Ovarian reserve and endometrial receptivity in patients after organ-sparing surgeries for ovarian endometriotic cysts

A.A. Solomatina, L.M. Mihaleva, I.Z. Khamzin, O.V. Bratchikova, M.Yu. Tyumentseva, L.B. Chabieva, T.N. Hovanskaya
In: Voprosy ginekologii, akušerstva i perinatologii · 2021 · vol. 20(1) , pp. 64–70 · doi:10.20953/1726-1678-2021-1-64-70 · W3157199020
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This study found that reduced ovarian reserve after surgery for endometriotic cysts correlates with altered endometrial morphology and hemodynamics, though improved receptivity supports pregnancy planning while extremely thin endometria require assisted reproductive technologies.

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This study evaluated the impact of ovarian reserve status on endometrial receptivity in 172 women who underwent organ-sparing cystectomy for ovarian endometriotic cysts. Participants were stratified into groups based on low or unchanged ovarian reserve, and all underwent pelvic ultrasonography to assess endometrial thickness, structure, and uterine artery hemodynamics at six and twelve months postoperatively. The results indicated that reduced ovarian reserve was associated with altered endometrial morphology and increased flow indices, yet patients with diminished reserve generally showed improvement in both ovarian and endometrial characteristics over time, supporting pregnancy planning, while those with persistently thin endometria were advised to consider assisted reproductive technologies. This paper is centrally about endometriosis — specifically the assessment of ovarian reserve and endometrial receptivity following surgical treatment for ovarian endometriotic cysts.

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Abstract

Objective. To analyze the significance of the ovarian reserve (OR) in the assessment of endometrial receptivity in patients after cystectomy for ovarian endometriotic cysts (OECs). Patients and methods. We examined 172 patients after organ-sparing surgeries for OECs. The mean patient age was 28.7 ± 4.8 years. Group I included 114 women with low OR. Group II comprised 58 patients with unchanged OR. All study participants underwent pelvic ultrasonography in the middle luteal phase 6 and 12 months postoperatively. We evaluated endometrial thickness and its echostructure, as well as Doppler-angle-independent flow indices, including resistance index, pulsatility index, and systolic/diastolic ratio. Reduced OR was diagnosed according to the ESHRE recommendations (2011 Anti-Müllerian hormone ≤ 0.5–1.1 ng/mL and ≤5–7 antral follicles in one ultrasound section. Results. Impairments in the morphological and functional state of the ovaries were associated with changes of the endometrial thickness, its ultrasonic structure, and hemodynamic parameters in the terminal branches of the uterine arteries (hypovascularization, increased flow indices). Simultaneous use of various methods for the assessment of ovarian tissue and endometrium allowed the detection of a decreased reproductive potential. Patients with a reduced OR after surgeries for OECs demonstrated improvement of both morphological/functional characteristics of ovarian tissue and endometrial receptivity, which allows pregnancy planning. Patients with extremely thin endometrium (3.0–5.0 mm) that does not improve are recommended to resort to assisted reproductive technologies. Key words: ovarian reserve, endometrium, ovarian endometriotic cysts
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Ovarian reserve and endometrial receptivity in patients after organ-sparing surgeries for ovarian endometriotic cysts Antonina A. Solomatina / Lyudmila M. Mikhaleva / Ildar Z. Khamzin / Olga V. Bratchikova / Marina Yu. Tyumentseva / Leila B. Chabieva / Tatyana N. Hovanskaya / Objective. To analyze the significance of the ovarian reserve (OR) in the assessment of endometrial receptivity in patients after cystectomy for ovarian endometriotic cysts (OECs). Patients and methods. We examined 172 patients after organ-sparing surgeries for OECs. The mean patient age was 28.7 ± 4.8 years. Group I included 114 women with low OR. Group II comprised 58 patients with unchanged OR. All study participants underwent pelvic ultrasonography in the middle luteal phase 6 and 12 months postoperatively. We evaluated endometrial thickness and its echostructure, as well as Doppler-angle-independent flow indices, including resistance index, pulsatility index, and systolic/diastolic ratio. Reduced OR was diagnosed according to the ESHRE recommendations (2011 Anti-Müllerian hormone ≤ 0.5–1.1 ng/mL and ≤5–7 antral follicles in one ultrasound section. Results. Impairments in the morphological and functional state of the ovaries were associated with changes of the endometrial thickness, its ultrasonic structure, and hemodynamic parameters in the terminal branches of the uterine arteries (hypovascularization, increased flow indices). Simultaneous use of various methods for the assessment of ovarian tissue and endometrium allowed the detection of a decreased reproductive potential. Patients with a reduced OR after surgeries for OECs demonstrated improvement of both morphological/functional characteristics of ovarian tissue and endometrial receptivity, which allows pregnancy planning. Patients with extremely thin endometrium (3.0–5.0 mm) that does not improve are recommended to resort to assisted reproductive technologies. Key words: ovarian reserve, endometrium, ovarian endometriotic cysts For citation: Solomatina A.A., Mihaleva L.M., Khamzin I.Z., Bratchikova O.V., Tyumentseva M.Yu., Chabieva L.B., Kochetkova A.M., Hovanskaya T.N. Ovarian reserve and endometrial receptivity in patients after organ-sparing surgeries for ovarian endometriotic cysts. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2021; 20(1): 64–70. DOI: 10.20953/1726-1678-2021-1-64-70

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