Impact of endometrioma surgery on ovarian reserve: a prospective, randomized, pilot study comparing stripping with CO(2) laser vaporization in patients with bilateral endometriomas

OBJECTIVE: To assess ovarian reserve through antral follicle count (AFC) and ovarian volume (OV) determination after decapsulation (stripping technique) or CO(2) laser vaporization in the surgical treatment of patients with bilateral ovarian endometriomas. METHODS: This prospective, randomized, blinded, self-controlled pilot study was set in a tertiary university hospital between January 2017 and December 2017, and included consecutive patients with bilateral ovarian endometriomas ≥3 cm. The study was registered with ClinicalTrials.gov under the title ‘Impact on ovarian reserve according to the type of ovarian endometrioma excision: laser versus conventional cystectomy’; NCT 03826355. For each patient, the endometrioma on one side was randomly selected to undergo CO(2) laser vaporization and the contralateral endometrioma to undergo laparoscopic decapsulation. RESULTS: A total of 16 patients were included. There were no statistically significant between-group differences in OV and AFC levels at baseline. At the 6-month follow-up, OV and AFC levels were significantly higher in the laser-treated group versus the stripping technique. CONCLUSION: Lower OV and AFC levels following excisional surgery for endometrioma versus CO(2) laser vaporization suggest a higher impact on ovarian reserve after the stripping procedure.