THE IMPACT OF DIFFERENT SURGICAL TREATMENTS FOR UTERINE FIBROIDS ON OVARIAN RESERVE INDICES


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Objective. To investigate ovarian reserve indices after various organ-sparing operations for uterine fibroids: hysteroresectoscopic (HRS) myomectomy, laparoscopic myomectomy, and uterine artery embolization (UAE). Subjects and methods. Ninety-two patients were examined; organ-sparing operations, such as laparoscopic and HRS myomectomies and UAE, were performed. All the examinees were divided into 3 groups: 1) 27 women after HRS myomectomy; 2) 42 patients after laparoscopic myomectomy; 3) 23 patients after UAE. A control group consisted of 20 healthy reproductive-aged women. Results. All surgical interventions lead to a significant decrease in the production of anti-Müllerian hormone (AMH) and estradiol in the presence of elevated luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels. HRS myomectomy results in a gradual restoration of ovarian reserve markers overtime at 4-6 months postsurgery. After laparoscopic myomectomy, the changes in the level of ovarian reserve markers were more pronounced and the production of gonadotropic and steroid hormones became normal at month 6 following surgery. After UAE, there was the most pronounced decline in the production of AMH and estradiol and an increase in the levels of LH and FSH; the production of AMH and estradiol significantly increased over time by the 6th postoperative month, but returned to the normal preoperative values only 10 months following surgery. Conclusion. UAE exerts the greatest impact on ovarian function, after which the changes in the hormonal status and blood flow in the uterus and ovaries remain for 10 months compared with 6 months after HRS and laparoscopic myomectomies.

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作者简介

Maxim VYSOTSKY

A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of the Russian Federation

Email: visotsky-gyn@mtu-net.ru
MD, PhD, Professor of the Department of Endoscopic Surgery, Head of the course «Endoscopic surgery in gynecology» Moscow, Russia

Ivan KURANOV

S.P. Botkin City Clinical Hospital, Moscow Healthcare Department

Email: Doktorkuranov@mail.ru
MD, Gynecologist of the 22nd Gynecological Department Moscow, Russia

Oleg NEVZOROV

A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of the Russian Federation

Email: nev266l@mail.ru
MD, PhD, Associate Professor of the Department of Obstetrics and Gynecology Moscow, Russia

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