The Effect of Hemostatic Method on Ovarian Reserve following Endometrioma Excision-Global Journal of Reproductive Medicine-Juniper Publishers

JUNIPER PUBLISHERS-Global Journal of Reproductive Medicine


The Effect of Hemostatic Method on Ovarian Reserve following Endometrioma Excision

Authored by Vasilios Tanos*

Endometrioma surgery and hemostasis negative affect ovarian reserve. The size of the endometrioma and the surgical technique are the most determining factors preserving ovarian function. Stripping the endometrioma pseudocapsule is detrimental for healthy ovarian tissue, reduces the risk of recurrence, however, not appropriate for infertility patients undergoing ART. Fenestration and laser vaporization of an endometrioma seems to minimally destruct the healthy ovarian tissue, offering the best surgical treatment option to infertility patients. Endometrioma develops from the ovarian epithelium, hence affects in general ovarian function but especially folliculogenesis. Decreased antral follicle count (AFC) and reduction in the number of oocytes retrieved during IVF have been repeatedly reported. Ovarian endometriosis is often a marker for more extensive pelvic and intestinal disease. Trans-vaginal hydrolaproscopy elucidates the pathogenesis and can provide the treatment of small ovarian endometrioma upto 3cm. Implantation of regurgitated endometrial cells via tubal lumen during menses on ovarian surface causes persistent inflammation, bleeding at implantation site and invagination of the ovarian cortex, adhesions, cystic formation, tissue alterations and hence, the endometrioma pseudocapsule is actually the ovarian epithelium with the follicular structures and oocytes. Once an endometrioma is open after thorough irrigation, careful endoscopic close up image reveals scanty areas of pinkish tissue which is actually the ovarian epithelium. Of course the majority of the exposed tissue is embedded with endometriotic cells that will be destroyed, usually by an effort of stripping the capsule or bipolar coagulation, laser etc.

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