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Endometriosis · Surgical Treatment

The optimal time for laparoscopic excision of ovarian endometrioma: a prospective randomized controlled trial

Wu Q, Yang Q, Lin Y, Wu L, Lin T

Published June 27, 2023 Reproductive Biology and Endocrinology : RB&E, 21(1), 59
DOI 10.1186/s12958-023-01109-2 PMID 37370122 PMC PMC10294415

RRM Academy Synopsis

After late luteal phase endometrioma surgery, AMH declined less

Late luteal phase surgery was followed by a smaller anti-Müllerian hormone (AMH) decline than early follicular phase surgery. The randomized trial enrolled 88 women with a first unilateral ovarian endometrioma. At six months, AMH had fallen by nearly a third in the late luteal group and by nearly half in the early follicular group.

Study at a glance, randomized controlled trial: Late luteal surgery led to a smaller AMH decline than early follicular
Study at a glance, randomized controlled trial of 88 women: Late luteal surgery led to a smaller AMH decline than early follicular. Source: Wu Q et al., 2023, PMID 37370122.

Key Findings

  • Researchers randomized 88 women with a first unilateral ovarian endometrioma to laparoscopic cystectomy in the late luteal phase (n = 44) or the early follicular phase (n = 44).
  • AMH fell by about a quarter at one week and nearly a third at six months after late luteal surgery, versus over a third and nearly half after early follicular surgery (P<0.001).
  • Preoperative AMH did not differ significantly between groups, and at six months serum AMH was higher in the late luteal group than in the early follicular group (P = 0.018).
  • The late luteal group's endometrioma wall held less AMH and more leukocyte esterase, a marker of leukocytes, than the early follicular group's (both P<0.001), and the two correlated negatively (P<0.001).
  • Age, cyst size, endometriosis stage, blood loss volume and operation time did not differ significantly between the two groups.

Interpretation

The study is a randomized controlled trial of women aged 20 to 36 years with regular menses and a first unilateral endometrioma. All took an oral contraceptive pill for one cycle before surgery, and stopping the pill for two days set the late luteal timing. AMH indirectly reflects the early growing follicles, and its decline at one week and six months was the main outcome. The authors propose that looser tissue borders in the late luteal phase may let the cyst wall peel away with less loss of normal ovarian tissue. The authors note the single-center design, the restriction to first unilateral cysts, and the six-month follow-up.

RRM Context

RRM treats endometriosis with excision and works to protect ovarian function. The authors advise a contraceptive pill, a suppressive medication, once surgery is proposed. NaProTechnology uses the woman's charted cycle and adds cycle-timed hormone support after excision.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

This study aimed to explore the optimal time of laparoscopic cystectomy for unilateral ovarian endometrioma patients and evaluate the influence on ovarian reserve.

Materials and Methods

This prospective randomized controlled study included 88 women with unilateral ovarian endometrioma at a tertiary teaching hospital. All patients received their first identified diagnosis of ovarian endometrioma by ultrasound (> 4 cm and ≤ 10 cm) and were administered an oral contraceptive pill (OC) for one cycle before laparoscopy. They were randomly divided into two groups: laparoscopy at the late luteal phase (group LLP) (n = 44) (termination of OC for two days) and laparoscopy at the early follicular phase (group EFP) (n = 44) (day 3 after menstruation). Basic clinical characteristics were recorded. Serum Anti-Müllerian hormone (AMH) levels were measured at various times to predict ovarian reserve. Serum levels of Anti-Müllerian hormone (AMH) were measured at several time sites to predict the ovarian reserve; AMH and leukocyte esterase (LE) levels of the endometrioma wall were measured.

Results

Before surgery, serum AMH levels decreased in both groups from preoperative to one week and six months postoperatively. In contrast, the difference values of group EFP were larger than those of group LLP at postoperative one week and postoperative six months (1.87 ± 0.97 vs. 1.31 ± 0.93, P = 0.07; 1.91 ± 1.06 vs. 1.54 ± 0.93, P = 0.001). The mean rates of postoperative serum AMH decline were 37.92% and 46.34% in group EFP, significantly higher than those in group LLP (25.83% vs. 31.43%, P < 0.001). Ovarian endometrioma wall AMH of group LLP was significantly lower than that of group EFP ([22.86 ± 3.74] vs. [31.02 ± 5.23], P < 0.001). Meanwhile, ovarian endometrioma LE concentration of group LLP was significantly higher than that of group EFP ([482.83 ± 115.88] vs. [371.68 ± 84.49], P<0.001). There was also a significant inverse correlation between leukocyte esterase and AMH concentration in an ovarian endometrioma cyst wall (r=-0.564, P<0.001).

Conclusions

The optimal time for laparoscopic cystectomy for patients with first identified unilateral ovarian endometrioma is the late luteal phase, which reduces ovarian tissue loss and preserves ovarian reserve effectively and safely.

Topics

By this author

Related research

Endometriosis › Surgical Treatment › Excision Surgery · Reproductive Surgery › Ovarian Surgery › Ovarian Reserve Preservation · Reproductive Endocrinology › Ovarian Hormones › Progesterone
Qing Wu, Qingmei Yang, Yanling Lin, Lin Wu, Tan Lin
Q Wu, Q Yang, Y Lin, L Wu, T Lin
PMID 37370122 37370122 DOI 10.1186/s12958-023-01109-2 10.1186/s12958-023-01109-2 Wu et al. 2023, Wu 2023

Keywords

Anti-Mullerian Hormone

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