Ovarian reserve and endometrial receptivity in patients after organ-sparing surgeries for ovarian endometriotic cysts

Abstract

Objective. To analyze the significance of the ovarian reserve (OR) in the assessment of endometrial receptivity in patients after cystectomy for ovarian endometriotic cysts (OECs). Patients and methods. We examined 172 patients after organ-sparing surgeries for OECs. The mean patient age was 28.7 ± 4.8 years. Group I included 114 women with low OR. Group II comprised 58 patients with unchanged OR. All study participants underwent pelvic ultrasonography in the middle luteal phase 6 and 12 months postoperatively. We evaluated endometrial thickness and its echostructure, as well as Doppler-angle-independent flow indices, including resistance index, pulsatility index, and systolic/diastolic ratio. Reduced OR was diagnosed according to the ESHRE recommendations (2011 Anti-Müllerian hormone ≤ 0.5–1.1 ng/mL and ≤5–7 antral follicles in one ultrasound section. Results. Impairments in the morphological and functional state of the ovaries were associated with changes of the endometrial thickness, its ultrasonic structure, and hemodynamic parameters in the terminal branches of the uterine arteries (hypovascularization, increased flow indices). Simultaneous use of various methods for the assessment of ovarian tissue and endometrium allowed the detection of a decreased reproductive potential. Patients with a reduced OR after surgeries for OECs demonstrated improvement of both morphological/functional characteristics of ovarian tissue and endometrial receptivity, which allows pregnancy planning. Patients with extremely thin endometrium (3.0–5.0 mm) that does not improve are recommended to resort to assisted reproductive technologies. Key words: ovarian reserve, endometrium, ovarian endometriotic cysts