Laparoscopic surgeries for uterine fibroids and ovarian cysts reduce ovarian reserve via age- and surgical type-manner

Abstract

Aim: Diminished ovarian reserve can be characterized by poor response to ovulation and low number of eggs. The risk factors include endometriosis, receiving cancer treatment, luteal phase deficiency and gynecologic surgery. Uterine fibroids and ovarian cysts are the most common benign gynecological diseases in women globally. This prospective study evaluated the influence of laparoscopic surgery treating benign gynecological diseases on ovarian reserve. Methods: A total of 121 patients with uterine fibroids or benign ovarian cysts who received laparoscopic surgeries (41 with hysterectomy, 36 with myomectomy, 18 with adnexectomy, and 26 with ovarian cystectomy) were included. The ovarian reserve status defined as serum anti-Mullerian hormone concentration was assessed at 1 month before and after surgery, respectively. Results: The anti-Mullerian hormone reduction level was 22.34% in cystectomy, 44.1% in adnexectomy, 24.92% in myomectomy, and 47.61% in hysterectomy (p < 0.001). Multivariate analysis showed that adnexectomy had significantly high risk of high serum anti-Mullerian hormone reduction level (adjusted odds ratio (aOR): 14.90, 95% confidence interval (CI): 2.56-86.93, p = 0.003). Conclusions: These 4 laparoscopic surgeries all reduced the AMH levels 1 month after the procedure. Further prospective studies with longer follow-up are necessary to know the real impact on the ovarian reserve. Adnexectomy was an independent factor of reduced ovarian reserve in 1 month after surgery.

摘要

目的

卵巢储备功能降低可表现为对排卵反应差和卵子数量少。危险因素包括子宫内膜异位症、接受肿瘤治疗、黄体功能不足和妇科手术。子宫肌瘤和卵巢囊肿是全球女性最常见的良性妇科疾病。此前瞻性研究评价腹腔镜手术治疗良性妇科疾病对卵巢储备功能的影响。

方法

收集121例行腹腔镜手术的子宫肌瘤或卵巢良性囊肿患者, 其中子宫切除术41例, 子宫肌瘤切除术36例, 附件切除术18例, 卵巢囊肿切除术26例。术前1个月、术后1个月评估卵巢储备功能情况, 即血清抗苗勒氏管激素浓度。

结果

抗苗勒氏激素降低水平在卵巢囊肿切除术中为22.34%, 附件切除术为44.1%, 子宫肌瘤剔除术为24.92%, 子宫切除术为47.61% (p<0.001)。多因素分析显示, 附件切除术患者血清抗苗勒氏管激素降低明显, 风险显著增加(调整优势比(aOR): 14.90, 95%置信区间(CI): 2.56 ∼ 86.93, p=0.003)。

结论

这四种腹腔镜手术术后1个月AMH水平均有降低。进一步的前瞻性研究和较长时间的随访很必要的, 以了解对卵巢储备功能的真正影响。附件切除术是术后1个月卵巢储备减少的独立因素。

Keywords:

• Anti-Mullerian hormone
• Benign ovarian cysts
• laparoscopic surgery
• ovarian reserve
• uterine fibroids

关键词:

• 抗苗勒氏管激素
• 良性卵巢囊肿
• 腹腔镜手术
• 卵巢储备功能
• 子宫肌瘤

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Startup Fund for scientific research of Fujian Medical University (Grant number 2018QH1118); Youth Scientific Research Project of Fujian Provincial Health Department(Grant number 2021QNB004).