Indicators of the reproductive function after endoscopic surgical treatment of uterine myomas
https://doi.org/10.17749/2313-7347.2019.13.4.297-304
Abstract
Aim: to characterize the function of the reproductive system in women after organ-preserving surgery for uterine myoma: hysteroresectoscopic (HRS) myomectomy and laparoscopic (LS) myomectomy.
Materials and methods. Forty one patients were examined and divided into 2 groups: Group 1 – 18 patients after HRS myomectomy and Group 2 – 23 patients after LS myomectomy. The control group included 20 healthy women of reproductive age.
Results. The HRS operation led to a significant decrease in the production of anti-Mullerian hormone (AMH), estradiol and progesterone, while the levels of luteinizing (LH) and follicle-stimulating (FSH) hormones increased. After myomectomy performed by the laparoscopic access, the levels of estradiol, progesterone, and AMH decreased but the levels of both LH and FSH increased so that the ratio LH/FSH remained unchanged. Almost all indices of gonadotropic and steroid hormone production became normalized over 6 months of the postoperative period.
Conclusion. The main factors of unfavorable prognosis in patients with ovarian tecoma are tumor necrosis, degree of malignancy and mitotic activity.
About the Authors
M. M. Vysotskiy
A.Y. Evdokimov State University of Medicine and Dentistry, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Maksim М. Vysotskiy – MD, PhD, Professor, Department of the Endoscopic Surgery (Head of the “Endoscopic Surgery in Gynecology” course)
20 bild. 1, Delegatskaya St., Moscow 127473, Russia.
I. I. Kuranov
S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
Russian Federation
Russian Federation
Ivan I. Kuranov – MD, Gynecologist, Department of Gynecology № 22
5 2nd Botkinsky passage, Moscow 125284, Russia.
O. B. Nevzorov
A.Y. Evdokimov State University of Medicine and Dentistry, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Oleg B. Nevzorov – PhD, Associate Professor, Department of Obstetrics and Gynecology
20 bild. 1, Delegatskaya St., Moscow 127473, Russia.
References
1. Dolmans M.M., Donnez J., Fellah L. Uterine fibroid management: Today and tomorrow. J Obstet Gynaecol Res. 2019;45(7):1222–9. DOI: 10.1111/jog.14002.
2. Bendifallah S., Brun J.L., Fernandez H.J. Myomectomy for infertile women: the role of surgery. Gynecol Obstet Biol Reprod. 2011;40(8):885–901. DOI: 10.1016/j.jgyn.2011.09.014.
3. Beyan E., Kanmaz A.G., İnan A.H. et al. Evaluation of occult uterine leiomyosarcomas. Ginekol Pol. 2019;90(8):433–7. DOI: 10.5603/GP.2019.0075.
4. Sidorova I.S., Unanyan A.L., Ageev M.B. et al. Current status of the pathogenesis, clinical features, diagnosis, and treatment of uterine fibroids in women of reproductive age. [Sovremennoe sostoyanie voprosa o patogeneze, klinike, diagnostike i lechenii miomy matki u zhenshchin reproduktivnogo vozrasta]. Akusherstvo, ginekologiya i reprodukciya. 2012;6(4):22–8. (In Russ.).
5. Legendre G., Brun J.L., Fernandez H. The place of myomectomy in woman of reproductive age. J Gynecol Obstet Biol Reprod (Paris). 2011;40(8):875–84. DOI: 10.1016/j.jgyn.2011.09.023.
6. Bourdel N., Bonnefoy C. Hysteroscopic myomectomy: recurrence and satisfaction survey at short- and long-term. J Gynecol Obstet Biol Reprod (Paris). 2011;40(2):116–22. (In French). DOI: 10.1016/j.jgyn.2011.01.003.
7. Li M.H., Leng J.H., Shi J.H et al. Comparison of postoperative residue, recurrence and pregnancy outcome between laparoscopic and transabdominal myomectomy. Zhonghua Fu Chan Ke Za Zhi. 2011;4(9):669–73. (In Chinese).
8. Agdi M., Tulandi T. Endoscopic management of uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2008;22(4):707–16. DOI: 10.1016/j.bpobgyn.2008.01.011.
9. American College of Obstetricians and Gynecologists. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol. 2008;112(2 Pt 1):387–400. DOI: 10.1097/AOG.0b013e318183fbab.
10. Panagiotopoulou N., Nethra S., Karavolos S. et al. Uterine-sparing minimally invasive interventions in women with uterine fibroids: A systematic review and indirect treatment comparison meta-analysis. Acta Obstet Gynecol Scand. 2014;93(9):858–67. DOI: 10.1111/aogs.12441.
11. Tal R., Seifer D.B. Ovarian reserve testing: a user’s guide. Am J Obstet Gynecol. 2017;217(2):129–40. DOI: 10.1016/j.ajog.2017.02.027.
12. Ulrich N.D., Marsh E.E. Ovarian reserve testing: A review of the options, their applications, and their limitations. Clin Obstet Gynecol. 2019;62(2):228–37. DOI: 10.1097/GRF.0000000000000445.
13. Ebner T., Sommergruber M., Moser M. et al. Basal level of anti- Müllerian hormone is associated with oocyte quality in stimulated cycles. Hum Reprod. 2006;21(8):2022–6. DOI: 10.1093/humrep/del127.
14. Sosnova E.A., Gasimova U.R. How to assess the state of the ovarian reserve after conservative surgical interventions on pelvic organs in women of reproductive age. [Ocenka sostoyaniya ovarial’nogo rezerva posle organosohranyayushchih metodov operativnogo lecheniya po povodu dobrokachestvennyh obrazovanij organov malogo taza u zhenshchin reproduktivnogo vozrasta]. Voprosy ginekologii, akusherstva i perinatologii. 2014;13(3):44–51. (In Russ.).
15. Alessandri F., Lijoi D., Mistrangelo E. et al. Randomized study of laparoscopic versus minilaparotomic myomectomy for uterine myomas. J Minim Invasive Gynecol. 2006;13(2):92–7. DOI: 10.1016/j.jmig.2005.11.008.
16. Vargas M.V., Larson K.D., Sparks A. et al. Association of operative time with outcomes in minimally invasive and abdominal myomectomy. Fertil Steril. 2019;111(6):1252–8. DOI: 10.1016/j.fertnstert.2019.02.020.
17. Kira E.F., Politova A.K., Gudebskaya V.A., Kuzmichev V.S. The role of laparoscopic robot-assisted myomectomy in the restoration of fertility in patients with uterine myoma in the reproductive period. [Rol’laparoskopicheskoj robot-assistirovannoj miomektomii pri vosstanovlenii fertil’nosti u bol’nyh s miomoj matki v reproduktivnom periode]. Akusherstvo i ginekologiya. 2016;(3):58–63. (In Russ.).
18. Hehenkamp W.J., Looman C.W., Themmen A.P. et al. Anti-Müllerian hormone levels in the spontaneous menstrual cycle do not show substantial fluctuation. J Clin Endocrinol Metab. 2006;91(10):4057–63. DOI: 10.1210/jc.2006-0331.
19. Zhang Y., Hua K.Q. Patients’ age, myoma size, myoma location, and interval between myomectomy and pregnancy may influence the pregnancy rate and live birth rate after myomectomy. J Laparoendosc Adv Surg Tech A. 2014;24(2):95–9. DOI: 10.1089/lap.2013.0490. 20.
20. Dubuisson J.B., O’Leary T., Feki A. et al. Laparoscopic myomectomy. Minerva Ginecol. 2016;68(3):345–51.
21. Arthur R., Kachura J., Liu G. et al. Laparoscopic myomectomy versus uterine artery embolization: long-term impact on markers of ovarian reserve. J Obstet Gynaecol Can. 2014;36(3):240–7. (In French). DOI: 10.1016/ S1701-2163(15)30632-0.
22. Sanders A.P., Norris S., Tulandi T., Murji A. Reproductive outcomes following uterine artery occlusion at the time of myomectomy: systematic review and meta-analysis. J Obstet Gynaecol Can. 2019 Oct 31. pii: S1701-2163(19)30661-9. DOI: 10.1016/j.jogc.2019.06.011.
Review
For citations:
Vysotskiy M.M., Kuranov I.I., Nevzorov O.B. Indicators of the reproductive function after endoscopic surgical treatment of uterine myomas. Obstetrics, Gynecology and Reproduction. 2019;13(4):297-304. (In Russ.) https://doi.org/10.17749/2313-7347.2019.13.4.297-304
Views: 776
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Email this article 
