The Prediction of Ovarian Reserve Changes after Cystectomy in Patients with Endometrioma Using the Point Scale System

Background. Ovarian endometriosis has the most aggressive effect on the ovarian reserve compared to other types of benign ovarian neoplasms. Laparoscopic cystectomy with pathomorphological verification remains the “gold standard” for the diagnosis of endometriosis in clinical practice. It is the lack of clear criteria for predicting damage to the ovarian reserve after surgical treatment and the future reproductive potential of a woman, as well as the inability to personalize treatment, that determined the purpose and objectives of this study. Aims — to develop a score scale for predicting changes in the ovarian reserve after cystectomy in ovarian endometriosis based on a comprehensive preoperative assessment of basic clinical, ultrasound, and molecular-biochemical parameters. Materials and methods. A single-center observational cohort prospective comparative study was conducted for 5 years. The study included 238 women aged 24.4 ± 3.1 years with pathomorphologically verified ovarian endometriosis, who came to the clinic with complaints of pain of varying intensity. Results. The content of anti-Muller hormone (AMH) less than 1.5 ng / ml was significantly highly correlated with the unfavorable outcome of surgery (r=0.723). The largest diameter of the formation more than 5 cm (r=0.826) and its “main” localization (r=0.743) correlated most strongly with a decrease in HR and intraovarian blood flow after cystectomy. The ROC analysis (receiver operating characteristic) and the evaluation of the area under the curve — the AUC indicator (area under ROC curve) revealed that the determining value of the “cut off” point for serum LDH was 107.35 U/l, for IL-8 — 94.55 pg/ml and IL-6 — 82.4 pg/ml, with an increase in which the probability of reducing AMH increases by more than 50%. Conclusions. The point scale system including preoperative assessment of ultrasound parameters (endometrioma size, localization, and bilaterality) and biochemical markers of toxicity in serum helps to predict changes of ovarian reserve after cystectomy (LDH, IL-6, IL-8).