Ovarian reserve in patients with borderline ovarian tumors after surgical treatment

Borderline ovarian tumors are often diagnosed in women under the age of 40 years (31.8 %), which determines the need to optimize the management of this cohort of patients, taking into account the possibility of maintaining their reproductive function. Purpose of the study. Assessment of the ovarian reserve based on a comprehensive sonographic diagnosis of the ovarian reserve in patients of reproductive age with borderline ovarian tumors. Materials and methods. Group I (n = 103) included patients with borderline serous epithelial ovarian tumors. Group II (n = 95) was formed from women with mucinous epithelial ovarian tumors. Comparison group III (n = 189) included patients with benign ovarian cystadenomas. Ultrasound scanning of the pelvic organs and color Doppler mapping (DLC) were performed using Aloka 3500, Semiens G‑60 ultrasound scanners operating in real time and equipped with a pulsed doppler using a 3.5 MHz convex sensor and a 7.5 MHz transvaginal sensor. Results. The number of antral follicles does not depend on the volume of the ovary. The healthy remaining ovarian tissue of the ovary is most pronounced in groups I and III, significantly less represented in group II (p ≤ 0.0001). Three months after adnexectomy, ovulatory function in the intact (healthy) ovary was preserved in 71% (n = 49) of women from group I; in 89% (n = 73) of patients of group II and in 93% (n = 25) of respondents of group III, with a predominance in group II (φ* = 2.7; p ≤ 0.0010 and φ* = 1.6; p ≤ 0.0500). After a conservative operation, the function of the operated (resected) ovary detected ovulation in 62% (n = 21) of group I participants; 68% (n = 9) of women of group II and 86% (n = 139) of patients of group III. After 6 months, an increase in the number of antral ovaries and the number of ovulations with a predominance of ovarian reserve in group III (p ≤ 0.0010 and p ≤ 0.0001) was generally observed. Conclusions. Integrated ultrasound is a reliable and objective method that evaluates the features of the ovulatory reserve in patients with borderline and benign ovarian tumors, which makes it possible to formulate a prognosis of a woman’s reproductive health after various types of surgical treatment.

ovulatory reserve, number of antral follicles, ovarian volume, ultrasound, borderline ovarian tumors, benign cystadenomas

1. Mangili G., Somigliana E., Giorgione V., et. al. Fertility preservation in women with borderline ovarian tumours // Cancer Treatment Reviews Volume 2016; 49; 13–24.

2. du Bois A., Trillsch F., Mahner S., Heitz F., Harter P. Management of borderline ovarian tumors // Annals of Oncology. 2016; Vol. (Suppl. 1); i20–i22.

3. Harter P., Gershenson D., Lhomme C., Lecuru F., Ledermann J., Provencher D.M. Gynecologic Cancer InterGroup (GCIG) consensus review for ovarian tumors of low malignant potential (Borderline Ovarian Tumors) // Int. J. Gynecol. Cancer. 2014; Vol. 24; 5–8.

4. Духин А.О. Репродуктивное здоровье женщин после хирургического лечения гинекологических заболеваний: автореф. дис. … канд. мед. наук: 14.00.01.– М., 2005.– 19 с.

5. Кавтеладзе Е. В. Морфофункциональное состояние яичников при эндометриозе до и после органосохраняющих операций: дис. … канд. мед. наук: 14.01.01. М., 2014.– 214 с.

6. Bath L.E., et al. Depletion of ovarian reserve in young women after treatment for cancer in childhood: detection by anti-Müllerian hormone, inhibin B and ovarian ultrasound // Hum Reprod. 2003; Vol. 18, N11; 2368–2374.

7. Chun S., Cho H.J., Ji Y.I. Comparison of early postoperative decline of serum anti-Müllerian hormone levels after unilateral laparoscopic ovarian cystectomy between patients categorized according to histologic diagnosis // Taiwan J. Obstet. Gynecol. 2016; Vol. 55, N5; 641–645.

8. Давыдова И.Ю., Карселадзе А.И., Кузнецов В.В., Максимов С. Я., Новикова Е. Г., Тюляндин С. А. и соавт. Практические рекомендации по лечению пограничных опухолей яичников // Злокачественные опухоли: Практические рекомендации RUSSCO #3s2, 2018 (том 8). С. 171–177.

9. Диагностика и лечение доброкачественных новообразований яичника с позиции профилактики рака. Клинические рекомендации (Протокол лечения). 2018.– 51 с.

10. Демидов В.Н. Эхография органов малого таза у женщин. Патология полости матки и эндометрия,– М.: БИНОМ, 2016.– 160 с.

11. Хамзин И. З. Органосохраняющие операции у пациенток с доброкачественными образованиями яичников. Состояние овариального резерва при использовании современных методов гемостаза: диc. … канд. мед. наук: 14.01.01.– М., 2018.– 188 с.

12. Сафронова Д. А. Репродуктивное здоровье женщин после органосохраняющих операций на яичниках: дис. …канд. мед. наук: 14.01.01.– М., 2011.– 130 с.

13. Chang H. J., Han S.H., Lee J.R., et al. Impact of laparoscopic cystectomy on ovarian reserve: serial changes of serum anti-Mülllerian hormone levels // Fertil. Steril. 2010; Vol. 94, N1; 343–349.

14. Денисенко М.В., Курцер М.А., Курило Л.Ф., Рабаданова А.К. Значение исследования биоптата яичника в оценке овариального резерва у пациенток с бесплодием // Российский вестник акушера-гинеколога.– 2017.– № 5.– С. 52–56.