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Should I do surgery for cyst removal?

Different sequential changes due to different mechanisms cuasing damage to the ovarian reserve


Menstrual pain, painful intercourse, and frequently lower abdominal pain are not unfamiliar to the women who are suffering with endometriosis. Besides this annoying pains, the problem of infertility is another agony. Endometriosis is one of primary infertility causes, especially if one or both ovaries are involved, and ovarian endometriomas are found in 20% of patients with endometriosis. The most common symptoms is so called as chocolate cyst, which is built up by menstrual blood over months and years and turned to brown color.


Ruptures of ovarian endometrioma are associated with pelvic adhesion and infections, so many patients would like to remove the cyst to alleviate pelvic pain or improve spontaneous fertility. However, the most effective treatment modality to endometrioma is still controversial. The postoperative safety to the ovarian function and the recurrence of the disease are two unsolved problems. In the published article of Fertility and Sterility Journal (2013), the group in department of obstetrics and gynecology, Nagoya university, has reported the statistical data of the endometrioma patients undertaking cystectomy. They analyzed the AMH levels of these patients before and after the surgery to evaluate the effect. The patients with bilateral cystectomy showed significant reduced AMH than that of patients with unilateral cystectomy,

AMH (ng/ml)a
Unilateral
Bilateral
P-valueb
Preoperative
4.21
3.49
0.944
Postoperative one month
2.49
1.04
0.03*
Postoperative one year
2.72
0.9
0.92
a Anti-Müllerian hormone (AMH): The hormone is secreted by ovary and reflects the ovarian reserve. It is decreased with decreasing of remaining ovarian follicle count. 
b P-value < .05, statistic difference



The article also indicated that the decreased AMH could be recovered after one year However, only half of the patients showed this AMH recovery, but the other half did not,
AMH (ng/ml)
Decreased group(19/39)
Recovered group (20/39)
AMH (ng/ml)
5.87
3.23
Preoperative
3.66
1.07
Postoperative one month
1.07
2.44

The patients with ovarian endometrioma at Stork Fertility Center always face a dilemma, "should I do my IVF program first or do the cystectomy first?" Which one is the most important in my limited time span? So many people want to do cystectomy first to alleviate the pain without considering the effect to their ovarian reserve, but they still have to confront the infertility issue at last.

" Threefold the stride of Time, from first to last:
Loitering slow, the Future creepeth--
Arrow-swift, the Present sweepeth--
And motionless forever stands the Past."~ Friedrich Schiller




Reference:
1. One-year follow-up of serum antimullerian hormone levels in patients with cystectomy: are different sequential changes due to different mechanisms causing damage to the ovarian reserve? Fertility & Sterility 2013-Aug/ Vol.100
Stork Fertility Center送子鳥 Stork Fertility Center送子鳥 Author