Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2024; 12(21): 4652-4660
Published online Jul 26, 2024. doi: 10.12998/wjcc.v12.i21.4652
Comparison of ovarian preservation versus oophorectomy on fertility outcomes in patients with endometriosis post-laparoscopic surgery: A prospective study
Jin-Jin Zhou, Ke Yu, Hai-Yan Mao, Cen Li
Jin-Jin Zhou, Ke Yu, Cen Li, Department of Gynecology, Affiliated Hospital of Yangzhou University, Yangzhou 225001, Jiangsu Province, China
Hai-Yan Mao, Department of Oncology, Affiliated Hospital of Yangzhou University, Yangzhou 225001, Jiangsu Province, China
Author contributions: The concept of this study was jointly proposed by Zhou JJ and Yu K, who participated in data collection; The initial draft was drafted by Mao HY; Zhou JJ contributed to the formal analysis of this study, while Li C conducted guiding research, methodology, and visualization on the manuscript; Zhou JJ and Li C participated in this study, validated it, and jointly reviewed and edited the manuscript.
Institutional review board statement: This study was reviewed and approved by the Affiliated Hospital of Yangzhou University Ethics Committee.
Clinical trial registration statement: This study is registered at the Clinical Registry: https://www.researchregistry.com (Reviewreg1833).
Informed consent statement: This study has obtained informed consent forms signed by patients and guardians.
Conflict-of-interest statement: We declare that there is no potential conflict of interest disclosure relationship.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cen Li, MM, Doctor, Department of Gynecology, Affiliated Hospital of Yangzhou University, No. 368 Hanjiang Middle Road, Hanjiang District, Yangzhou 225001, Jiangsu Province, China. licen86@163.com
Received: April 24, 2024
Revised: May 23, 2024
Accepted: June 7, 2024
Published online: July 26, 2024
Processing time: 68 Days and 3.3 Hours
Abstract
BACKGROUND

Endometriosis is a chronic inflammatory condition affecting a significant proportion of women of reproductive age. Although laparoscopic surgery is commonly the preferred treatment, the decision to preserve or remove the ovaries remains controversial. Previous studies have yielded inconsistent results regarding the impact of ovarian preservation vs oophorectomy on fertility outcomes and disease recurrence. This prospective study aimed to address this knowledge gap by comparing the effects of these surgical approaches on spontaneous pregnancy rates, time to pregnancy, recurrence rates, and postoperative pain in patients with endometriosis.

AIM

To compare the reproductive outcomes and recurrence rates between ovarian preservation and oophorectomy in women undergoing laparoscopic surgery for endometriosis.

METHODS

This study was conducted at a tertiary care hospital between January 2019 and December 2023. A total of 312 women aged 18 to 40 years, diagnosed with endometriosis and undergoing laparoscopic surgery, were included. The patients were categorized into the ovarian preservation group (n = 204) and the oophorectomy group (n = 108). The primary outcome measure was the achievement of spontaneous pregnancy within 24 months post-surgery. Secondary outcomes included time to spontaneous pregnancy, recurrence rates, and postoperative pain scores.

RESULTS

The ovarian preservation group exhibited a significantly higher spontaneous pregnancy rate than that in the oophorectomy group (43.6% vs 28.7%, P = 0.006). Moreover, the median time to spontaneous pregnancy was shorter in the ovarian preservation group (8.2 months vs 11.4 months, P = 0.018). Nonetheless, endometriosis recurrence was more prevalent in the ovarian preservation group (22.1% vs 11.1%, P = 0.014). The postoperative pain scores demonstrated similar improvements in both groups, with no significant differences observed. Subgroup analyses indicated that the benefit of ovarian preservation on spontaneous pregnancy rates was more evident among younger women (≤ 35 years) and those with advanced-stage endometriosis.

CONCLUSION

Ovarian preservation is associated with a high spontaneous pregnancy rate and a short time to pregnancy. However, because of the increased risk of recurrence, the decision should be based on age, fertility aspirations, and disease severity.

Keywords: Endometriosis; Ovarian; Pregnancy; Oophorectomy; Laparoscopic; Spontaneous pregnancy

Core Tip: Preserving ovaries during laparoscopic surgery for endometriosis enhances spontaneous pregnancy rates and reduces time to conception. However, increased risk of disease recurrence necessitates individualized decision-making based on patient age, fertility goals, and disease severity.