The impact of different surgical treatments for uterine fibroids on ovarian reserve indices
Objective. To investigate ovarian reserve indices after various organ-sparing operations for uterine fibroids: hysteroresectoscopic (HRS) myomectomy, laparoscopic myomectomy, and uterine artery embolization (UAE).Vysotsky M.М., Kuranov I.I., Nevzorov O.B.
Subjects and methods. Ninety-two patients were examined; organ-sparing operations, such as laparoscopic and HRS myomectomies and UAE, were performed. All the examinees were divided into 3 groups: 1) 27 women after HRS myomectomy; 2) 42 patients after laparoscopic myomectomy; 3) 23 patients after UAE. A control group consisted of 20 healthy reproductive-aged women.
Results. All surgical interventions lead to a significant decrease in the production of anti-Müllerian hormone (AMH) and estradiol in the presence of elevated luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels. HRS myomectomy results in a gradual restoration of ovarian reserve markers overtime at 4-6 months postsurgery. After laparoscopic myomectomy, the changes in the level of ovarian reserve markers were more pronounced and the production of gonadotropic and steroid hormones became normal at month 6 following surgery. After UAE, there was the most pronounced decline in the production of AMH and estradiol and an increase in the levels of LH and FSH; the production of AMH and estradiol significantly increased over time by the 6th postoperative month, but returned to the normal preoperative values only 10 months following surgery.
Conclusion. UAE exerts the greatest impact on ovarian function, after which the changes in the hormonal status and blood flow in the uterus and ovaries remain for 10 months compared with 6 months after HRS and laparoscopic myomectomies.
Keywords
uterine myoma
hysteroresectoscopic myomectomy
laparoscopic myomectomy
uterine artery embolization
ovarian reserve
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Received 21.11.2019
Accepted 29.11.2019
About the Authors
Maxim M. Vysotskiy, MD, PhD, Professor of the Department of Endoscopic Surgery, The A.I. Yevdokimov Moscow State University of Medicine and Dentistry,Head of the course «Endoscopic surgery in gynecology». E-mail: visotsky-gyn@mtu-net.ru. 39 Losinoostrovskaja str., Moscow, 107150, Russian Federation.
Ivan I. Kuranov, MD, Gynecologist of the 22nd Gynecological Department, The S.P. Botkin City Clinical Hospital. E-mail: Doktorkuranov@mail.ru.
5 Vtoroi Botkinsky proezd, Moscow, 125284, Russian Federation.
Oleg B. Nevzorov, MD, PhD, Associate Professor of the Department of Obstetrics and Gynecology, The A.I. Yevdokimov Moscow State University of Medicine and Dentistry. E-mail: nev2661@mail.ru. 39 Losinoostrovskaja str., Moscow, 107150, Russian Federation.
For reference: Vysotsky M.М., Kuranov I.I., Nevzorov O.B. The impact of different surgical treatments for uterine fibroids on ovarian reserve indices.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 5: 132-138 (In Russian).
https://dx.doi.org/10.18565/aig.2020.5. 132-138
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