| Background and ObjectiveBenign ovarian cysts are the common gynecological diseases and frequently seen during reproductive age.There are various histological types of benign ovarian cysts.The common clinical histological types include endometrioma,serous or mucinous cystadenoma,mature teratoma,which the etiology and development of is still not exactly known.Benign ovarian cysts are related to acute and chronic abdominal pain,pelvic adhesion and infertility.Endometrioma is defined as the presence of endometrial gland and stroma that grow and bleed repeatly in the ovarian cortex.Endometrioma is the common clinical type of endometriosis.Endometriosis is closely associated with infertility.25% 35% infertility patients are diagnosed with endometriosis.In recent years,the incidence of endometriosis has been increasing reported in the literature.The incidence of endometriosis in patients with infertility is as high as 35.5%.Endometriosis has also been reported to decline the ovarian reserve by a variety of mechanisms,thereby affecting pregnancy and reducing the quality of life of patients.Ovarian reserve reflects the quantity and quality of the ovarian follicles with normal functional potential.A variety of factors can lead to the reduction of the number or the quality of follicles,resulting in decreased ovarian reserve,and even premature ovarian failure.There are many indicators to predict and evaluate of ovarian reserve,at present the common clinical indicators are age,basal sex hormone?follicle-stimulating hormone FSH,luteinizing hormone LH,estradiol E2?,anti-Mullerian hormone?AMH?and ultrasound basal antral follicle count?AFC?.However,there is no absolute sensitivity and specificity for any index,and more comprehensive evaluation of ovarian reserve function can be achieved by considering multiple indexes.Laparoscopic excision of endometrioma is regarded as a first-line treatment,which can diagnose ovarian cysts definitely and recovery the size or location of ovary.However,the removal of endometrioma is often reported to inevitably damage the normal tissue of ovary,resulting in reduced ovarian reserve or premature ovatian failure.In order to improve the pregnancy rate of patients,and avoid the damage of ovarian reserve,clinicians have explored a variety of methods for the treatment of ovarian endometrioma.However,the effect of excision of the benign ovarian cysts on ovarian reserve is controversial.Some scholars believe that ovarian reserve decreases immediately after cystectomy of the benign ovarian cyst,but the basic hormone levels 3 months after cystectomy can be recovered to 65% of the preoperative levels.According to some research,the effect of laparoscopic ovarian cystectomy on ovarian reserve is different because of the different histological types of benign ovarian cysts.On the other hand,the preoperative impact of the presence of benign ovarian cyst on ovarian reserve has received less attention.It is helpful for applying appropriate operative techniques in order to preserve ovarian tissue and ovarian reserve to predict the ovarian reserve of different histological types of ovarian cyst before surgery.At present,numbers of researches show the endometrioma may per se damage the ovarian reserve.Unfortunately few scholars have paid attention to the relationship between non-endometrioma ovarian cysts and ovarian reserve.The purpose of this study is to investigate the impact of ovarian endometriomas and other histological patterns of benign ovarian cysts on ovarian reserve prior to surgery,which helps the clinician choose appropriate and individualized treatment combined with the reproductive requirements of patients.Materials and methods1.Source of materials We collected 79 patients with benign ovarian cysts diagnosed during laparoscopy and confirmed histopathologically and 40 healthy controls with infertility because of male factors or fallopian tube factor in the Second Affiliated Hospital of Zhengzhou University from April 2015 to October 2016.Based on histological patterns,those women were divided into 3 groups,including 43 cases with ovarian endometriomas,36 cases with other benign ovarian cysts?non-endometriomas?and 40 healthy controls.The 36 patients with other benign cysts were as follows: 11 patients with mature cystic teratoma,10 patients with serous cystadenoma,8 patients with mucinous cystadenoma,3 patients with simple cyst and 4 patients with more than two kinds of mixed type cyst.2.Method Analysed and recorded the general characteristics of 119 patients,including age,body mass index?BMI?,age of menarche,numbers of gestation and delivery,days of the menstrual cycle,laterality of cysts,diameter of cysts,preoperative levels of serum based FSH,LH,E2 and AFC in the 2-3 days of menstrual cycle.Compared the levels of serum based FSH,E2,FSH/LH,AFC and explored the related factors effecting the ovarian reserve.Age is an important factor affecting the ovarian reserve.Therefore divided by age group,there are three groups:25-29 years,30-34 years,35-40 years.3.Statistical methods Statistical analyses were performed using the computer software SPSS statistics version 21.0,and the quantitative datas are expressed as the meanąstandard deviation or medianąstandard deviation.The t test and one-way analysis of variance were used to compare the quantitative datas with normal distribution.The quantitative and qualitative datas of multiple groups were analyzed by Kruskal-Wallis H test,and Wilcoxon test were used to compare the quantitative datum without normal distribution and the qualitative datum.The count datum were compared by chi-square.Attribution analysis of the factors influencing ovarian reserve were performed by Pearson correlation or Spearman rank correlation.A p value of <0.05 was considered statistically significant.Results1.The comparison of general datum among the three groupsThe difference of age,BMI,age of menarche,parity,days of the menstrual cycle of patients among the three groups were not statistically significant?p>0.05?.There were no significant differences when the laterality and diameter of cysts were,compared?p>0.05?.2.Differences in serum based sex hormone levels and AFC among the three groupsCompared with the non-endometriomas group and the control group,Patients with ovarian endometriomas showed the higher average of FSH,FSH/LH and the lower average of AFC,the difference was statistically significant?p<0.05?,there were no significant differences in the level of E2?p>0.05?.Between the non-endometriomas group and the control group,the non-endometriomas group showed the lower AFC,FSH/LH and higher average of FSH,E2,the differences were not statistically significant?p>0.05?.3.The relationship between age and serum based sex hormone levels and AFC among the three groupsThere was a positive correlation between age and FSH?r=0.44 vs 0.34 vs 0.28?and an age-related decrease in AFC was also confirmed?r=-0.60 vs-0.53 vs-0.64?in the three groups,and the difference was statistically significant?p <0.05?.While there was no correlation between age and E2,FSH/LH in the three groups?p>0.05?.Compared with the non-endometriomas group and the control group,Patients in ovarian endometriomas group aged 25-34 years showed the higher average of FSH,E2,FSH/LH and the lower average of AFC,the difference was not statistically significant?p>0.05?.However,the levels of FSH,FSH/LH were higher and the average of AFC was lower in the endometriomas group aged 35-40 years compared withthe non-endometriomas group and the control group,the differences were statistically significant?p<0.05?.Compared with the control group,the differences of FSH,E2,FSH/LH,AFC were not statistically significant in the non-endometriomas group aged 25-40 years?p>0.05?.4.The relationship between cyst size and serum based sex hormone levels and AFC in patients with ovarian cystsAccording to the diameter of ovarian cyst,the endometriomas group and the non-endometriomas group were divided into?7cm subgroup?group A?,>7cm subgroup?group B?.Compared with group B in the endometriomas group,the FSH,E2,FSH/LH of group A were lower,the AFC of group A was higher,and the differences were not statistically significant?p>0.05?.There was no significant difference in the levels of FSH,E2,FSH/LH and AFC between group A and group B in the non-endometriomas group?p>0.05?.5.The relationship between laterality of cyst and serum based sex hormone levels and AFC in patients with ovarian cystsThe levels of FSH was higher and AFC was lower in bilateral endometrioma group than those in unilateral endometrioma group?p<0.05?,but the difference was not statistically significant in the level of E2 and FSH/LH?p>0.05?.Compared with the unilateral non-endometrioma group,the levels of FSH and FSH/LH were higher,E2 and AFC were lower,and there was no significant difference?p>0.05?.Conclusions1.Endometriotic ovarian cysts per se can damage the ovarian reserve,especially in the 35-40 year old patients,while non-endometriotic ovarian cysts are failed to be detected the effect on the ovarian reserve;2.The effect of endometrioma on the ovarian reserve is not related to the diameter of the ovarian cyst.Bilateral cysts have more impact on the reduced ovarian reserve than unilateral cysts in endometriotic ovarian cysts. |
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