Algorithm of differentiated treatment of patients with ovarian endometrioma and infertility
DOI:
https://doi.org/10.15574/HW.2024.170.71Keywords:
endometrioma, anti-mullerian hormone, antral follicle count, ovarian reserve, laparoscopy, sclerotherapy, platelet-rich plasmaAbstract
Purpose - to improve fertility in women with ovarian endometrioma (ОЕ) and infertility using the proposed algorithm and treatment methods.
Materials and methods. The prospective study was conducted in 2 stages. In the first stage, 93 women with infertility were included in the study, who were divided into the following groups depending on the surgery performed: the Group 1 - with ОЕ sclerotherapy followed by platelet-rich plasma (PRP) injection into the ovarian tissue; the Group 2 - laparoscopic cystectomy followed by PRP injection into the ovarian tissue; the Control (C) group - with classical laparoscopic cystectomy.
After dynamic observation, assessment of ovarian reserve and control of pregnancy for 12 months, an algorithm for differentiated treatment of ОЕ in women with infertility was developed. At the 2nd stage, 20 women (the Group 3) were treated with the proposed methods of treatment, such as sclerotherapy with ОЕ + PRP (the Subgroup 3a) and laparoscopic excision of the ОЕ + PRP capsule (the Subgroup 3b), based on the algorithm, and analyzed. Statistical processing of the results was performed using Microsoft Excel.
Results. The mean level of anti-mullerian hormone (AMH) in the Subgroup 3a increased from 1.76 (CI: 1.47-1.71) ng/ml to 1.87 (CI: 1.63-1.86) ng/ml (p=0.036). In the Subgroup 3b, AMH changed from 2.15 (CI: 1.89-2.48) ng/ml to 2.22 (CI: 1.91-2.53) ng/ml (p>0.05). The number of antral follicles (AF) in the Subgroup 3a increased from 8.88 (CI: 7.90-9.90) to 11.10 (CI: 10.40-11.80) (p<0.001). In the Subgroup 3b, from 10.60 (CI: 9.90-11.20) to 11.00 (CI: 10.50-11.50) (p>0.05). Spontaneous pregnancy within 6 months occurred in 6 (60%) patients from the Subgroup 3a, and in 4 (40%) women from the Subgroup 3b (p>0.05). After 6 months of follow-up, 2 underwent assisted reproductive technology. The remaining women from the Subgroup 3a (3 (30%)) and the Subgroup 3b (5 (50%)) also had spontaneous pregnancies by 1 year of follow-up (p>0.05).
Conclusions. The proposed methods of treatment of ОЕ, sclerotherapy + PRP and laparoscopy + PRP, showed a significant positive effect on the preservation of ovarian reserve. A differential approach to the treatment of ОЕ based on the proposed algorithm increases the occurrence of spontaneous pregnancy.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
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