scholarly journals The time-interval of ovarian reserve recovery after laparoscopic unilateral ovarian nonendometriotic cystectomy: a prospective cohort study

2019 ◽  
Author(s):  
huaping Li ◽  
bing Yan ◽  
yanli Wang ◽  
yahong Liu ◽  
zhou Liu
Keyword(s):  
Ovarian Reserve ◽  
Resistance Index ◽  
Reproductive Age ◽  
Optimal Time ◽  
Enzyme Linked Immunosorbent Assay ◽  
Time Interval ◽  
Ovarian Cystectomy ◽  
Referent Group ◽  
Rate Of Decline

Abstract Background: Ovarian benign cyst, frequently seen in women of reproductive age, is one of the most important causes of damaging effect of ovarian reserve. Laparoscopic ovarian cystectomy is established as the gold standard surgical approach to the ovarian benign cyst. Studies have shown that potential fertility can be directly impaired by laparoscopic ovarian cystectomy and diminished ovarian reserve. There is little data about the time-interval of ovarian reserve recovery after the laparoscopic unilateral ovarian cystectomy. The objective of this study was to investigate the time-interval of ovarian reserve recovery after laparoscopic unilateral ovarian nonendometriotic cystectomy.Method: In the first part of the study, a total number of 67 patients with unilateral ovarian nonendometriotic cyst who underwent laparoscopic unilateral ovarian cystectomy were recruited as a postoperative observation group (POG). A total number of 69 same-aged healthy women without ovarian cyst who did not undergo surgery were recruited as a referent group (RFG).The serum anti-Müllerian hormone (AMH) levels were measured using a commercially available enzyme-linked immunosorbent assay kit; the Follicle-stimulating hormone (FSH)and E2 levels, measured using a chemiluminescent reagent kit. The ovarian arterial resistance index (OARI) and AFC were measured by transvaginal ultrasonography on the 3rd-5th day of the same menstrual cycle. In the second part of the study, a prospective postoperative 6-month follow-up of cases was performed. Results: When compared with RFG, the AFC of POG’s cyst side showed no difference in the 1st, 3rd, 6th postoperative month (F = 0.03, 0.02, 0.55; P = 0.873, 0.878, 0.460). The OARI of POG’s cyst side presented no difference in the 1st, 3rd, 6th postoperative month ( F = 0.73, 3.57, 1.75; P=0.395, 0.061, 0.188). In the first month, the postoperative AMH levels declined significantly, 1.88 ng/ml (IQR: 1.61-2.16 ng/ml) in POG and 2.57 ng/ml (IQR: 2.32-2.83 ng/ml) in RFG (F = 13.43; P = 0.000). At the time interval, the rate of decline was significantly lower postoperatively than preoperatively in POG (32.75 %),and was also the case in the comparison of POG with RFG (26.67 %). Conclusions: After the laparoscopic unilateral ovarian cystectomy, the optimal time-interval can be the 6th month for ovarian reserve recovery. Semiannually, AMH levels were to be detected to find those whose window time to conceive was likely to be shorter than others of the same age.

scholarly journals The Optimal Time of Ovarian Reserve Recovery After Laparoscopic Unilateral Ovarian Non-Endometriotic Cystectomy

2021 ◽  
Vol 12 ◽  
Author(s):  
Huaping Li ◽  
Bin Yan ◽  
Yanli Wang ◽  
Zhiming Shu ◽  
Ping Li ◽  
...  
Keyword(s):  
Ovarian Reserve ◽  
Resistance Index ◽  
Antral Follicle ◽  
Optimal Time ◽  
Time Interval ◽  
Treatment Protocols ◽  
Ovarian Cystectomy ◽  
Time Period ◽  
Referent Group ◽  
Rate Of Decline

BackgroundLaparoscopic ovarian cystectomy is established as the standard surgical approach for the treatment of benign ovarian cysts. However, previous studies have shown that potential fertility can be directly impaired by laparoscopic ovarian cystectomy, diminished ovarian reserve (DOR), and even premature ovarian failure. Therefore, fertility-preserving interventions are required for benign gynecologic diseases. However, there are still little data on the time period required for recovery of ovarian reserve after the laparoscopic unilateral ovarian cystectomy, which is very important for the individualization of treatment protocols. This study aimed at investigating the time needed for the ovarian reserve to recover after laparoscopic unilateral ovarian non-endometriotic cystectomy.Materials and MethodsSixty-seven patients with unilateral ovarian non-endometriotic cyst from Zhoupu and Punan Hospitals who underwent laparoscopic unilateral ovarian cystectomy were recruited as a postoperative observation group (POG). Also, 69 healthy age-matched women without ovarian cyst who did not undergo surgery were recruited as a referent group (RFG). Ovarian reserve with the serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), estradiol (E2) levels, ovarian arterial resistance index (OARI), and antral follicle counts (AFCs) were measured on the third to fifth days of the same menstrual cycle. A postoperative 6-month follow-up of cases was performed.ResultsCompared with RFG, AFC of cyst side in the POG group showed no difference in the first, third, and sixth postoperative month (F = 0.03, F = 0.02, F = 0.55, respectively; p = 0.873, p = 0.878, p = 0.460, respectively). The OARI of cyst side in the POG group revealed no differences in the first, third, and sixth postoperative month (F = 0.73, F = 3.57, F = 1.75, respectively; p = 0.395, p = 0.061, p = 0.701, respectively). In the first month, the postoperative AMH levels significantly declined, reaching 1.88 ng/ml [interquartile range (IQR): 1.61–2.16 ng/ml] in POG and 2.57 ng/ml (IQR: 2.32–2.83 ng/ml) in RFG (F = 13.43, p = 0.000). For the data of AMH levels stratified by age, the same trend was observed between less than 25 and more than 26 years old. At this same time interval, the postoperative rate of decline was significantly lower compared to the preoperative one in POG (32.75%). The same trend was observed between the POG and RFG groups (26.67%).ConclusionsThe optimal time for recovery of ovarian reserve after laparoscopic unilateral ovarian cystectomy is estimated to be 6 months.

Evaluation of iatrogenic lesions in 722 surgically treated cases of peripheral nerve trauma

2001 ◽  
Vol 94 (6) ◽  
pp. 905-912 ◽  
Author(s):  
Thomas Kretschmer ◽  
Gregor Antoniadis ◽  
Veit Braun ◽  
Stefan A. Rath ◽  
Hans-Peter Richter
Keyword(s):  
Traumatic Injury ◽  
Common Peroneal Nerve ◽  
Iatrogenic Injury ◽  
Optimal Time ◽  
Motor Deficits ◽  
Time Interval ◽  
Content Type ◽  
Iatrogenic Injuries ◽  
Fine Print

Object. The purpose of this study was to discover the number and types of iatrogenic nerve injuries that were surgically treated during a 9-year period at a relatively busy nerve center. The specific nerves involved, their sites of injury, and the mechanisms of injury were also documented. Methods. The authors retrospectively evaluated the surgically treated iatrogenic lesions by reviewing case histories, operative reports, and follow-up notes in 722 cases of trauma. These cases were treated between January 1990 and December 1998 because of pain, dysesthesias, and sensory and/or motor deficits. Iatrogenic injury was a much larger category of trauma than predicted. One hundred twenty-six (17.4%) of the 722 surgically treated cases were iatrogenic in origin. Most of these injuries occurred during a previous operation. To a major extent, nerves of the extremities were affected, and a relatively large number of injuries occurred in the neck and groin. Incidence was highest in the spinal accessory nerve (14 cases), the common peroneal nerve (11 cases), the superficial radial nerve (10 cases), the genitofemoral nerve branches (10 cases), and the median nerve (nine cases). At least two thirds of the patients did not undergo surgery for the iatrogenic injury within an optimal time interval due to delayed referral. Follow-up data were available in 97 of the 126 patients. Surgical outcomes demonstrated improvement in 70% of patients. Operative results were especially favorable in patients suffering from iatrogenic injuries to the accessory and superficial sensory radial nerves. Conclusions. Iatrogenic injuries should be corrected in a timely fashion just like any other traumatic injury to nerve.

scholarly journals Do dietary intakes influence the rate of decline in anti-Mullerian hormone among eumenorrheic women? A population-based prospective investigation

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Nazanin Moslehi ◽  
Parvin Mirmiran ◽  
Fereidoun Azizi ◽  
Fahimeh Ramezani Tehrani
Keyword(s):  
Ovarian Reserve ◽  
Dairy Products ◽  
Dietary Factors ◽  
Rapid Decline ◽  
Preventive Strategy ◽  
Dietary Intakes ◽  
Rate Of Decline ◽  
Fermented Dairy ◽  
Prospective Investigation

Abstract Background Dietary intakes are suggested to affect age at menopause but associations between dietary factors and ovarian reserve reduction have not yet been investigated. We aimed to examine dietary intakes in relation to the rate of decline in anti-Mullerian hormone (AMH), an indicator of ovarian reserve, in a generally healthy cohort of women. Methods This prospective investigation was conducted among 227 eumenorrheic women, aged 20–50 years, from the Tehran Lipid and Glucose study, who were followed over a mean of 16 years. AMH was measured twice, at baseline and the 5th follow-up examination cycle, and yearly rate of decline in AMH was calculated. Rapid decline in AMH was defined as the annual percent change AMH > 5.9%/year based on tertile 3 of the variable. Average usual dietary intakes were estimated using the food frequency questionnaires administered at the second, third, and the fourth follow-up examinations. After adjusting for potential covariates, the association between dietary factors and both risk of rapid decline in AMH and also annual percent decline of AMH (as a continuous variable) were examined using logistic regression and the Spearman correlation, respectively. Results The baseline age of the participants and the median rate of decline in AMH were 37.2 years and was 5.7% yearly, respectively. The odds of rapid decline in AMH was reduced by 47% for dairy products (95% CIs = 0.36, 0.79; p = 0.002), 38% for milk (95% CIs = 0.41, 0.93; p = 0.020), and 36% for fermented dairy (95% CIs = 0.45, 0.93, p = 0.018) per one standard deviation (SD) increase in their dietary intakes. The odds of rapid decline in AMH was significantly reduced with higher intakes of fat, carbohydrate, protein, and calcium intakes from dairy sources, lactose and galactose. Annual rate of AMH decline was inversely correlated with dairy products, milk, fermented dairy, fruits, dairy carbohydrate, dairy fat, dairy protein, total calcium and dairy calcium, lactose and galactose, and positively correlated with organ meats. Conclusion Dairy foods consumption may reduce the rate of AMH decline in regularly menstruating women. Life style modification in terms of dietary advice may be considered as a preventive strategy for reduction in the rate of ovarian reserve loss.

scholarly journals A randomized controlled trial of ovarian reserve preservation and hemostasis during ovarian cystectomy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Soo Jin Park ◽  
◽  
Aeran Seol ◽  
Nara Lee ◽  
Seungmee Lee ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Ovarian Cyst ◽  
Ovarian Reserve ◽  
Controlled Trial ◽  
Reproductive Age ◽  
Hemostatic Agent ◽  
Cyst Excision ◽  
Hemostatic Agents ◽  
Ovarian Cystectomy ◽  
Randomized Controlled

AbstractThe preservation of ovarian reserve during laparoendoscopic single-site (LESS) ovarian cystectomy is crucial for reproductive-age women. This study was a single-blinded, single-center, and randomized controlled trial to evaluate the effect of hemostatic agents on the preservation of ovarian reserve and hemostasis during LESS ovarian cystectomy. Patients with unilateral ovarian cyst were randomized to the hemostatic agent and coagulation groups according to the hemostasis method. Afterwards, the patients underwent LESS ovarian cystectomy, and hemostasis was performed after ovarian cyst excision according to the assigned hemostasis method. If hemostasis was not completed within 10 min. After discharge, the patients were followed until 3 months after surgery. We compared the hemoglobin, anti-Müllerian hormone (AMH) levels, and ovarian volumes before surgery, and 2 days, 1 week, and 3 months after surgery (3 M-POST), and the decline ratio between the two groups. The decline ratio of serum AMH levels was greater at 3 M-POST in the coagulation than in the hemostatic agent group (median intention-to-treat [ITT], − 36.7 vs. − 13.3%; per-protocol [PP], − 36.8 vs. − 13.3%; P < 0.05). Notably, the difference of the decline ratio of serum AMH levels was only shown in endometriosis patients (median; ITT, − 50.7 vs. − 14.4%; PP, − 50.7% vs. − 14.4%; P < 0.05), while there was no difference in non-endometriosis patients. In conclusion, Hemostatic agents may be non-inferior to bipolar coagulation for preserving ovarian reserve and hemostasis during LESS ovarian cystectomy, in particular, for endometriosis patients. (Trial registry: ClinicalTrials.gov Identifier NCT03374397).

Increasing trend of serum antimullerian hormone level after long term follow up of endometrioma resection

2021 ◽  
pp. 228402652199046
Author(s):  
Ameneh Haghgoo ◽  
Adel Shervin ◽  
Shahla Chaichian ◽  
Mehran Ghahremani ◽  
Abolfazl Mehdizadeh Kashi ◽  
...  
Keyword(s):  
Ovarian Reserve ◽  
Reproductive Age ◽  
Complete Excision ◽  
Energy Devices ◽  
Antimullerian Hormone ◽  
Increasing Trend ◽  
Laparoscopic Cystectomy ◽  
Antimüllerian Hormone ◽  
A Prospective Study

Background: Endometriosis is a chronic disease mostly affecting women at reproductive age. Some evidence suggests that surgery of ovarian endometrioma may have a detrimental effect on ovarian reserve. The aim of this study was to evaluate the changes of serum antimullerian hormone (AMH) levels in patients with endometrioma after cystectomy. Methods: A prospective study was performed at Nikan hospital on 58 patients with endometrioma who underwent laparoscopic cystectomy. Of them, 30 had unilateral endometrioma and 28 had bilateral endometrioma. Complete excision was done, pelvic endometriosis implants as well as deep infiltrative endometriosis was resected. Sutures were made for the closure of ovarian parenchyma and bleeding control. We did not use any hot energy devices such as cautery on ovaries for ablation, coagulation or resection of endometrioma. Serum AMH levels were measured preoperatively, 3, 9, and 15 months postoperatively. Results: Serum AMH levels decreased significantly from the preoperative sample (2.98 ± 2.47 ng/ml) to 3 months after laparoscopy (1.07 ± 1.06 ng/ml), then gradually increased 9 months (1.47 ± 1.16 ng/ml) and 15 months (1.95 ± 1.85 ng/ml) after surgery, without returning to the preoperative levels during the follow-up time of study. Conclusion: There is a fluctuation pattern in AMH levels from preoperative to 15-month follow-up after endometrioma surgery using only suture for ovarian hemostasis. Firstly, there is decline in AMH level 3 months after surgery, then an increasing trend was observed gradually up to 15 months after surgery. Controlled studies are needed to compare the effects of various cystectomy methods on the ovarian reserve after endometrioma surgery

scholarly journals Evaluation of ovarian reserve in women undergoing ovarian cystectomy by laparoscopy and laparotomy

2016 ◽  
Author(s):  
Amandeep Chahal ◽  
Pushpa Dahiya
Keyword(s):  
Ovarian Reserve ◽  
Ovarian Tissue ◽  
Serum Levels ◽  
Reproductive Age ◽  
Laparoscopic Technique ◽  
Laparoscopy Group ◽  
Ovarian Cystectomy ◽  
Laparoscopic Cystectomy ◽  
Ovarian Masses ◽  
Reproductive Age Group

Ovarian cysts are one of the commonest problems encountered in the gynecological field. Majority of these cysts are functional i.e., disappear spontaneously, while few need cystectomy. Ovarian cystectomy is done by laparotomy and laparoscopic technique. The method to achieve haemostasis in the ovarian bed after cyst removal varies with the type of technique. Electrocoagulation is used to achieve haemostasis in laparoscopic cystectomy while the bleeding vessels are sutured for haemostasis in cystectomy by laparotomy. Both the modalities of management varies in terms of compromise of ovarian reserve. The study was carried out to evaluate the surgical impact of benign ovarian masses on ovarian reserve as measured by serum levels of antimullerian harmone. In this prospective study on 30 women of reproductive age group with benign ovarian masses, 15 women were enrolled for laparoscopic ovarian cystectomy and another 15 women were enrolled for cystectomy by laparotomy and ovarian reserve was measured by levels of serum AMH preoperatively, postoperative one week and postoperative 3 months using standard ELISA assay kit. The preoperative, postoperative one week and postoperative 3 months levels of mean AMH were 4.74 ± 1.86 ng/ml, 2.92 ± 1.45 ng/ml and 2.64 ± 0.96 ng/ml respectively, in women undergoing laparoscopic cystectomy and 3.98 ± 1.35 ng/ml, 2.48 ± 0.64 ng/ml and 2.11 ± 0.63 ng/ml respectively in women undergoing ovarian cystectomy by laparotomy. So there was decline of mean AMH levels in postoperative one week and postoperative 3 months samples in both of the groups of enrolled women. However, this decline varied with the type of cyst removed and is insignificantly greater in laparoscopy group, wherein electrocoagulation may cause extensive and sustained damage to ovarian tissue.

scholarly journals Effect of pessary cleaning and optimal time interval for follow-up: a prospective cohort study

2020 ◽  
Vol 31 (8) ◽  
pp. 1567-1574 ◽  
Author(s):  
Susanne D. Thys ◽  
Robert A. Hakvoort ◽  
Joyce Asseler ◽  
Alfredo L. Milani ◽  
Astrid Vollebregt ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Optimal Time ◽  
Time Interval ◽  
Serious Adverse Events ◽  
Pop Surgery ◽  
Vaginal Pain ◽  
Vas Scores

Abstract Introduction and hypothesis The objective of this study was to determine the efficacy of routine follow-up visits for pessary cleaning, the effect of extended time intervals between visits and the proportion of patients being able to self-manage their pessary for pelvic organ prolapse (POP). Methods We conducted a prospective cohort study in patients with a stage ≥II POP without previous POP surgery. All patients received a pessary as primary treatment. Our main outcome measure was a difference ≥2 in median visual analogue scale (VAS) scores (for pain, discharge, irritation) 1 week before and 1 week after cleaning. Measurements were performed after 3- and 9-month cleaning intervals. For the evaluation of the effect of cleaning, 132 patients (3 months’ follow-up) and 87 patients (12 months’ follow-up) were available for analysis. For the evaluation of the effect of the lengthening interval, 123 patients were available. Results Self-management was performed in 45.2% of patients at 1 year. In 93.1% of patients, no differences were observed in pre-and post-cleaning VAS scores (effect of cleaning) on vaginal pain. Nor was there a difference in discharge (72.4%) or irritation 85.1% (p = 0.00). No differences were observed in pre-cleaning VAS scores for vaginal pain, discharge and irritation when the interval was lengthened from 3 to 9 months. No serious adverse events occurred. Conclusions There is no proven benefit of regular follow-up visits to clean a pessary. Also, the length of the cleaning interval does not seem to matter.

Reliability of doppler ultrasound in follow-up studies

1998 ◽  
Vol 39 (2) ◽  
pp. 193-199 ◽  
Author(s):  
R. H. M. Mikkonen ◽  
J. M. Kreula ◽  
P. J. Virkkunen
Keyword(s):  
Pulsatility Index ◽  
Resistance Index ◽  
Peak Systolic Velocity ◽  
Observer Variation ◽  
Time Interval ◽  
Short Term ◽  
Doppler Us ◽  
Follow Up Studies

Purpose: to evaluate the reliability of repeat Doppler US measurements Material and Methods: Nine radiologists conducted two sets of Doppler US measurements on a healthy volunteer, with a time interval of 9 months. Peak systolic velocity (PSV), resistance index (RI), and pulsatility index (PI) were measured 10 times in 4 arteries Results: There was considerable intra- and inter-observer variation both at baseline and 9 months later. the PSV values from the carotid artery varied from 0.27 m/s to 1.95 m/s in February and from 0.22 m/s to 1.38 m/s in November. the RI values from the renal artery ranged from 0.44 to 0.71 in February and from 0.41 to 0.67 in November. the results of the 9-month follow-up varied markedly too. Best reproducibility was achieved by highly experienced radiologists both at baseline and 9 months later Conclusion: the short-term and long-term reliability of Doppler US was poor when the measurements were performed by a heterogeneous group of radiologists. the RI and PI measurements were somewhat more reliable than the PSV measurements and are recommended for use in follow-up studies

Features of the ovarian reserve of women of reproductive age suffering from autoimmune diseases

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 27-30
Author(s):  
Elena N. Andreeva ◽  
Olga R. Grigoryan ◽  
Yulia S. Absatarova ◽  
Irina S. Yarovaya ◽  
Robert K. Mikheev
Keyword(s):  
Type 1 Diabetes ◽  
Thyroid Gland ◽  
Autoimmune Diseases ◽  
Ovarian Reserve ◽  
Reproductive Potential ◽  
Reproductive Age ◽  
Control Group ◽  
Antithyroid Antibodies ◽  
Healthy Women

The reproductive potential of a woman depends on indicators of the ovarian reserve, such as the anti-Muller hormone (AMH) and the number of antral follicles (NAF). Autoimmune diseases have a significant effect on fertility and contribute to the development of premature ovarian failure. Aim.To evaluate the parameters of the ovarian reserve in patients with type 1 diabetes mellitus, carriers of antibodies to the thyroid gland in a state of euthyroidism and compare them with similar parameters in healthy women. Materials and methods.In the first block of the study, the level of AMH, follicle-stimulating hormone, luteinizing hormone, NAF was studied among 224 women with diabetes and 230 healthy women in the control group. In block II, the level of the above hormonal indices was studied in 35 carriers of antithyroid antibodies in the state of euthyroidism and 35 healthy women. Results.In patients with type 1 diabetes, the level of AMH, NAF was statistically significantly lower when compared with the control group. Among carriers of antithyroid antibodies and healthy women, no difference in AMH and NAF was found. Conclusion.The autoimmune processes accompanying diabetes are more influenced by the ovarian reserve indices than autoimmune aggression to the tissues of the thyroid gland.

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