IMPACTUL CHIRURGIEI ENDOMETRIOMULUI OVARIAN ASUPRA FERTILITĂŢII

Abstract

Introducere. Endometriomul ovarian reprezintă o cauză semnificativă de infertilitate şi se tratează prin excizie la-paroscopică completă sau metode conservatoare (drenaj, ablaţie). Aceste tehnici diferă în eficacitate şi impact asupra rezervei ovariene, necesitând o evaluare atentă a efectelor asupra fertilităţii. Scop. Analiza comparativă a efectelor chistectomiei laparoscopice şi ale metodelor conservatoare, precum drenajul şi ablaţia, asupra fertilităţii şi rezervei ovariene la femeile cu endometriom ovarian. Material şi metode. A fost efectuată o revizuire sistematică a literaturii publicate între 2019 şi 2024, utilizând PubMed, Medline, Scopus, Cochrane şi Google Scholar. Au fost selectate 38 de studii originale, 12 meta-analize şi 7 articole de sinteză. Analiza a vizat recurenţa, AMH şi rata sarcinilor spontane. Au fost utilizate testul Chi-pătrat şi analiza Cox. Rezultate. Analiza comparativă a tehnicilor chirurgicale pentru tratamentul endometrioamelor ovariene arată că excizia laparo-scopică completă reduce semnificativ rata recurenţei faţă de drenaj sau ablaţia peretelui chistului (12% vs. 33%, p Concluzii. Excizia laparoscopică endometriomului ovarian asigură un control mai bun al bolii şi creşte rata sarcinilor spontane comparativ cu metodele conservatoare. Studiul demonstrează că metoda de tratament trebuie aleasă în funcţie de vârsta pacientei, dimensiunea chistului şi dorinţa reproductivă.

Introduction. Ovarian endometrioma is a major cause of infertility and is treated by complete laparoscopic excision or conservative methods such as drainage and ablation. These approaches differ in efficacy and impact on ovarian reserve, requiring careful evaluation of their effects on fertility outcomes. Objective. Comparative analysis of the effects of laparoscopic cystectomy and conservative methods, such as drainage and ablation, on fertility and ovarian reserve in women with ovarian endometrioma. Material and methods. A systematic review of literature from 2019 to 2024 was performed using PubMed, Medline, Scopus, Cochrane, and Google Scholar. Thirty-eight original studies, 12 meta-analyses, and 7 reviews were included. The analysis assessed recurrence, AMH levels, and spontaneous pregnancy rates using Chi-square and Cox regression tests. Results. A comparative analysis of surgical techniques for ovarian endometrioma treatment demonstrates that complete laparoscopic excision significantly lowers recurrence rates compared to drainage or cyst wall ablation (12% vs. 33%, p < 0.01). However, this approach is associated with a greater reduction in ovarian reserve, as measured by serum AMH levels, which decrease by an average of 35% following excision versus approximately 12% after conservative procedures (p < 0.05). Additionally, spontaneous pregnancy rates are significantly higher post-excision, approximately 50% compared to 27% following drainage or ablation (p < 0.05). Conclusion. Laparoscopic excision of ovarian en-dometrioma offers superior disease control and a higher rate of spontaneous pregnancies compared to conservative approaches. The study highlights that treatment selection should be individualized, taking into account patient age, cyst size, and reproductive goals.