The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis
STUDY QUESTION Does surgical treatment of endometriomas impact on the ovarian reserve as evaluated with antral follicle count (AFC)? SUMMARY ANSWER This meta-analysis of published data shows that surgery for endometrioma does not significantly affect ovarian reserve as evaluated by AFC. WHAT IS KNOW...
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| Veröffentlicht in: | Human reproduction (Oxford) 2014-10, Vol.29 (10), p.2190-2198 |
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| creator | Muzii, Ludovico Di Tucci, Chiara Di Feliciantonio, Mara Marchetti, Claudia Perniola, Giorgia Panici, Pierluigi Benedetti |
| description | STUDY QUESTION
Does surgical treatment of endometriomas impact on the ovarian reserve as evaluated with antral follicle count (AFC)?
SUMMARY ANSWER
This meta-analysis of published data shows that surgery for endometrioma does not significantly affect ovarian reserve as evaluated by AFC.
WHAT IS KNOWN ALREADY
Surgical excision of an ovarian endometrioma significantly affects ovarian reserve evaluated with anti-Mullerian hormone (AMH) levels. Data for other reliable markers of ovarian reserve, such as AFC, have not been pooled in meta-analyses.
STUDY DESIGN, SIZE, DURATION
A systematic review with electronic searches of PubMed, MEDLINE and Embase up to April 2014 was conducted to identify articles evaluating AFC before and after surgery for ovarian endometriomas, or before or after surgery for the affected versus the contralateral ovary.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Of the 24 studies evaluated in detail, 13 were included for data extraction and meta-analysis, including a total of 597 patients. The primary outcome at pooled analysis was AFC (mean and SD) for affected ovaries before and after surgery. Secondary outcomes were AFC for the affected ovary versus the contralateral ovary before surgery, and AFC for the operated versus the contralateral ovary after surgery. The data were pooled using the RevMan software by the Cochrane Collaboration. Heterogeneity between studies was based on the results of the χ2 and I2 statistics. A random-effect model was used for the meta-analysis because of high heterogeneity between studies.
MAIN RESULTS AND THE ROLE OF CHANCE
AFC for the operated ovary did not change significantly after surgery (mean difference 0.10, 95% CI −1.45 to 1.65; P = 0.90). Lower AFC for the diseased ovary compared with the contralateral one was present before surgery, although the difference was not significant (mean difference −2.79, 95% CI −7.10 to 1.51; P = 0.20). After surgery, the operated ovary showed a significantly lower AFC compared with the contralateral ovary (mean difference −1.40, 95% CI −2.27 to −0.52; P = 0.002).
LIMITATIONS, REASONS FOR CAUTION
Heterogeneity among the selected studies was high; therefore, limiting the conclusions of the present systematic review.
WIDER IMPLICATIONS OF THE FINDINGS
Ovarian reserve evaluated with AFC is not reduced after surgical treatment of an endometrioma. A lower AFC is present for the affected ovary both before and after surgery. Recently, concerns have been raised as to the reliability |
| doi_str_mv | 10.1093/humrep/deu199 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1562661443</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/humrep/deu199</oup_id><sourcerecordid>1562661443</sourcerecordid><originalsourceid>FETCH-LOGICAL-c431t-67dd8ce195769704f0b5676b728bc39875e2c0a75d815c6d75ecaf1734992c273</originalsourceid><addsrcrecordid>eNqFkLtu3DAQRYnAQXbjpHRrsHSjLCmJpOTOWDgPwEAapxZG5MiWQYlrPmSozo-HxvpRppoZ4Nw7wCHkjLNvnLXV7j5NHg87g4m37Qey5bVkRVkJdkK2rJRNwbnkG_I5hAfG8trIT2RTCtaIhrEt-Xt7jxSHAXWkbqAh-Tv0Kx2cpzgbN2H0o5uAupm6BfwIM_UY0C85tYBNENHQfqUwRw8256wdtUWqXZrjJQUa1hBxgjjqHFxGfMqoobkXCpjBrmEMX8jHAWzAry_zlPz5fn27_1nc_P7xa391U-i64rGQyphGI2-Fkq1i9cB6IZXsVdn0umobJbDUDJQwDRdamnxrGLiq6rYtdamqU3Jx7D1495gwxG4ag0ZrYUaXQseFLKXkdV1ltDii2rsQPA7dwY8T-LXjrHv23h29d0fvmT9_qU79hOaNfhX9_tulw3-6_gEFMpBk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1562661443</pqid></control><display><type>article</type><title>The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Muzii, Ludovico ; Di Tucci, Chiara ; Di Feliciantonio, Mara ; Marchetti, Claudia ; Perniola, Giorgia ; Panici, Pierluigi Benedetti</creator><creatorcontrib>Muzii, Ludovico ; Di Tucci, Chiara ; Di Feliciantonio, Mara ; Marchetti, Claudia ; Perniola, Giorgia ; Panici, Pierluigi Benedetti</creatorcontrib><description>STUDY QUESTION
Does surgical treatment of endometriomas impact on the ovarian reserve as evaluated with antral follicle count (AFC)?
SUMMARY ANSWER
This meta-analysis of published data shows that surgery for endometrioma does not significantly affect ovarian reserve as evaluated by AFC.
WHAT IS KNOWN ALREADY
Surgical excision of an ovarian endometrioma significantly affects ovarian reserve evaluated with anti-Mullerian hormone (AMH) levels. Data for other reliable markers of ovarian reserve, such as AFC, have not been pooled in meta-analyses.
STUDY DESIGN, SIZE, DURATION
A systematic review with electronic searches of PubMed, MEDLINE and Embase up to April 2014 was conducted to identify articles evaluating AFC before and after surgery for ovarian endometriomas, or before or after surgery for the affected versus the contralateral ovary.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Of the 24 studies evaluated in detail, 13 were included for data extraction and meta-analysis, including a total of 597 patients. The primary outcome at pooled analysis was AFC (mean and SD) for affected ovaries before and after surgery. Secondary outcomes were AFC for the affected ovary versus the contralateral ovary before surgery, and AFC for the operated versus the contralateral ovary after surgery. The data were pooled using the RevMan software by the Cochrane Collaboration. Heterogeneity between studies was based on the results of the χ2 and I2 statistics. A random-effect model was used for the meta-analysis because of high heterogeneity between studies.
MAIN RESULTS AND THE ROLE OF CHANCE
AFC for the operated ovary did not change significantly after surgery (mean difference 0.10, 95% CI −1.45 to 1.65; P = 0.90). Lower AFC for the diseased ovary compared with the contralateral one was present before surgery, although the difference was not significant (mean difference −2.79, 95% CI −7.10 to 1.51; P = 0.20). After surgery, the operated ovary showed a significantly lower AFC compared with the contralateral ovary (mean difference −1.40, 95% CI −2.27 to −0.52; P = 0.002).
LIMITATIONS, REASONS FOR CAUTION
Heterogeneity among the selected studies was high; therefore, limiting the conclusions of the present systematic review.
WIDER IMPLICATIONS OF THE FINDINGS
Ovarian reserve evaluated with AFC is not reduced after surgical treatment of an endometrioma. A lower AFC is present for the affected ovary both before and after surgery. Recently, concerns have been raised as to the reliability of AMH as a marker of ovarian reserve. Based on the present findings, surgical treatment of an endometrioma may be considered safer for the ovarian reserve than previously thought.
STUDY FUNDING/COMPETING INTERESTS
No external funding was sought or obtained for this study. No conflicts of interest are declared.</description><identifier>ISSN: 0268-1161</identifier><identifier>EISSN: 1460-2350</identifier><identifier>DOI: 10.1093/humrep/deu199</identifier><identifier>PMID: 25085800</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adult ; Endometriosis - surgery ; Female ; Gynecologic Surgical Procedures - adverse effects ; Humans ; Ovarian Reserve</subject><ispartof>Human reproduction (Oxford), 2014-10, Vol.29 (10), p.2190-2198</ispartof><rights>The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com 2014</rights><rights>The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c431t-67dd8ce195769704f0b5676b728bc39875e2c0a75d815c6d75ecaf1734992c273</citedby><cites>FETCH-LOGICAL-c431t-67dd8ce195769704f0b5676b728bc39875e2c0a75d815c6d75ecaf1734992c273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25085800$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Muzii, Ludovico</creatorcontrib><creatorcontrib>Di Tucci, Chiara</creatorcontrib><creatorcontrib>Di Feliciantonio, Mara</creatorcontrib><creatorcontrib>Marchetti, Claudia</creatorcontrib><creatorcontrib>Perniola, Giorgia</creatorcontrib><creatorcontrib>Panici, Pierluigi Benedetti</creatorcontrib><title>The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis</title><title>Human reproduction (Oxford)</title><addtitle>Hum Reprod</addtitle><description>STUDY QUESTION
Does surgical treatment of endometriomas impact on the ovarian reserve as evaluated with antral follicle count (AFC)?
SUMMARY ANSWER
This meta-analysis of published data shows that surgery for endometrioma does not significantly affect ovarian reserve as evaluated by AFC.
WHAT IS KNOWN ALREADY
Surgical excision of an ovarian endometrioma significantly affects ovarian reserve evaluated with anti-Mullerian hormone (AMH) levels. Data for other reliable markers of ovarian reserve, such as AFC, have not been pooled in meta-analyses.
STUDY DESIGN, SIZE, DURATION
A systematic review with electronic searches of PubMed, MEDLINE and Embase up to April 2014 was conducted to identify articles evaluating AFC before and after surgery for ovarian endometriomas, or before or after surgery for the affected versus the contralateral ovary.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Of the 24 studies evaluated in detail, 13 were included for data extraction and meta-analysis, including a total of 597 patients. The primary outcome at pooled analysis was AFC (mean and SD) for affected ovaries before and after surgery. Secondary outcomes were AFC for the affected ovary versus the contralateral ovary before surgery, and AFC for the operated versus the contralateral ovary after surgery. The data were pooled using the RevMan software by the Cochrane Collaboration. Heterogeneity between studies was based on the results of the χ2 and I2 statistics. A random-effect model was used for the meta-analysis because of high heterogeneity between studies.
MAIN RESULTS AND THE ROLE OF CHANCE
AFC for the operated ovary did not change significantly after surgery (mean difference 0.10, 95% CI −1.45 to 1.65; P = 0.90). Lower AFC for the diseased ovary compared with the contralateral one was present before surgery, although the difference was not significant (mean difference −2.79, 95% CI −7.10 to 1.51; P = 0.20). After surgery, the operated ovary showed a significantly lower AFC compared with the contralateral ovary (mean difference −1.40, 95% CI −2.27 to −0.52; P = 0.002).
LIMITATIONS, REASONS FOR CAUTION
Heterogeneity among the selected studies was high; therefore, limiting the conclusions of the present systematic review.
WIDER IMPLICATIONS OF THE FINDINGS
Ovarian reserve evaluated with AFC is not reduced after surgical treatment of an endometrioma. A lower AFC is present for the affected ovary both before and after surgery. Recently, concerns have been raised as to the reliability of AMH as a marker of ovarian reserve. Based on the present findings, surgical treatment of an endometrioma may be considered safer for the ovarian reserve than previously thought.
STUDY FUNDING/COMPETING INTERESTS
No external funding was sought or obtained for this study. No conflicts of interest are declared.</description><subject>Adult</subject><subject>Endometriosis - surgery</subject><subject>Female</subject><subject>Gynecologic Surgical Procedures - adverse effects</subject><subject>Humans</subject><subject>Ovarian Reserve</subject><issn>0268-1161</issn><issn>1460-2350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkLtu3DAQRYnAQXbjpHRrsHSjLCmJpOTOWDgPwEAapxZG5MiWQYlrPmSozo-HxvpRppoZ4Nw7wCHkjLNvnLXV7j5NHg87g4m37Qey5bVkRVkJdkK2rJRNwbnkG_I5hAfG8trIT2RTCtaIhrEt-Xt7jxSHAXWkbqAh-Tv0Kx2cpzgbN2H0o5uAupm6BfwIM_UY0C85tYBNENHQfqUwRw8256wdtUWqXZrjJQUa1hBxgjjqHFxGfMqoobkXCpjBrmEMX8jHAWzAry_zlPz5fn27_1nc_P7xa391U-i64rGQyphGI2-Fkq1i9cB6IZXsVdn0umobJbDUDJQwDRdamnxrGLiq6rYtdamqU3Jx7D1495gwxG4ag0ZrYUaXQseFLKXkdV1ltDii2rsQPA7dwY8T-LXjrHv23h29d0fvmT9_qU79hOaNfhX9_tulw3-6_gEFMpBk</recordid><startdate>20141010</startdate><enddate>20141010</enddate><creator>Muzii, Ludovico</creator><creator>Di Tucci, Chiara</creator><creator>Di Feliciantonio, Mara</creator><creator>Marchetti, Claudia</creator><creator>Perniola, Giorgia</creator><creator>Panici, Pierluigi Benedetti</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20141010</creationdate><title>The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis</title><author>Muzii, Ludovico ; Di Tucci, Chiara ; Di Feliciantonio, Mara ; Marchetti, Claudia ; Perniola, Giorgia ; Panici, Pierluigi Benedetti</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c431t-67dd8ce195769704f0b5676b728bc39875e2c0a75d815c6d75ecaf1734992c273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Endometriosis - surgery</topic><topic>Female</topic><topic>Gynecologic Surgical Procedures - adverse effects</topic><topic>Humans</topic><topic>Ovarian Reserve</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Muzii, Ludovico</creatorcontrib><creatorcontrib>Di Tucci, Chiara</creatorcontrib><creatorcontrib>Di Feliciantonio, Mara</creatorcontrib><creatorcontrib>Marchetti, Claudia</creatorcontrib><creatorcontrib>Perniola, Giorgia</creatorcontrib><creatorcontrib>Panici, Pierluigi Benedetti</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Human reproduction (Oxford)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Muzii, Ludovico</au><au>Di Tucci, Chiara</au><au>Di Feliciantonio, Mara</au><au>Marchetti, Claudia</au><au>Perniola, Giorgia</au><au>Panici, Pierluigi Benedetti</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis</atitle><jtitle>Human reproduction (Oxford)</jtitle><addtitle>Hum Reprod</addtitle><date>2014-10-10</date><risdate>2014</risdate><volume>29</volume><issue>10</issue><spage>2190</spage><epage>2198</epage><pages>2190-2198</pages><issn>0268-1161</issn><eissn>1460-2350</eissn><abstract>STUDY QUESTION
Does surgical treatment of endometriomas impact on the ovarian reserve as evaluated with antral follicle count (AFC)?
SUMMARY ANSWER
This meta-analysis of published data shows that surgery for endometrioma does not significantly affect ovarian reserve as evaluated by AFC.
WHAT IS KNOWN ALREADY
Surgical excision of an ovarian endometrioma significantly affects ovarian reserve evaluated with anti-Mullerian hormone (AMH) levels. Data for other reliable markers of ovarian reserve, such as AFC, have not been pooled in meta-analyses.
STUDY DESIGN, SIZE, DURATION
A systematic review with electronic searches of PubMed, MEDLINE and Embase up to April 2014 was conducted to identify articles evaluating AFC before and after surgery for ovarian endometriomas, or before or after surgery for the affected versus the contralateral ovary.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Of the 24 studies evaluated in detail, 13 were included for data extraction and meta-analysis, including a total of 597 patients. The primary outcome at pooled analysis was AFC (mean and SD) for affected ovaries before and after surgery. Secondary outcomes were AFC for the affected ovary versus the contralateral ovary before surgery, and AFC for the operated versus the contralateral ovary after surgery. The data were pooled using the RevMan software by the Cochrane Collaboration. Heterogeneity between studies was based on the results of the χ2 and I2 statistics. A random-effect model was used for the meta-analysis because of high heterogeneity between studies.
MAIN RESULTS AND THE ROLE OF CHANCE
AFC for the operated ovary did not change significantly after surgery (mean difference 0.10, 95% CI −1.45 to 1.65; P = 0.90). Lower AFC for the diseased ovary compared with the contralateral one was present before surgery, although the difference was not significant (mean difference −2.79, 95% CI −7.10 to 1.51; P = 0.20). After surgery, the operated ovary showed a significantly lower AFC compared with the contralateral ovary (mean difference −1.40, 95% CI −2.27 to −0.52; P = 0.002).
LIMITATIONS, REASONS FOR CAUTION
Heterogeneity among the selected studies was high; therefore, limiting the conclusions of the present systematic review.
WIDER IMPLICATIONS OF THE FINDINGS
Ovarian reserve evaluated with AFC is not reduced after surgical treatment of an endometrioma. A lower AFC is present for the affected ovary both before and after surgery. Recently, concerns have been raised as to the reliability of AMH as a marker of ovarian reserve. Based on the present findings, surgical treatment of an endometrioma may be considered safer for the ovarian reserve than previously thought.
STUDY FUNDING/COMPETING INTERESTS
No external funding was sought or obtained for this study. No conflicts of interest are declared.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>25085800</pmid><doi>10.1093/humrep/deu199</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0268-1161 |
| ispartof | Human reproduction (Oxford), 2014-10, Vol.29 (10), p.2190-2198 |
| issn | 0268-1161 1460-2350 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1562661443 |
| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Endometriosis - surgery Female Gynecologic Surgical Procedures - adverse effects Humans Ovarian Reserve |
| title | The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis |
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