ENDOMETRIOMAS AND OVARIAN RESERVE
(LITERATURE REVIEW)
DOI:
https://doi.org/10.11603/24116-4944.2020.1.11491Keywords:
endometrioma, anti-Mullerian hormone, AMH, antral follicle count, AFC, laparoscopy, sclerotherapy, PRP-therapy, ovarial reserveAbstract
The aim of the study – to collect and analyze world literature data on the problem of the influence of endometriotic cysts on the ovarian reserve in women of fertile age and the choice of optimal methods for assessing the ovarian reserve, as well as the choice of surgical technologies for the treatment of endometriomas with the possibility of maintaining the ovarian reserve for reproductive function in women.
Endometriosis is one of the problems of modern reproductive medicine, since it can cause infertility in 50 % of cases. Ovarian endometriomas account for 35 % of all benign ovarian cysts and are found in 17–44 % of women with endometriosis. In 1/3 of cases, endometriomas are represented by bilateral localization, which significantly worsens the prognosis of reproductive plans. The origin of the endometrioma and its negative effect on the ovarian reserve is explained by a complex and ambiguous pathogenesis. The choice of diagnostic methods for assessing the condition of the ovarian reserve in women with pregnancy planning endometrioma is important, since they can be used to predict the risks before and after surgical damage to the ovarian reserve, which allows the gynecologist to choose a surgical treatment method and also plan for ART. Laparoscopic stripping of the capsule of the endometrial cyst is the "gold standard" for the treatment of these cysts. However, this method can lead to irreversible damage to the ovarian reserve, which jeopardizes the woman's reproductive plans. This negative impact of surgical intervention can be minimized with PRP therapy from autologous blood. Platelet rich plasma (PRP) is a concentrated platelet source obtained from venous blood after centrifugation. PRP as a unique system containing more than 800 biologically active substances can contribute to the development of primary and primary follicles to the preantral stage. Another prescriptive method for treating endometriomas with a minimized effect on the ovarian tissue, therefore, on the ovarian reserve, is sclerotherapy with ethanol, which can be used both in primary and relapsed endometriomas.
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