Impact of endometrioma surgery on ovarian reserve: a prospective, randomized, pilot study comparing stripping with CO 2 laser vaporization in patients with bilateral endometriomas.

Objective: To assess ovarian reserve through antral follicle count (AFC) and ovarian volume (OV) determination after decapsulation (stripping technique) or CO ₂ laser vaporization in the surgical treatment of patients with bilateral ovarian endometriomas.
Methods: This prospective, randomized, blinded, self-controlled pilot study was set in a tertiary university hospital between January 2017 and December 2017, and included consecutive patients with bilateral ovarian endometriomas ≥3 cm. The study was registered with ClinicalTrials.gov under the title 'Impact on ovarian reserve according to the type of ovarian endometrioma excision: laser versus conventional cystectomy'; NCT03826355. For each patient, the endometrioma on one side was randomly selected to undergo CO ₂ laser vaporization and the contralateral endometrioma to undergo laparoscopic decapsulation.
Results: A total of 16 patients were included. There were no statistically significant between-group differences in OV and AFC levels at baseline. At the 6-month follow-up, OV and AFC levels were significantly higher in the laser-treated group versus the stripping technique.
Conclusion: Lower OV and AFC levels following excisional surgery for endometrioma versus CO ₂ laser vaporization suggest a higher impact on ovarian reserve after the stripping procedure.