1. The long-term effect of endometrioma surgery on ovarian reserve:
A prospective case-control study
Ilgın Türkçüoğlu
Rauf Melekoglu
Ayşe Gülçin Baştemur
Good afternoon my name is Rauf Melekoglu I have been working as assistant professor in Inonu University School of Medicine Department of Obstetrics and Gynecology. Today I want to present our study titled ‘The long-term effect of endometrioma on ovarian reserve: A prospective case-control study’.
Before starting my presentation I want to thank scientific committee to give us the oppurtunity to present our study in this Congress.
Inonu University, Turgut Ozal Medical Centre

2. Effect of endometrioma on ovarian reserve
Endometriosis is a chronic disease effecting the 2 to 10% of general population and 30 to 50% of infertile women and/or women with pelvic pain.
A rising trend has been found in the endometriosis and endometriosis associated infertility over years.
Endometrioma is present in 30 to 40% of cases with endometriosis.
The recommended treatment option is surgery due to the ineffectiveness of medical treatment in case of endometrioma.

3. Effect of endometrioma on ovarian reserve
The cumulative spontaneous pregnancy rate has been found around 50% after excision of the endometrioma.
Guidelines have recommended surgery in case of pelvic pain, to improve access to follicles during oocyte retrieval if the endometrioma is larger than 3 cm or 4 cm in diameter, to reduce risk of infection during oocyte retrieval and possibly improve ovarian response.
However patients should be councelled about the possible decrease in ovarian reserve after endometrioma excision.

4. Effect of endometrioma on ovarian reserve
The findings of studies evaluating the effect of endometrioma excision on the ovarian reserve are heterogeneous.
Although some found a decrease in the ovarian reserve evaluated by the AMH level short after the surgery, the others found no change in the ovarian reserve.
Moreover the long term consequence of endometrioma excision on ovarian reserve, is unknown

5. Effect of endometrioma on ovarian reserve
Objective
To evaluate the long term effect of endometrioma excision on the ovarian reserve.
21 endometrioma surgery
Material and Methods
All the participants were called on the D3 and evaluated by TVUSG. Blood samples were obtained on the same day .
Patients who underwent laparoscopic excisional ovarian endometrioma surgery with the diagnosis of unilateral or bilateral endometrioma between the years
21 age-matched cases with unilateral or bilateral endometrioma .
21 age-matched fertile women with no pathological findings

6. Effect of endometrioma on ovarian reserve
Inclusion criteria
Women aged between 18 to 39 years;
Having no other ovarian surgery accept one course of endometrioma surgery for the ES group;
The presence of a standard operation technique applied by one surgeon for the ES group;
Presence of at least 12 months of duration after surgery, for the ES group.
Exclusion criteria
Presence of previous ovarian surgery (other than one course of endometrioma surgery for the ES group);
A history of early menopause or premature ovarian failure;
A history of autoimmune or genetic disease;
Using oral contraceptive pills or hormone preparations within three months before enrollment;
Patients who met the following criteria were enrolled. A history of chemotherapy treatment toxic to the ovaries, a history of pelvic radiotherapy, the diagnosis of chronic pelvic pain for the control group, the diagnosis of infertility for the control group, presence of polycystic ovary syndrome, patients with unexplained infertility diagnosed.

7. Effect of endometrioma on ovarian reserve
Operation Technique
All endometrioma operations were performed by the one operator experienced in endometrioma surgery (I.T.).
The cystectomy procedure stripping technique including a sharp dissection of the ovarian-surface to reveal the cleavage plane of the cyst pseudocapsule and removal of the pseudocapsule by blunt dissection and traction from the ovary, with two atraumatic grasper.
Hemostasis was achieved with bipolar cautery, and cauterization was avoided as much as possible to reduce ovarian damage.
In the cases, the ovarian cortex was left open without suturization.
Excised cysts were undergone histopathologic examination, and the diagnosis was confirmed by pathology.
. Other endometriotic foci that were seen in the abdominal cavity were cauterized, and adhesiolysis was applied in the presence of adhesions.

8. Effect of endometrioma on ovarian reserve
The mean duration after endometrioma surgery was 30.4 ± 18.0 month, for the ES group. The mean age of control, surgery, and endometrioma groups were similar. The rate of bilateral endometrioma and the mean endometrioma size at the initial diagnosis were similar in the surgery and endometrioma groups.

9. Effect of endometrioma on ovarian reserve
In respect to ovarian reserve tests, total antral follicle count on both ovaries was similar in the groups. However, the average ovarian volume was significantly lower in the ES group compared to C group. The mean menstrual cycle day 3 FSH, LH, and E2 levels were similar in the groups. Nevertheless mean AMH level was significantly lower in the surgery group compared to control group (p<0.001), and also it was lower in surgery group compared to endometrioma group. However, the difference was not statistically significant (p=0.080).

10. Effect of endometrioma on ovarian reserve
Independent Predictors of Low AMH In Endometrioma Cases P
Age
Surgery
Bilaterality
Endometrioma
size
Smoking
The effect of Age and Surgery on the AMH level
R square B P
Age
Surgery
Age and Surgery <0.001
Linear regression analysis model revealed the increasing age and presence of endometrioma surgery significantly decreased the AMH level. Nevertheless presence of bilateral or unilateral endometrioma, endometrioma size and smoking did not have significant effect on AMH level.
The surgery was a better predictor than age for the AMH level, however age and surgery together predicted the AMH level more. A one-year increase in age resulted in a unit decrease in the AMH level. Presence of endometrioma surgery decreased the AMH level by unit

11. Conclusion Effect of endometrioma on ovarian reserve Thank you
The results of this study demonstrated the deleterious effect of excisional endometrioma surgery on ovarian reserve in the long-term period.
Besides, this study showed that increasing age and presence of endometrioma surgery are significantly associated with diminished ovarian reserve.
Therefore, the decision of surgery should be done carefully especially in elderly patients with ovarian endometrioma by considering these long-term detrimental effects.
Thank u for your attention
Thank you