The effect of laparoscopic ovarian cystectomy versus coagulation in bilateral endometriomas on ovarian reserve as determined by antral follicle count and ovarian volume: a prospective randomized study

Objective: To evaluate the effect of two different laparoscopic methods on ovarian reserve as determined by antral follicle count (AFC) and ovarian volume in patients with bilateral endometriomas. Design: Randomized prospective study. Setting: Tertiary education and research hospital. Patient(s): Forty-eight patients with bilateral endometriomas. Intervention(s): AFC and ovarian volumes determined before and after surgery; coagulation and cystectomy performed on one randomly selected side of each patient for their endometriomas; in vitro fertilization and embryo transfer. Main Outcome Measure(s): Ovarian reserve damage as determined by AFC and ovarian volume, and number of dominant follicles and retrieved oocytes after controlled ovarian hyperstimulation. Result(s): In vitro fertilization and embryo transfer were performed for 37 of 48 patients. The number of dominant follicles and the retrieved oocytes were assessed after controlled ovarian hyperstimulation. The postprocedural AFC was 3.67 perpendicular to 1.26 and 4.75 perpendicular to 0.60 after cystectomy and coagulation, respectively. A statistically significantly greater decrease in AFC was found after cystectomy as compared with coagulation. Postprocedural ovarian volumes were 6.27 +/- 1.95 and 9.87 +/- 2.01 after cystectomy and coagulation, respectively. A decrease in ovarian volume was found after cystectomy when compared with coagulation. Conclusion(s): The decreases in AFC and ovarian volume were found for both coagulation and cystectomy, but the decrease was statistically significantly more frequent in cystectomized ovaries than in coagulated ovaries. Also, in the in vitro fertilization cycles, the ovarian response to ovulation induction was statistically significantly reduced in cystectomized ovaries as compared with coagulated ovaries. (Fertil Steril (R) 2011;95:2247-50. (C)2011 by American Society for Reproductive Medicine.)