ng/mL to 2.15 +/- 1.48 ng/mL in group 2. In addition, antral follicle count and ovarian volume decreased significantly (p < .001) in both groups by 1 month postsurgery. The decreases in these 3 parameters were more significant (p < .001) in group 1 than in group 2. Conclusion: Laparoscopic cyst deroofing of endometriomas appears to be a promising alternative to laparoscopic cystectomy, with less postoperative decrease in ovarian reserve; however, the higher rate of endometrioma recurrence warrants future clinical research to determine the optimal surgical management of endometriomas. (C) 2018 AAGL. All rights reserved.