Follicular loss in endoscopic surgery for ovarian endometriosis: Quantitative and qualitative observations

Objective: To identify a possible marker of follicular depletion in relation to some histologic parameters of endometriotic cysts. Design: Prospective study. Setting: Università Cattolica del Sacro Cuore, Operative Division of Endocrinological Gynecology. Patient(s): Seventy-seven patients (aged 20-40 years) with endometrioma. Intervention(s): Patients underwent laparoscopic surgery for ovarian endometriosis. Main Outcome Measure(s): After excision of the cyst wall, involuntarily removed follicles were correlated with age at surgery and with intrinsic histologic parameters of the specimen (thickness and composition of capsule; size of cyst). Result(s): There was a statistically significant relationship between patient age and number of follicles in the histologic section, a statistically significant inverse relationship between size of cyst and number of follicles, and no significant correlation between thickness of the capsule and number of follicles. Fibroblastic-type capsule, most frequently found in younger patients, was associated with removal of a significantly higher number of follicles. Conclusion(s): Our study suggests that patient age and cyst dimension are related to the histologic composition of the capsule, which is a marker of the aggressiveness of the cyst itself. Copyright © 2011 American Society for Reproductive Medicine, Published by Elsevier Inc.