The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study

Objective: To investigate the effect of two different laparoscopic methods on ovarian reserve in patients with ovarian endometriomas. Design: Prospective, randomized clinical trial. Setting: Endoscopy unit of a university hospital. Patient(s): Twenty women with endometriomas. Intervention(s): Patients were randomly selected to undergo either laparoscopic cystectomy for endometrioma (group 1) or the "three-step procedure" (group 2). Before and 6 months after laparoscopy all patients were evaluated, and 12 months postoperatively they underwent ultrasound scan examination. Main Outcome Measure(s): The primary end point was ovarian reserve damage based on the alterations of anti-Mullerian hormone (AMH). Secondary end points were the changes of antral follicle count and serum concentration of FSH, LH, E-2, and inhibin B. Result(s): Mean serum AMH was reduced significantly from 3.9-2.9 ng/mL in group 1 compared with the reduction from 4.5-3.99 ng/mL in group 2. Conclusion(s): Ovarian reserve determined by AMH is less diminished after the three-step procedure compared with cystectomy of endometriomas. (Fertil Steril (R) 2010;94:71-7. (C) 2010 by American Society for Reproductive Medicine.)