Does ovarian cystectomy pose a risk to ovarian reserve and fertility? TOG 2020 Flashcards
Treatment got persistent function ovarian cyst?
prolonged downregualrtion - POP/COCP
Last resort - USS or Lap drainage
Most common pathological cyst in premenopausal women
Dermoid cyst
What proportion of dermoid cysts are bilateral
10-20%
How fast do dermoids grow?
1.8mm/year
Recurrence of dermoid cysts after cystectomy?
3-4%
Do dermoid cysts reduce fertility
No but treatments can - especially if repeat surgery, bilateral surgery, large cystectomies.
Better to operate early
What proportion of endometriomas are bilateral?
28%
Recurrence rates of endometriomas after cystectomy?
30%
Detorsion of ischaemic ovary preserves what proportion of ovarian functino
91%
Detorsion should remain topical teatment in girls and premenopausal women
Can offer elective cystectomy 2-3 weeks later
With stripping techniques - what proportion of ovarian tissues was inadvertently excised with cyst wall
- endometriotic cysts
- non endometriotic cyst
- endometriotic cysts 54%
- non endometriotic cyst 6%
Effect of cystectomy on ovarian function represented by AMH
30% decrease in AMH
- Higher risk if large cyst, bilateral or oopherectomy performed
Clinical considerations when deciding on performing surgery for endometriomas before IVF
Lap suturing vs bipolar?
Suturing has better AMH/AFC than bipolar
Which women should have assessment for ovarian reserve before cystectomy
- Repeat surgery - same or contralateral ovary
- Dx severe endometriosis/bilateral endoemtioma
- co-existant aetiologioes for subfertility (including low sperm count in male)
- advanced reproductive age
- Women with coexistent RF for POI
If ovarian reserve is already compromised - what to consider
Fertility preservation before cystectomy
How to perform cystectomy for non-endometriotic cysts
