الفهرس 
EndometriosisOnly 14 pages are availabe for public view
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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).
Ovarian reserve is related to the size, number and quality of oocyte within follicles. The ovarian reserve is the reproductive ability of the ovary that show the number of follicles in it. Aging decrease the ovarian reserve and subsequently the reproductive ability of women. Evaluation of antimullerian hormone (AMH) serum level can be used as a predictor to ovarian reserve. Serum AMH levels through the whole cycle has minimum intracycles changes.
The aim of this study was to evaluate the effect of laparoscopic ovarian cystectomy on the ovarian reserve in patients with endometriosis.
This study was conducted at Ain-Shams Maternity University Hospital including 44 patients of ovarian endometriosis candidate for laparoscopic ovarian cystectomy due to either pain or infertility aging from 18-35 years old. Patients with age out of this range (18-35), previous adnexal surgery, endocrinal disorders, hormonal therapy or suspected ovarian malignancy are excluded from the study.
All patients included in the study were subjected to; detailed history taking and full examination, day 3 Anti-mullerian hormone (AMH), Follicular Stimulating hormone (FSH), day 3 trans-vaginal ultrasound for Antral Follicular count (AFC). Then the same tests were repeated on day 3 of the cycle after three months from the surgical treatment of endometrioma.
Descriptive statistics was done including mean, standard deviation and prevalence. Comparison between before and after surgery was done using paired student’s t-test (for parametric continuous variables), Wilcoxon rank signed test (for numeric non-parametric variables) and McNemar’s test (for categorical variables). Significance level is set at 0.05.
There was a statistically significant reduction in postoperative median values of AFC, serum AMH, serum E2 and serum E2: FSH ratio, and a statistically significant rise in postoperative median serum FSH, when compared to preoperative measurements. Two of these parameters had postoperative values of clinically-significant diminished ovarian reserve (DOR) in a number of included patients: the AFC (with a cutoff < 4) [11 (25%) vs. 0 (0%), p=0.001] and the serum AMH concentration (with a cutoff < 1 ng/ml) [21 (47.7%) vs. 17 (38.6%), p=0.125].
Obesity and bilaterality of endometriomas were significant risk factors for diminished ovarian reserve (DOR); the former raised the risk of DOR by almost 1.5-fold, while the latter by almost 5-folds.
The anti-mullerian hormone, AFC & Ovarian volume after laparoscopic ovarian cystectomy decreased significantly (P <0.001), While the FSH after laparoscopic ovarian cystectomy increased significantly (P >0.001).