Preservation of Ovarian Reserve: Study Compares Haemostasis Methods

Approximately 6.6% of women of reproductive age commonly present with ovarian cysts in gynecological practice. Recent study aimed to assess the impact of three different haemostasis methods (bipolar energy, suture, and haemostatic sealant) on ovarian reserve in patients undergoing ovarian cystectomy. The authors conducted a pairwise meta-analysis and network meta-analysis (NMA) to compare the mean postoperative reduction of anti-Müllerian hormone (AMH) levels in the different groups and determine the optimal haemostasis method for ovarian reserve preservation.

Comparison Results

The results of the direct meta-analysis comparison showed that the mean postoperative reduction of AMH levels was significantly higher in the electrocoagulation (bipolar) group than the suture and haemostatic sealant groups. Additionally, in the NMA, the reduction of postoperative AMH levels in the electrocoagulation (bipolar) group was higher than the suture group at 6 months with statistical significance, and at 1, 3, and 12 months without significant difference. The comprehensive ranking results revealed that suture treatment was beneficial for the protection of ovarian reserve and was considered the best choice.

The study included 10 prospective, randomized controlled trials assessing the impact of different haemostasis methods. It was found that electrocoagulation was associated with a more significant decline in serum AMH levels than alternative haemostatic methods, such as suture and haemostatic sealant. The network meta-analysis indicated that the suture was likely the best haemostasis, while electrocoagulation was the worst.

Implications and Recommendations

The study suggested that haemostasis by electrocoagulation (bipolar) should be avoided when possible, and the suture was considered the best choice for ovarian reserve preservation. The authors also highlighted the need for further well-designed randomized controlled trials and high-quality evidence to better guide clinical practice. Overall, the study emphasized the importance of choosing the appropriate haemostasis method to preserve ovarian reserve during ovarian cystectomy, especially in women with fertility desires. The study acknowledged some limitations, such as the limited number of included trials, variations in inclusion and exclusion criteria, and the reliance on AMH as the sole indicator of ovarian reserve. Despite these limitations, the findings of the study provide valuable insights into the comparative impacts of different haemostasis methods on ovarian reserve in patients undergoing ovarian cystectomy.

Key Points

- The study aimed to assess the impact of three different haemostasis methods (bipolar energy, suture, and haemostatic sealant) on ovarian reserve in patients undergoing ovarian cystectomy through pairwise and network meta-analyses.

- The direct meta-analysis comparison revealed that the mean postoperative reduction of anti-Müllerian hormone (AMH) levels was significantly higher in the bipolar energy (electrocoagulation) group than the suture and haemostatic sealant groups. The network meta-analysis also indicated a higher reduction in AMH levels in the bipolar group compared to the suture group at 6 months with statistical significance and at 1, 3, and 12 months without a significant difference.

- The study included 10 prospective, randomized controlled trials and found that electrocoagulation was associated with a more significant decline in serum AMH levels than alternative haemostatic methods, with the suture being identified as the best haemostasis method for ovarian reserve preservation.

- The study recommended avoiding haemostasis by electrocoagulation when possible and highlighted the suture as the best choice for preserving ovarian reserve during ovarian cystectomy. It emphasized the importance of choosing the appropriate haemostasis method, especially in women with fertility desires.

- The study acknowledged limitations, such as the limited number of included trials, variations in inclusion and exclusion criteria, and the reliance on AMH as the sole indicator of ovarian reserve, but provided valuable insights into the comparative impacts of different haemostasis methods on ovarian reserve in patients undergoing ovarian cystectomy. - The authors also emphasized the need for further well-designed randomized controlled trials and high-quality evidence to better guide clinical practice in preserving ovarian reserve during ovarian cystectomy.

Reference –

Qin Xie, Yue Xie, Ying Shi, Xiaozhen Quan & Xuezhou Yang (2024) Impact of haemostasis methods during ovarian cystectomy on ovarian reserve: a pairwise and network meta-analysis, Journal of Obstetrics and Gynaecology, 44:1, 2320294, DOI:10.1080/01443615.2024.2320294