Objective: To evaluate the effect of laparoscopic treatment of large ovarian endometrioma >3cm by two modalities ; namely, cystectomy and a combination of partial cystectomy with ultrasound power, ablation on the ovarian reserve and recurrence.
Method: A prospective randomized clinical study at Obstetrics and Gynecology Department at Tanta University Hospital, Egypt, included 40 women less than 35 years with large ovarian endometrioma >3 cm complaining of infertility and/or pelvic pain with no previous history of medical or surgical treatment of endometriosis. These patients were randomized for either laparoscopic complete cystectomy (Cystectomy group; 20 patients) or partial cystectomy combined with ultrasound power ablation (Combined group, 20 patients). Main outcome measures included the changes in levels of AMH. Basal serum levels of FSH and LH, and AFC before laparoscopy and six months later. Recurrence and spontaneous pregnancy rates were recorded.
Results: Mean serum AMH was significantly decreased in cystectomy group from 3.1±0.28 to 1.8±0.5 ng/ml compared with the nonsignificant decrease in combined group from 3.9±0.27 to 3.1±0.4 ng/inl. Also, AFC was significantly decreased in cystectomy group from 4.1±0.4 to 2.7±l.l compared with the nonsignificant change in combined group from 3.8± 0.6 to 4.l±l.9. Basal serum levels of FSH and LH did not change in the two groups. Spontaneous pregnancy and recurrence were comparable in both groups.
Conclusion: Combination of partial cystectomy with ultrasound powered ablation yielded better results than complete cystectomy with regard to the ovarian reserve.