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The effect of vasopressin injection on ovarian reserve in patients who had cystectomy for ovarian endometrioma; a randomized controlled trial

  • Saeed Alborzi
    Affiliations
    Full Professor of Obstetrics & Gynecology, Fellowship of Infertility and Endoscopic Gynecology, Department of Obstetrics and Gynecology, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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  • Tahereh Poordast
    Affiliations
    Associated Professor of Obstetrics & Gynecology, Fellowship of Endoscopic Gynecology, Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University Of Medical Sciences, Shiraz, Iran
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  • Elham Askary
    Correspondence
    Corresponding Author: Dr. Elham Askary, Assistant Professor of Obstetrics & Gynecology, Fellowship of Endoscopic Gynecology Address: Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Zand Street, Shiraz, Iran. Postal Code: 7134844119. Tel: +98-9171127112.
    Affiliations
    Assistant Professor of Obstetrics & Gynecology, Fellowship of Endoscopic Gynecology, Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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  • Kefayat Chamanara
    Affiliations
    Fellowship of Endoscopic Gynecology, Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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  • Ziba Zahiri Sorouri
    Affiliations
    Full Professor of Obstetrics & Gynecology, Fellowship of Infertility, Department of Obstetrics and Gynecology, School of Medicine, Laparoscopy Research Center, Guilan University of Medical Sciences, Rasht, Iran
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  • Elnaz Hosseini Najar Kellaii
    Affiliations
    Fellowship of Endoscopic Gynecology, Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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  • Siavash Pirzadeh Nahooji
    Affiliations
    Assistant Professor of Statistical Analysis, Department of Statistics, Roudehen Branch, Islamic Azad University, Tehran, Iran
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Published:December 03, 2021DOI:https://doi.org/10.1016/j.rbmo.2021.11.024

      Abstract

      Research Question

      Does injecting the vasopressin into the mesovarium during endometrioma cystectomy further preserve postoperative ovarian reserve by reducing intraoperative bleeding and electrocoagulation points?

      Design

      In this randomized controlled trial, from March 2016 to March 2020, 120 patients with unilateral and unilobulated endometrioma were included and divided into two groups. (N=60) Group 1 comprised all patients with ovarian cystectomy following vasopressin injection in the mesovarium space. Group 2, which included the controls. In both groups the anti mullerian hormone (AMH), was examined prior to operation and 3, 6 and 12 months following surgery. In both groups, the number of bipolar cauterization points and the amount of bleeding during cystectomy as well as the pain symptoms related to endometriosis and pregnancy rate were further assessed and compared.

      Results

      Compared with the vassopresine group, the controls had significantly higher hemostasis points and bleeding (P=0.0001). There was no significant difference between the two groups regarding the serum AMH level 3, 6 and 12 months following surgery. Regarding the pain symptoms associated with endometriosis, a significant reduction was reported in both groups six months after surgery (P=0.0001). There was no difference between the two groups in terms of spontaneous pregnancy, IVF (in vitro fertilization), abortion rate, and pregnancy time following surgery (P>0.05).

      Conclusion

      Despite the reduction in the amount of bleeding and electrocoagulation points in the vasopressin group, ovarian reserve had a similar downward trend in both groups, which is attributed to the nature of these cysts.

      Keywords

      Abbreviations:

      OMA (ovarian endometrioma), SUMS (Shiraz University of Medical Sciences), TVUS (transvaginal ultrasound), GNRH (gonadotropin-releasing hormone), ASRM (American society for reproductive medicine)
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      Biography

      Saeed Alborzi is Board-Certified Infertility and Gynecology Endoscopy Specialist since 2004 in Shiraz, Iran. He had innovations in the field of uterine anomaly laparoscopic surgery. He has published more than 80 articles and is a board member of several committees, to supported the community in upgrading the knowledge in the field of infertility and especially endometriosis disease.
      Key Message
      Although vasopressin reduces bleeding and the electrocoagulation points during endometrioma cystectomy, it does not contribute to maintain the post-operation ovarian reserve.