CLINICAL ARTICLE Effect on ovarian reserve of laparoscopic bipolar electrocoagulation versus laparotomic hemostatic sutures during unilateral ovarian cystectomy Mohamed L. Mohamed a , Amal A. Nouh a , Manal M. El-Behery a, ⁎, Shymaa A.E.-A. Mansour b a Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt b Department of Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt abstract article info Article history: Received 25 October 2010 Received in revised form 4 January 2011 Accepted 7 March 2011 Keywords: Ovarian cystectomy Ovarian cysts Ovarian reserve Objective: To compare the effects of laparoscopic bipolar electrocoagulation with laparotomic hemostatic suturing during unilateral ovarian cystectomy on the ovarian reserve. Methods: A prospective randomized trial was conducted on 59 women with unilateral benign ovarian cysts who underwent laparoscopic ovarian cystectomy by a stripping technique (n = 30) or open laparotomy with hemostatic suturing (n = 29). Serum anti-Müllerian hormone (AMH), antral follicle count (AFC), and ovarian stromal peak systolic velocity (PSV) at the 1st, 3rd, and 6th postoperative cycle were used to assess the ovarian reserve. Results: Preoperative AMH levels did not differ significantly (P = 0.18) between the laparoscopy and laparotomy groups. In the laparoscopy group, there was a significant decrease in AMH levels, AFC, and PSV at the 3rd and 6th postoperative cycles compared with the 1st postoperative cycle, with an insignificant decrease between the 3rd and 6th cycles. In the laparotomy group, nonsignificant decreases in AMH levels, AFC, and PSV were detected at the 1st, 3rd, and 6th postoperative cycle and between the 3rd and 6th cycles. Conclusion: Laparoscopic ovarian cystectomy is associated with a significant reduction in ovarian reserve. This is a consequence of damage to the ovarian vascularity and the removal of an increased amount of ovarian tissue. © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. 1. Introduction The ovarian reserve is defined as the functional potential of the ovary and reflects the number of the follicles left in the ovary at any given time [1]. Over the years, various tests and markers of ovarian reserve have been reported [2]. Static tests include the age, hormonal parameters such as follicle-stimulating hormone (FSH), estradiol, luteinizing hormone (LH), anti-Müllerian hormone (AMH), and inhibin B levels and the FSH/LH ratio, and sonographic variables such as ovarian volume, antral follicle count (AFC), and ovarian stromal blood flow. Dynamic tests such as the clomifene citrate challenge test, the gonadotropin- releasing hormone agonist stimulation test, and the exogenous FSH ovarian reserve test have also been reported. Serum AMH and ovarian AFC seem to be the most sensitive noninvasive markers of ovarian reserve [3]. Transvaginal pulsed Doppler has been used to assess ovarian blood flow patterns in both natural and stimulated cycles [4]. Ovarian stromal peak systolic velocity (PSV) is the most important single independent predictor of ovarian response in women with normal basal serum FSH levels, compared with the predictive value of age, basal FSH level, estradiol level, and FSH/LH ratio [5]. Furthermore, in women undergoing ovulation induction, a low arterial ovarian stromal pulsatility index seems to be associated with a higher pregnancy rate and the use of reduced gonadotropin quantities during treatment [6]. Anti-Müllerian hormone is a member of the transforming growth factor beta superfamily [7]. It is produced by granulosa cells of preantral and small antral follicles. Its principal function is to inhibit the initiation of primordial follicle growth and it therefore has a potential role in dominant follicle selection [8]. As the ovaries run out of primordial follicles, the number of preantral follicles entering the growth phase diminishes, resulting in a fall in plasma AMH levels [9]. This makes AMH an ideal candidate for the early detection of a reduced ovarian reserve. In a study of women undergoing laparoscopic ovarian cystectomy [10], serum AMH levels were reduced at the first week postoperatively and then recovered to approximately 65% of the preoperative level at 1 and 3 months after the surgery. Laparoscopy and minilaparotomy are common approaches for the surgical removal of benign ovarian cysts. Several studies support the link between laparoscopic ovarian cystec- tomy and injury to the ovarian reserve [2,11]. Laparoscopic excision of benign ovarian cysts was associated with a statistically significant reduction in the ovarian reserve, compared with laparotomic ovarian cystectomy [2]. This was attributed to the amount of ovarian tissue removed during surgery and the damage to the ovarian vascular system during laparoscopic electrocoagulation [2]. Laparoscopic ovarian strip- ping is associated with the removal of ovarian tissue along with removal of the wall of ovarian cysts (especially endometriomas), causing loss of International Journal of Gynecology and Obstetrics 114 (2011) 69–72 ⁎ Corresponding author at: Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, 18 El Tahreer Street, 00202 Zagazig, Egypt. Tel.: +20 105277722. E-mail address: mbhry@hotmail.com (M.M. El-Behery). 0020-7292/$ – see front matter © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2011.01.010 Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo