Impact of laparoscopic cystectomy of endometriotic and non-endometriotic cysts on ovarian volume,antral follicle count (AFC) and ovarian doppler velocimetry

Objective: To evaluate the effect on ovarian reserve and blood flow of unilateral laparoscopic stripping of endometriotic versus non-endometriotic cysts.

Design: Prospective observational study.

Setting: Tertiary university gynecology unit.

Patients: During the study period, 71 subjects underwent the first laparoscopic surgery for removal of a monolateral benign ovarian cyst.

Interventions: Trans-vaginal ultrasound scans of the pelvis about six months after surgery.

Main outcome measures: Ovarian volume, Antral Follicle Count (AFC) and Resistance Index (RI) of ovarian artery of the operated and the contralateral ovary.

Results: Among 71 cysts, 39.4% were endometriotic and 60.6% non-endometriotic benign cysts. All the procedures were performed by the same experienced surgeons with a standardized technique. No major complications were reported during surgery. The mean (±SD) age and BMI of women were 31.0?±?6.8 years and 24.2?±?3.3?kg/m², respectively. Mean diameter of the removed cysts was smaller for endometriotic than non-endometriotic cysts (4.35?±?1.77?cm versus 6.33?±?3.71?cm, p?=?0.046). In comparison to non-operated, volume of the operated ovary was significantly lower and with a reduced AFC, with no difference between endometriotic and non-endometriotic cysts (?2.41?±?2.35 versus ?2.00?±?2.23?cm³, p?=?0.496) (?3.45?±?3.07 versus ?2.43?±?1.95, p?=?0.11). Ovarian artery RI was higher in the operated ovary with no difference between endometriotic and non-endometriotic cysts (0.19?±?0.14 versus 0.14?±?0.10, p?=?0.455). The difference in ovarian volume (r?=?0.178), AFC (r?=?0.094) and RI (r?=?0.079) between operated and non-operated ovary was not dependent on the diameter of the removed cyst.

Conclusion: Ovarian surgery is associated with a decline of ovarian reserve, independently on the histological type and the diameter of the removed cyst.