Change in ovarian reserve after treatment of endometrioma
- VernacularTitle:Өндгөвчийн эндометриомын эмчилгээний үр дүнд нөөцөнд гарсан өөрчлөлт
- Author:
Munkhbayar Ch
1
;
Amarjargal O
1
;
Munkhbayarlakh S
2
;
Yanjinsuren D
2
Author Information
1. National Center for Maternal and Child Health
2. Mongolian National University of Medical Sciences
- Publication Type:Journal Article
- Keywords:
endometrioma;
ovarian reserve;
treatment
- From:Mongolian Medical Sciences
2020;191(1):26-31
- CountryMongolia
- Language:Mongolian
-
Abstract:
Background:Endometriosis is a condition in which cells in the endometrium, layer of tissue normally covers uterine
cavity, which grows outside to ovaries and other pelvic organs [1-4]. That may happen chronic pelvic
pain, adhesion and pelvic organs dysfunction which leads to infertility later life [1-4]. In worldwide,
19-45 aged women have endometriosis, which is counted for 176 million, from 44% women have
ovarian endometrioma [5]. In our country, 56% women received laparoscopic surgery due to ovarian
cysts, which is diagnosed endometrioma. In recent years, ovarian endometriosis treated by synthetic
progestin, gonadotropin analogues, combined contraceptive pills, intra-uterine device containing with
progestin, and non-steroid anti-inflammatory drugs and laparoscopic surgeries [6, 7]. Serum antimullerian hormone (AMH) is key marker to define ovarian reserve, which correlates ovarian number of antral follicle counts [6, 7].
Material and Methods:We studied 129 patients who has diagnosed with ovarian endometrioma, aged 20-46 years, using
case-control study design. There are 4 groups with medication and surgeries.
Approval for the study was obtained from the review board and the ethics committee of MNUMS. All
the recruited patients provided their informed written consents.
Results:When treatment groups were compared, level of AMH before synthetic progestin therapy was 3.48±0.9
and after it 3.41±1.0 (p-0.456), and that was before non-steroid anti-inflammatory drugs 3.68±0.8 and
after it 3.11±0.8 ng/ml (p-0.212). Before laparoscopic surgeries for severe endometrioma, average
level of AMH was 2.3±1.8ng/ml for synthetic progestin therapy group and it was 1.68±0.2ng/ml (p-0.007) after surgical peeling of endometrioma. For patients of 4th group who had not taking oral
synthetic progestin before laparoscopic surgeries average level of AMH was 3.11±1.88 ng/ml before
surgery and it became 2.21±0.28 ng/ml (p-0.005). Level of СА-125 marker was before medical
therapy for group 1 was 37,9±5,25 IU/ml and after therapy - 20,6±2,03 IU/ml. For group 2 it was
69,9±9,79IU/ml and 35.1±6.76 IU/ml respectively. Average level for group 4 before surgical treatment
it was 96.6±36.6 IU/ml, and after surgery became 25.71±2.96 IU/ml, and that for group 3 was before
surgery 102±29.1 IU/ml and decreased after surgery to 29.2±4.15 IU/ml.
There are significant reduction of pain in patients who received synthetic progestin (p=0.001) groups.
Serum AMH were 3.48±0.9 before treatment and 3.41±1.0 after treatment respectively (p=0.456).
Prior treatment of laparoscopic surgery with progestin 3 months, it decreases abdominal lower
pain (p=0.001) and dysmenorrhea (p=0.001). Serum AMH level were 3.11±1.8 before surgery and
2.21±0.2 after surgery,respectively, (p=0.005).
Conclusion:
1. There were little decrease in level of antimullerian hormone and less risk for ovarian reserve when
mild endometrioma was treated with synthetic progestin and non-steroid anti-inflammatory drugs in
two groups.
When severe and middle degree of endometrioma was treated with laparoscopic surgery there were
significant decrease of antimullerian hormone, but it was less in group that had synthetic progestin
therapy before surgery and it was more effective that surgical therapy without preparation.
2. Comparison of Serum level of СА-125, marker of ovarian tumor, was decreased less in group of
non-steroid anti-inflammatory drugs, and was decreased more or it was more effective.
- Full text:2020-191(1)-26-31.pdf
