Assessing Ovarian Reserve in Women After Laparoscopic Surgery for Ovarian Endometriosis

Objective: A retrospective study to evaluate the ovarian reserve via antral follicle counts and basal hormone changes in infertile patients who had previously undergone laparoscopic surgery for ovarian endometriosis. Materials and Methods: Infertile women who had undergone laparoscopy for ovarian endometriosis were enrolled and divided into four groups according to the ovarian surgical procedure, determined by the degree of the invading lesion: bipolar cauterization of the superficial ovarian endometriosis (group A), cystectomy of the endometrioma with a diameter of less than 5 cm (group B) or a diameter of at least 5 cm (group C), or unilateral oophorectomy (group D). Follow-up statistics included basal serum hormone levels and ovarian antral follicle counts, which were determined about 12 months after surgery. Results: The study included 233 women. We found a significant difference in remaining antral follicle counts in groups A, B, C, and D: 11.1 ± 3.5, 9.4 ± 3.1, 7.5 ± 2.3, and 4.0 ± 2.0, respectively (p < 0.001). There was no difference in day 3 follicle-stimulating hormone (FSH) levels: 6.2 ± 2.0, 6.2 ± 2.8, 6.3 ± 2.2, and 7.8 ± 2.1 IU/L in groups A, B, C, and D, respectively. Significantly higher basal FSH levels were noted when comparing group D with groups A, B, and C (p < 0.05). Conclusion: Ovarian endometrioma cystectomy or oophorectomy damages the ovarian reserve. Damage to the vascular system and the cortex of the ovary during surgery might accelerate depletion of the follicular pool. The FSH level is compromised significantly until the follicular pool is depleted below a certain threshold. This might be because of various components controlling FSH modulation, mainly inhibin but possibly other steroids and peptides influenced by extraovarian mechanisms or the aging of neuroendocrine tissues.