The Effect of Laparoscopic Cystectomy on Ovarian Reserve in Patients with Endometrioma

Abstract

Endometriosis is defined as the presence of endometrium-like tissue outside the uterine cavity. Several hypotheses have been proposed to explain the development of endometriosis: 1. Retrograde menstruation 2. Coelomic metaplasia 3. Lymphatic and vascular embolism However, other factors help to sustain the continuity of this endometrium-like tissue in place. These include hormonal and immunological factors. In addition, there are several risk factors such as, familial, genetic mutations, and environmental toxins. The commonest symptoms of endometriosis are infertility & subfertility, pelvic pain, dysmenorrehea, dysparunia, dyschesia, & dysuria. The diagnosis of endometriosis is made primarily by history and clinical examination. Serum markers such as CA-125 & CA19-9, though may be elevated in endometriosis, yet are nonspecific for endometriosis.

The gold standard for diagnosis of endometriosis however, is laparoscopy, where the lesion could be seen directly by visual inspection. However, laparoscopy is expensive and needs high experience. In addition, biopsies have to be taken for histopathological confirmation. Endometrioma is a pelvic mass arising from growth of ectopic endometrial tissue within the ovary and are often densely adherent to surrounding structures, such as the peritoneum, fallopian tubes, and bowel. An endometrioma may be associated with symptoms of endometriosis or identified at the time of evaluation for a pelvic mass or infertility. Ultrasound findings suggestive of an endometrioma include homogeneous low to medium level echoes in a thick walled, cystic mass (unilocular or multilocular).