Surgical removal of ovarian cysts: helpful or harmful?

Infertility, or the inability to conceive, affects 5-15% of couples worldwide. Endometriosis is a common health problem among women and is one of the leading causes of female infertility. It is a type of ovarian cyst or abnormal growth. It happens when tissue that is normally found in the uterus (womb) grows in other places outside of the uterus, such as the ovaries. Endometriosis can make it difficult for women to become pregnant due to build up of scar tissue in the ovaries and fallopian tubes, important organs for the development of the egg. 

 

Treatment for endometriosis includes medication to reduce painful symptoms. Another option is surgery to remove the build up of tissue. Surgery is performed to increase the quantity of eggs available, also known as ovarian reserve. However, recent studies suggest that surgery may actually reduce ovarian reserve. 

The authors argue that the evidence is not strong enough to recommend against surgery for treatment of endometriosis. The findings that surgery may reduce ovarian reserve were based on the measurement of a blood marker called anti-müllerian hormone (AMH) following surgery. It is typically used as an indicator of ovarian reserve. However, AMH is not a perfect marker, and this result was only seen in 50% of the studies.

 

The authors argue that antral follicle count (AFC) may be a more accurate method of determining ovarian reserve. Here, ultrasound is used to count the number of eggs a woman has at a point in time. Out of 7 studies where women had surgery to treat endometriosis, 3 showed overall increased follicle counts (groups of cells containing an egg) and 4 showed no change in follicle counts after surgery. The authors state that this indicates that surgery does not damage ovarian reserve and may even improve it.

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