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• W2073062024 abstract "We compared antral follicle count in ovaries harboring different types of cysts to the contralateral normal ovaries. Besides endometrioma, the presence of other types of ovarian cysts does not influence the antral follicle count. We compared antral follicle count in ovaries harboring different types of cysts to the contralateral normal ovaries. Besides endometrioma, the presence of other types of ovarian cysts does not influence the antral follicle count. In the past decade, antral follicle count (AFC) has become one of the parameters for determining ovarian reserve (1Hendriks D.J. Mol B.W. Bancsi L.F. Te Velde E.R. Broekmans F.J. Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: a meta-analysis and comparison with basal follicle-stimulating hormone level.Fertil Steril. 2005; 83: 291-301Abstract Full Text Full Text PDF PubMed Scopus (296) Google Scholar). It provides a good correlation with the outcome of treatment with assisted reproductive technology (ART) (2Bancsi L.F. Broekmans F.J. Eijkemans M.J. de Jong F.H. Habbema J.D. te Velde E.R. Predictors of poor ovarian response in in vitro fertilization: a prospective study comparing basal markers of ovarian reserve.Fertil Steril. 2002; 77: 328-336Abstract Full Text Full Text PDF PubMed Scopus (371) Google Scholar, 3Eldar-Geva T. Ben-Chetrit A. Spitz I.M. Rabinowitz R. Markowitz E. Mimoni T. et al.Dynamic assays of inhibin B, anti-Mullerian hormone and estradiol following FSH stimulation and ovarian ultrasonography as predictors of IVF outcome.Hum Reprod. 2005; 20: 3178-3183Crossref PubMed Scopus (222) Google Scholar, 4Popovic-Todorovic B. Loft A. Lindhard A. Bangsboll S. Andersson A.M. Andersen A.N. A prospective study of predictive factors of ovarian response in ‘standard’ IVF/ICSI patients treated with recombinant FSH: a suggestion for a recombinant FSH dosage normogram.Hum Reprod. 2003; 18: 781-787Crossref PubMed Scopus (157) Google Scholar, 5Broekmans F.J. Kwee J. Hendriks D.J. Mol B.W. Lambalk C.B. A systematic review of tests predicting ovarian reserve and IVF outcome.Hum Reprod Update. 2006; 12: 685-718Crossref PubMed Scopus (921) Google Scholar). Today, AFC is considered to be one of the best clinical predictors of ovarian response in ART. Antral follicle count does not appear to be influenced by the use of gonadotropin-releasing hormone agonist (GnRH-a), oral contraceptives, or ovulation inducing agents (6Cedrin-Durnerin I. Bstandig B. Parneix I. Bied-Damon V. Avril C. Decanter C. et al.Effects of oral contraceptive, synthetic progestogen or natural estrogen pre-treatments on the hormonal profile and the antral follicle cohort before GnRH antagonist protocol.Hum Reprod. 2007; 22: 109-116Crossref PubMed Scopus (73) Google Scholar, 7Ng E.H. Chan C.C. Tang O.S. Ho P.C. Antral follicle count and FSH concentration after clomiphene citrate challenge test in the prediction of ovarian response during IVF treatment.Hum Reprod. 2005; 20: 1647-1654Crossref PubMed Scopus (39) Google Scholar, 8Sharara F.I. Lim J. McClamrock H.D. The effect of pituitary desensitization on ovarian volume measurements prior to in-vitro fertilization.Hum Reprod. 1999; 14: 183-185Crossref PubMed Scopus (33) Google Scholar, 9Yu Ng E.H. Chi Wai Chan C. Tang O.S. Shu Biu Yeung W. Chung Ho P. Effect of pituitary downregulation on antral follicle count, ovarian volume and stromal blood flow measured by three-dimensional ultrasound with power Doppler prior to ovarian stimulation.Hum Reprod. 2004; 19: 2811-2815Crossref PubMed Scopus (35) Google Scholar). In addition, the count is independent of the phase of the menstrual cycle (10Broekmans FJ, de Ziegler D, Howles CM, Gougeon A, Trew G, Olivennes F. The antral follicle count: practical recommendations for better standardization. Fertil Steril. Published online July 7, 2009.Google Scholar). However, the effect of ovarian cysts on AFC is unclear. Our study evaluated the influence of different types of ovarian cysts on the number of antral follicles. We examined all records of baseline transvaginal ultrasounds performed between November 2007 and September 2009 at McGill University Health Center in Montreal. We found 273 women with unilateral ovarian cyst had undergone a baseline ultrasound using two-dimensional (2D) transvaginal sonography (Voluson E8 ultrasound machine; GE Healthcare, Milwaukee, WI) between days 2 and 4 of the menstrual cycle. Our patient population was heterogeneous, and the patients were subsequently treated with various fertility treatments. Two experienced ultrasonographers counted the number antral follicles that were 2 to 10 mm in diameter (antral follicle count). The size of the follicles was measured using the internal diameter of the sonolucent area. For ovoid follicles, the mean diameter was calculated using two dimensions. The ultrasound ovarian findings were subdivided into four categories: functional cyst (including simple cysts and hemorrhagic), endometrioma, dermoid cysts, and multiloculated cysts. We excluded paraovarian cysts and cysts that could not be categorized. Women with polycystic ovaries and women with a past history of ovarian surgery were excluded from the study. We measured the diameter of the cyst in three dimensions, and the average was calculated. The AFC in the ovary that contained the cyst and the contralateral ovary were compared. Institutional review board approval was not requested because the nature of the study was retrospective. We analyzed the data for normal distribution using the Shapiro-Wilk test. As the data were not normally distributed, we compared continuous variables using Wilcoxon's signed rank test. P<.05 was required to reject the null hypothesis. Of 2864 women who underwent baseline ultrasound examination, we found 273 women with an ovarian cyst (9.5%). The number of women with functional, endometriotic, dermoid, or multiloculated cysts was 198 (72.5%), 53 (19.4%), 14 (5.1%), and 8 (2.9%), respectively, and their mean age was 34.1 ± 0.3, 33.3 ± 0.6, 34.2 ± 1.2, 32.7 ± 1.6 years (± SD), respectively. The mean diameter was 1.9 ± 0.07 cm (± SD) for functional cysts, 2.7 ± 0.2 cm (± SD) for endometrioma, 2.1 ± 0.3 cm (± SD) for dermoid cysts, and 2.3 ± 0.3 cm (± SD) for multiloculated cysts. Overall, the AFC of the ovary that contained a cyst (8.4 ± 0.4) was comparable (P=.19; 95% CI, 0 to –1) with those that did not contain a cyst (8.8 ± 0.4). The AFC in an ovary that had a functional, dermoid, or multiloculated cyst was not statistically significantly different from that of the contralateral ovary that did not contain a cyst (Table 1). However, an ovary that contained an endometrioma had a statistically significantly lower AFC (7.5 ± 0.7) than the contralateral ovary (9.3 ± 0.9; P<.05; 95% CI, –2.5 to 0). There was no correlation between increasing size of the endometrioma and the AFC (correlation coefficient [r] = –0.17). Of the 53 women with endometrioma, 39 (73.5%) were found in the left ovary and 14 (26.5%) in the right ovary.Table 1Antral follicle count in the ovary that contained a cyst and in the contralateral ovary.Antral follicle countOvary with cystOvary with no cystP value95% CIFunctional cyst8.5 ± 0.78.8 ± 0.6.39–1.0 to 0.0Dermoid cyst11.9 ± 2.39.2 ± 1.6.16–0.5 to 6.5Endometrioma7.5 ± 0.79.3 ± 0.9.03–2.5 to 0.0Multiloculated cyst7.2 ± 2.97.5 ± 2.0.9–5.0 to 4.5 Open table in a new tab The finding of ovarian cyst during a baseline transvaginal ultrasound is not uncommon among infertile women. Our study found that the presence of ovarian endometrioma decreased the AFC. However, AFC was not affected by the presence of other types of ovarian cyst. We evaluated only women with unilateral ovarian cyst, but the results could be extrapolated to women with bilateral ovarian cysts. Our observations support previous reports that showed consistency of AFC under different conditions (6Cedrin-Durnerin I. Bstandig B. Parneix I. Bied-Damon V. Avril C. Decanter C. et al.Effects of oral contraceptive, synthetic progestogen or natural estrogen pre-treatments on the hormonal profile and the antral follicle cohort before GnRH antagonist protocol.Hum Reprod. 2007; 22: 109-116Crossref PubMed Scopus (73) Google Scholar, 7Ng E.H. Chan C.C. Tang O.S. Ho P.C. Antral follicle count and FSH concentration after clomiphene citrate challenge test in the prediction of ovarian response during IVF treatment.Hum Reprod. 2005; 20: 1647-1654Crossref PubMed Scopus (39) Google Scholar, 8Sharara F.I. Lim J. McClamrock H.D. The effect of pituitary desensitization on ovarian volume measurements prior to in-vitro fertilization.Hum Reprod. 1999; 14: 183-185Crossref PubMed Scopus (33) Google Scholar, 9Yu Ng E.H. Chi Wai Chan C. Tang O.S. Shu Biu Yeung W. Chung Ho P. Effect of pituitary downregulation on antral follicle count, ovarian volume and stromal blood flow measured by three-dimensional ultrasound with power Doppler prior to ovarian stimulation.Hum Reprod. 2004; 19: 2811-2815Crossref PubMed Scopus (35) Google Scholar). Increased knowledge of the relationship between ovarian cysts and AFC can assist physicians in choosing the type of protocol and the dosage of gonadotropins for ART. The decreased AFC in an ovary that contains an endometrioma could be explained by the effects of endometriosis on the granulosa cells, follicles, and oocytes (11Gupta S. Agarwal A. Agarwal R. Loret de Mola J.R. Impact of ovarian endometrioma on assisted reproduction outcomes.Reprod Biomed Online. 2006; 13: 349-360Abstract Full Text PDF PubMed Scopus (112) Google Scholar). Granulosa cell apoptosis increases proportionally with the severity of disease (12Fujino K. Yamashita Y. Hayashi A. Asano M. Morishima S. Ohmichi M. Survivin gene expression in granulosa cells from infertile patients undergoing in vitro fertilization-embryo transfer.Fertil Steril. 2008; 89: 60-65Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar, 13Harada T. Kaponis A. Iwabe T. Taniguchi F. Makrydimas G. Sofikitis N. et al.Apoptosis in human endometrium and endometriosis.Hum Reprod Update. 2004; 10: 29-38Crossref PubMed Scopus (190) Google Scholar). Moreover, it has been suggested that reactive oxygen species, which cause oxidative stress, are produced from erythrocytes and apoptotic endometrioma cells (14Gupta S. Agarwal A. Krajcir N. Alvarez J.G. Role of oxidative stress in endometriosis.Reprod Biomed Online. 2006; 13: 126-134Abstract Full Text PDF PubMed Scopus (148) Google Scholar). The follicular fluid of women with endometriosis also has been reported to contain increased concentrations of interleukins 6, 1β, and 10, and tumor necrosis factor-α as well as decreased levels of vascular endothelial growth factor (15Bulun S. Endometriosis is an estrogen-dependent inflammatory disease that affects 5 to 10% of women of reproductive age in the United States.N Engl J Med. 2009; 360: 268-279Crossref PubMed Scopus (1415) Google Scholar, 16Garcia-Manero M. Alcazar J.L. Toledo G. Vascular endothelial growth factor (VEGF) and ovarian endometriosis: correlation between VEGF serum levels, VEGF cellular expression, and pelvic pain.Fertil Steril. 2007; 88: 513-515Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 17Kyama C.M. Overbergh L. Debrock S. Valckx D. Vander Perre S. Meuleman C. et al.Increased peritoneal and endometrial gene expression of biologically relevant cytokines and growth factors during the menstrual phase in women with endometriosis.Fertil Steril. 2006; 85: 1667-1675Abstract Full Text Full Text PDF PubMed Scopus (121) Google Scholar, 18Martinez S. Garrido N. Coperias J.L. Pardo F. Desco J. Garcia-Velasco J.A. et al.Serum interleukin-6 levels are elevated in women with minimal-mild endometriosis.Hum Reprod. 2007; 22: 836-842Crossref PubMed Scopus (72) Google Scholar). It is possible that the changes related to the presence of endometriosis may locally impair the antral follicles. However, we also found that the effect on AFC was not correlated with the size of the endometrioma. This is consistent with the finding that the mere presence of an ovarian cyst does not impair AFC. This suggests that endometriosis itself, not the endometriosis-related cyst, affects AFC. As previously reported, we also found that endometrioma had a left lateral predisposition (19Vercellini P. Aimi G. De Giorgi O. Maddalena S. Carinelli S. Crosignani P.G. Is cystic ovarian endometriosis an asymmetric disease?.Br J Obstet Gynaecol. 1998; 105: 1018-1021Crossref PubMed Scopus (115) Google Scholar, 20Al-Fozan H. Tulandi T. Left lateral predisposition of endometriosis and endometrioma.Obstet Gynecol. 2003; 101: 164-166Crossref PubMed Scopus (80) Google Scholar). A possible limitation of our study is that the type of ovarian cyst was not confirmed by histopathologic examination. However, the specificity of ultrasound diagnosis has been found to be very high (21Sokalska A. Timmerman D. Testa A.C. Van Holsbeke C. Lissoni A.A. Leone F.P. et al.Diagnostic accuracy of transvaginal ultrasound examination for assigning a specific diagnosis to adnexal masses.Ultrasound Obstet Gynecol. 2009; 34: 462-470Crossref PubMed Scopus (122) Google Scholar). The results of our study suggest that ovarian cysts that are not endometrioma do not influence the AFC. The reliability of AFC in the presence of an ovarian cyst adds to its usefulness as a clinical tool." @default.
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• W2073062024 date "2010-11-01" @default.
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• W2073062024 title "Effect of different types of ovarian cyst on antral follicle count" @default.
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