P-72: What Is Your Approach in The Treatement of Ovarin Endometrioma

Background: Endometriosis is defined as the presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature. The most common site of endometriosis is pelvis, but endometrotic implants may occur nearly anywhere in the body. Endometriosis is a common and serious gynecologic problem in reproductive age women, who have pelvic pain, dyspareunia, or infertility. The goal of this research, using immediate medical treatment after surgical laparoscopic fenestration and coagulation of the inner wall cyst procedure to improve the fertility rate in ovarian endometriomas. Materials and Methods: This clinical trial research evaluates 189 patients with primary infertility during 5 years were operated due to unresponsive to medical therapy. Women aged were 21-35 years. 17(8.9%) patients who had ovarian endometriom greater than 3 cm, which underwent surgical Laparoscopy. The technique was applied ovarian laparoscopic fenestration and coagulation of the inner wall of the endometriotic ovarian cyst in 9 to 10 points at 70 watt cutting power and a 40 watt coagulating power setting and as the probe is pushed into the capsule, electricity is activated for 3-4 seconds were performed. At the end of ovarian drilling was cooled down by irrigation using saline normal solution (500-1000 cc). The data were analyzed by SPSS. Results: The patients were followed up about 8 years.13 (76.4 %) patients from 17(8.95%) patients with ovarian endometriomas who had clinical pregnancies rates after 18 months of operation and immediate medical therapy. 10 (58.8%) patients from 13 patients had term pregnancy. 3(30%) of 10 patients had stillbirth initially and their second pregnancy was term. 3(30%) patients had 2 abortions without term pregnancy. 4(23.5%) patients have not conception yet. One (5.8%) of them have had recurrent endometriomal cyst. Conclusion: The application of ovarian laparoscopic fenestration and coagulation of the inner wall of the endometriotic ovarian cyst and immediate medical therapy is suggested. Because Conception occurred more quickly in this technique than ovarian cystectomy in literature (6% versus 22%). Recurrent pain was minimal in this research. But broader research will be needed in this field.