Rationale for preoperative treatment of advanced-stage endometrial ovarian cysts in infertile women

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Abstract

Objective: This study aimed to optimize the preoperative treatment of advanced-stage endometrial ovarian cysts (EOC) in infertile women to ensure ovarian protection, improve endometrial receptivity, and normalize the pro-inflammatory status.

Materials and methods: A comprehensive examination and treatment were performed on 114 patients with stage III–IV EOC. Group I consisted of 65 infertile women who received differentiated treatment with GnRH antagonists or dienogest to overcome infertility preoperatively. The aim was to reduce the size of the EOC, decrease the severity of pain, preserve the ovarian reserve, normalize endometrial receptivity, and correct the inflammatory status. Group II consisted of 49 women who underwent surgical treatment for infertility, similar to the patients in Group I. The examination was conducted before the start of treatment/surgery, in the postoperative period, and after six months of waiting for spontaneous pregnancy. To obtain reference values for the studied parameters, control group III was formed consisting of 35 healthy women with intact ovaries and male factor infertility. These women underwent infertility treatment with ART.

Results: Changes in EOC size, ovarian reserve (antral follicle count, AMH, FSH, and E2 levels), sex steroid receptors, molecular markers of cellular transformation and apoptosis, levels of pro-inflammatory cytokines in the eutopic endometrium, and EOC capsules in the study groups demonstrated the protective effect of preoperative hormonal preparation against surgical trauma. These changes resulted in an increase in the spontaneous pregnancy rate by 9.3 times, pregnancy rate with the use of ART by 2.4 times, and live birth rate by 3.5 times.

Conclusion: This study demonstrated the advantage of the preoperative hormonal stage of treatment in infertile patients with advanced-stage EOC. This advantage was observed in relation to the structural and functional state of the EOC, preservation of the ovarian reserve, normalization of endometrial receptivity and pro-inflammatory state, and increased effectiveness in achieving pregnancy with favorable perinatal outcomes.

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About the authors

Igor S. Lipatov

Samara State Medical University

Email: i.lipatoff2012@yandex.ru
ORCID iD: 0000-0001-7277-7431
SPIN-code: 9625-2947
ResearcherId: С-5060-2018

Professor, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology of the Institute of Clinical Medicine

Russian Federation, Samara

Yurii V. Tezikov

Samara State Medical University

Author for correspondence.
Email: yra.75@inbox.ru
ORCID iD: 0000-0002-8946-501X
SPIN-code: 2896-6986
ResearcherId: С-6187-2018

Professor, Dr. Med. Sci., Head of the Department of Obstetrics and Gynecology of the Institute of Clinical Medicine

Russian Federation, Samara

Victor L. Tyutyunnik

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: tioutiounnik@mail.ru
ORCID iD: 0000-0002-5830-5099
SPIN-code: 1963-1359
Scopus Author ID: 56190621500
ResearcherId: B-2364-2015

Professor, Dr. Med. Sci., Leading Researcher of Research and Development Service

Russian Federation, Moscow

Natalia E. Kan

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: kan-med@mail.ru
ORCID iD: 0000-0001-5087-5946
SPIN-code: 5378-8437
Scopus Author ID: 57008835600
ResearcherId: B-2370-2015

Professor, Dr. Med. Sci., Deputy Director of Science

Russian Federation, Moscow

Darya A. Martynyuk

Samara State Medical University

Email: martynuk.darya@yandex.ru
ORCID iD: 0009-0002-3253-7382

6th year student of the Institute of Clinical Medicine

Russian Federation, Samara

Ivan S. Belousov

Samara State Medical University

Email: beloucov_ivan@icloud.com
ORCID iD: 0009-0001-0889-0218

6th year student of the Institute of Clinical Medicine

Russian Federation, Samara

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2. Fig. 1. CAF in comparison groups before treatment, after surgery and before IVF

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3. Fig. 2. AMH level in the comparison groups before treatment, after surgery and before IVF

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