Ovarian reserve and endometrioid ovarian cysts: Clinical and ultrasound aspects
The objective. To study laparoscopic values and establish specificities of endometrioid ovarian cysts and Doppler parameters in healthy ovarian tissue containing an endometrioid cyst in infertile patients with low and normal ovarian reserve. Patients and methods. We examined 100 patients of reproductive age with primary infertility and endometrioid ovarian cysts. Depending on the state of ovarian reserve, 2 groups were singled out: Group 1 comprised patients with low ovarian reserve (n = 55) (anti-Müllerian hormone level (AMH) less than 2.0 ng/ml, follicle-stimulating hormone (FSH ΦCT) higher than 10 IU/l), group 2 - patients (n = 45) with normal ovarian reserve (AMH level higher than 2.0 ng/ml, FSH less than 8 IU/l). Before and after surgery, 2D- and 3D-transvaginal ultrasound was used in grey-scale, colour and power Doppler modes. 3D-angiography was used to assess vascularisation of ovarian tissue. Results. In the group of patients with low ovarian reserve, in case of cyst location in the area of the infundibulopelvic and proper ovarian ligament vascularisation and perfusion of normal ovarian tissue were significantly lower as compared to «marginal» location of the cyst in the same group (VI - 0.62 ± 0.16%, FI - 18.11 ± 2.53, PI - 1.77 ± 0.14, RI - 0.72 ± 0.05 and VI - 0.81 ± 0.57%, FI - 25.7 ± 2.53%, PI - 1.56 ± 0.11, RI - 0.65 ± 0.04, respectively). In patients with normal ovarian reserve, intraovarian blood flow in the affected ovary was damaged insignificantly. Conclusion. The presence of an endometrioid cyst is not always associated with damage to ovarian reserve: If the cyst size is more than 5 cm the possibility of damage to ovarian reserve increases by 3.5 times; if cyst sizes are 3-5 cm ovarian reserve might be both low and high. Influence of endometrioid cysts on ovarian reserve is conditioned by their size, location, characteristics of the capsule and spread of extragenital endometriosis.