子宮內膜異位瘤手術卵巢嚴重受損機率約13%

子宮內膜異位瘤接受手術治療後，卵巢嚴重受損(COH後無成熟卵子形成)機率約13%

若計算卵巢輕微或中等受損機率，恐怕更高

子宮內膜異位瘤接受手術治療仍應保守為宜

http://humrep.oxfordjournals.org/content/25/3/678.full

Figure 1

Sonographic findings in a 34-year-old woman who underwent excision of a 4 cm right ovarian endometrioma, three years prior to IVF.

A representative sonographic section of the operated and contralateral non-operated gonad on the day of hCG administration is shown in the upper and lower panel, respectively, and the total number of follicles with a mean diameter ≥11 mm in the two ovaries was 0 and 10, respectively.

Rate of severe ovarian damage following surgery for endometriomas

1. Laura Benaglia1,2,3, 
2. Edgardo Somigliana1, 
3. Valentina Vighi1,2,
4. Guido Ragni1, 
5. Paolo Vercellini1,2 and 
6. Luigi Fedele1,2

+Author Affiliations

1. ¹Infertility Unit, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via M. Fanti 6, 20122 Milan, Italy
2. ²Università degli Studi di Milano, Milan, Italy

1. 3Correspondence address. Tel: +39-02-55034303; Fax: +39-02-55034302; E-mail:laurabenaglia@hotmail.it

• Received September 21, 2009.
• Revision received December 9, 2009.
• Accepted December 11, 2009.

 

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Abstract

BACKGROUND There is growing and consistent evidence showing that ovarian reserve is affected following surgical excision of ovarian endometriomas. Of particular concern is the risk of severe ovarian damage leading to unresponsiveness to ovarian hyperstimulation. In this study, we aimed to determine the rate of this complication.

METHODS Ninety-three women underwent surgery for monolateral endometriomas were recruited. Patients who underwent IVF were selected and, in all cases, follicular growth was monitored by serial transvaginal ultrasonography. The main outcome measure was the rate of ovaries remaining silent when stimulated after surgery for endometriomas.

RESULTS Absence of follicular growth was observed in 12 operated ovaries although this event never occurred in the contralateral gonad (P < 0.001). The frequency (95% confidence interval) of severe ovarian damage following surgery was 13% (7–21%).

CONCLUSIONS Severe ovarian damage, occurring in gonads operated on for ovarian endometriomas, is not a rare event.