Clinico-laparoscopic correlation in infertile women

To determine which laparoscopic findings among infertile endometriotic women such as peritoneal involvement, ovarian endometrioma, tubal blockade, tuboovarian adhesions, and adenomyosis, alone or in combination best correlated with the mean number of years of infertility of the patient.

Ovulatory response after ovarian cystectomy

Objective: To determine the ovulatory response of a cystectomized ovary sonographically in the first three cycles post-op in terms of the number and diameter of pre-ovulatory follicles, development of 18 mm follicle, development of corpus luteum, and their correlation to the type of operation, use of cautery, type of ovarian pathology, and use of ovulatory drugs. Design: Prospective study Methods: Thirty (30) patients who underwent ovarian cystectomy either by laparoscopy of laparotomy from February to May 1998 were included in the study. These patients had follicular monitoring for three cycles post-op at days 14, 16 and 18. The number of pre-ovulatory follicles (/- 12 mm), the diameter (mm) of the largest follicle, onset of development of 18 mm follicle, and onset of development of corpus luteum were noted. The onset of development of 18 mm follicle was correlated to the type of operation (laparoscopy versus laparotomy), use of cautery, type of ovarian pathology (endometrial versus dermoid), and use of ovulatory drugs post-op. Statistical analysis used was student t-test. Results: The mean number of pre-ovulatory follicles (/- 12 mm) during the first three cycles was 1-2 follicles. The mean diameter of the largest follicle during the first cycle post-op was 12-16 mm and increased to 14-18 mm during the second and third cycles. The earliest 18 mm follicle was observed on day 14 of the first cycle but 75.1 percent of patients had an 18 mm follicle by day 18 of the first cycle. The type of operation, use of cautery, type of ovarian pathology, and use of ovulatory drugs post-op did not significantly alter the onset of development of an 18 mm folicle. The earliest corpus luteum was noted on day 18 of the first cycle. Conclusion: There is an adequate ovulatory response after ovarian cystectomy in the first three cycles post-op.

Recurrence of ovarian endometrioma after surgery

Objective: To determine which of the following factors at initial surgery-such as diameter of largest endometriotic cyst, number of cysts, diseases severity, type of surgery (laparoscopy versus laparotomy), or postoperative medical therapy-best correlated with the time of recurrence of ovarian endometrioma. Design: A retrospective descriptive study was performed on 25 patients who underwent initial surgical excision of endometriotic cyst and had cyst recurrence demonstrated either on ultrasound or repeat surgery. The clinical presentation of cyst recurrence was described. The operative findings of the first and second surgeries were compared. Factors which may affect the time of cyst recurrence were evaluated. Results: Cyst recurrence was demonstrated by ultrasound in 24 (96 percent) cases; repeat surgery for recurrence was done in only 10 (40 percent) cases. The different factors in the initial surgery: type of operation, size, number, and laterality of the endometriotic cyst, disease severity, adhesions and postoperative medical therapy, did not influence the time of recurrence of ovarian endometrioma. Disease severity was a significant factor on repeat surgery. Conclusion: The different factors aforementioned, which were present in the first surgery, did not influence the time of recurrence of ovarian endometrioma.