Purpose: Surgery for endometriomas may cause detrimental effects on ovarian reserve. We evaluated the safety of three-step laparoscopic surgery for endometriomas utilizing dienogest in terms of post-surgical ovarian reserve.
Methods: Twelve women received first look laparoscopy (FLL) with fenestration and drainage. Immediately after the surgery, they took oral dienogest 2 mg for three months; then, they received second look laparoscopy (SLL) with cystectomy. We compared serum AMH levels between women had three-step management with dienogest, and another twelve women had conventional one-step surgery without medications. In women had three-step procedures, the changes in concentration of proinflammatory cytokines and chemokines in peritoneal fluids were evaluated.
Results: Serum AMH levels were significantly decreased after three months of dienogest following FLL. AMH levels were also significantly decreased 3-6 months both after SLL and after one-step surgery; however, recovery of serum AMH levels at 9-12 months after surgery was evident in women had three-step surgery comparing to those of one-step surgery. Proinflammatory cytokines and chemokines in peritoneal fluids were downregulated at the time of SLL comparing to those of FLL.
Conclusions: Three-step surgery with dienogest may be a beneficial approach to protect ovarian reserve. Dienogest may exert its effects in part by lowering proinflammatory cytokines and chemokines.
Keywords: AMH; dienogest; endometrioma; laparoscopic three‐step management; ovarian reserve.
© 2020 The Authors. Reproductive Medicine and Biology published by John Wiley & Sons Australia, Ltd on behalf of Japan Society for Reproductive Medicine.