Surgery for Cysts in Ovaries Can Cause Fertility Problems, Study Reports

Surgery for Cysts in Ovaries Can Cause Fertility Problems, Study Reports

Surgery to remove cysts in the ovaries, a condition called endometriomas — and a possible complication for people with endometriosis — can also cause fertility problems in women, researchers reported.

The study, “Involvement of mesosalpinx in endometrioma is a possible risk factor for a decrease of ovarian reserve after cystectomy: a retrospective cohort study,” was published in Reproductive Biology and Endocrinology.

Endometriosis is characterized by the presence of the uterine tissue outside of the uterus, and is considered the most cause of infertility in reproductive-age women.

Endometriomas, cysts caused by endometrial tissue growing specifically in the ovaries, can be treated using various approaches. But a surgical procedure called laparoscopic cystectomy is considered the gold standard.

A growing body of evidence suggests that laparoscopic cystectomy lead to a loss in the number and quality of ovarian folliculles — also known as a reduction in the ovarian reserve, which is important to menstrual cycles — as a result of damage during the procedure. The decrease in ovarian reserve can be quantified by measuring levels of a serum called anti-Müllerian hormone (AMH), due to its independent relationship to menstrual cycle phases. (Low AMH levels reflect poor ovarian response and likely fertility problems.)

The researchers evaluated modifications in AMH serum levels before and after laparoscopic cystectomy, as determined by cyst involvement in an abdominal cavity lining called the mesosalpinx (which supports the blood supply to the ovaries), and these levels’ link to ovarian reserve.

A total of 53 patients who underwent laparoscopic cystectomy to treat endometriomas were included in this retrospective cohort study. Patients were divided into two groups: those with “involved mesosalpinx” (14),  where the mesosalpinx was affected by the endometrioma, and those with “intact mesosalpinx” (39), or people in whom it was not.

AMH serum levels were measured in patient blood samples at several points in the study: two weeks before surgery, and again one month and one year after surgery.

Results revealed differences in AMH serum levels between the two groups. At two weeks before surgery, patients with “involved mesosalpinx” had higher levels of AMH compared to the other group (1.92 vs. 0.98 ng/mL, respectively). But at one month after surgery, AMH levels had dropped to 0.59 ng/mL in these women and continued to decline, falling to  0.48 ng/mL one year later in the “involved mesosalpinx” group. In contrast, women with “intact mesosalpinx” tended to recover (1.99 and 2.37 ng/mL at one month and one year post-surgery, respectively).

“We demonstrated that the involvement of mesosalpinx in endometrioma is a possible risk factor for decrease of ovarian reserve after cystectomy. The mesosalpinx disturbance, in tandem with adhesiolysis, may have a negative impact on the ovarian blood supply. Our results suggest that an adequate ovarian blood supply is required for the restoration of the follicle cohort followed by recovery of serum AMH levels,” the researchers concluded.