Assessment of ovarian reserve after unilateral diathermy with thermal doses adjusted to ovarian volume

Abstract

Women with polycystic ovary syndrome seem to have a larger ovarian reserve. However, regardless of a greater reserve, diminished ovarian reserve has been reported after laparoscopic diathermy. The aim of this article was to determine whether the doses adjusted unilateral laparoscopic ovarian drilling with diathermy (ULOD) diminishes ovarian reserve to compare with bilateral laparoscopic ovarian drilling with diathermy (BLOD). Ninety-six women were assigned in two groups. One group underwent ULOD receiving thermal doses (0–840 J per ovary) adjusted to volume one ovary. The other group underwent BLOD receiving fixed doses (600 J per ovary). Ovarian reserve markers [anti-Müllerian hormone (AMH); antral follicle count (AFC) and ovarian volume] were measured before and after surgery (1 and 6 months). Both groups showed a decrease in AMH after surgery, but it was significantly more distinct in the BLOD versus ULOD group (2.0 ng/mL versus 1.3 ng/mL; p = 0.018) in the first follow-up month and remained significantly different through the sixth follow-up month (1.9 ng/mL versus 1.15 ng/mL; p = 0.023). In contrast, in the sixth month, the ULOD versus BLOD showed a significantly greater increase AFC (p < 0.001) and volume (p = 0.013). Our findings evidenced that the dose-adjusted unilateral diathermy (60 J/cm³) does not have significant and long-term effects on ovarian reserve.

Chinese abstract

患有多囊卵巢综合征的妇女似乎具有更多的卵巢储备，然而也有腹腔镜透热打孔术后卵巢储备功能降低的报道。本篇文章的目的为探究与双侧腹腔镜下卵巢打孔术(BLOD)相比，调整透热剂量单侧腹腔镜下卵巢打孔术(ULOD)对卵巢储备降低是否有影响。96名妇女被分为两组，一组接受了根据其一侧卵巢体积所调整透热剂量的ULOD（0-840J每卵巢），另一组接受了固定透热剂量的BLOD（600J每卵巢）。在术前和术后（1个月及6个月）均测定了卵巢储备指标[抗苗勒氏管激素（AMH）；窦卵泡计数（AFC）和卵巢体积] 。两组在术后都出现了AMH的降低，但在术后一个月BLOD组相较于ULOD组表现得更为明显（2.0ng/mL 比1.3ng/mL; p=0.018），术后六个月这种明显的区别仍然存在（1.9 ng/mL 比1.15 ng/mL; p=0.023）。与此相比，在第六个月ULOD组AFC与卵巢体积升高的幅度与BLOD组相比显著增多。研究结果表明根据卵巢体积调整剂量的单侧卵巢透热疗法(60 J/cm³)对卵巢储备功能无显著和长期的影响。

• Dose-adjusted unilateral diathermy
• laparoscopic ovarian drilling
• ovarian reserve
• polycystic ovary syndrome

Acknowledgements

The authors wish to thank Ana Jeroncic for editing and critical reading of the article.

Supplementary material available online

Supplementary Figure S1 and Table S2.