Review Article
Endometrioma Excision and Ovarian Reserve: A Dangerous Relation

https://doi.org/10.1016/j.jmig.2008.12.013Get rights and content

Abstract

Endometrioma is one of the most frequent pathologies in gynecologic surgery. Laparoscopic cyst excision is considered the best treatment in terms of lower recurrence and improved fertility. However, it was recently questioned whether the excision of the endometrioma could decrease the function of the operated ovary and if it could affect the subsequent fertility. Even if a consistent amount of ovarian tissue is unintentionally removed together with the capsule of the cyst, resulting in does not show the follicular pattern observed in working ovaries. Currently, no definitive data clarify whether the damage to the ovarian reserve, observed in patient with endometrioma, is related to the surgical procedure, to the previous presence of the cyst, or both. Electrosurgial coagulation during hemostasis could play an important role in terms of damage to ovarian stroma and vascularization. Particular attention must be paid in presence of bilateral endometriotic cysts. In fact, an increase in premature ovarian failure rate was reported when both the ovaries are involved in surgery. Incase of assisted reproductive techniques, no clear evidence indicates which is the best approach for concomitant endometriotic cyst. On the base of these considerations endometriomas Should be treated only in case of pain, infertility, and in asymptomatic patients if the cyst diameter is greater than 4 cm.

Section snippets

Final Remarks

Endometriotic cyst is one of the most frequent pathologies in gynecologic surgery. At the moment there is good evidence that, when necessary, it must be treated by laparoscopy and the capsule of the cyst excised. The results in terms of recurrence and fertility are improved in comparison with other procedures, particularly with the drainage and coagulation technique. However, it was recently questioned whether the excision of the endometrioma could decrease the function of the operated ovary

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    The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.

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