Effect of Vasopressin Injection Technique in Laparoscopic Excision of Unilateral Ovarian Endometriomas on Ovarian Reserve

Study Objective: To assess the efficacy of vasopressin injection in reducing anti-Müllerian hormone(AMH) decreases following surgery for unilateral endometrioma.
Design: In this randomized controlled study, patients were stratified according to AMH level, then randomly assigned to the vasopressin injection group or control group. AMH level was measured 12 months after laparoscopic surgery (primary endpoint). Analyses for the primary endpoint were performed using an independent t-test, analysis of covariance, and linear mixed model for random and fixed effects.
Setting: Tertiary university-affiliated medical center.
Patients: Seventy-five women.
Interventions: Conservative laparoscopic surgery for unilateral ovarian endometrioma with or without vasopressin injection.
Measurements and Main Results: In the intention-to-treat analysis, cyst stripping (14.38±13.68 min vs. 8.91±7.89 min, p=.054) and bleeding control (6.53±6.77 min vs. 2.15±2.53 min, p=.002) times were shorter in women who received vasopressin. However, the decrease of AMH level 12 months after surgery did not differ significantly between the the control and vasopressin groups (-1.17±0.97 ng/mL vs.-0.96±1.11 ng/mL, respectively; p=.426). AMH values did not differ significantly between the 2 groups over time (pgroup × time= .816) or at any time point (baseline, 3, 6, or 12 months). In subgroup analysis according to baseline AMH level (<3 ng/mL and 3-7 ng/mL), hormone values between the control and vasopressin groups did not differ significantly over time (pgroup × time= .923 and .556, respectively) or at each time point. Similar results were obtained in the per-protocol analysis. In the pathological analysis, the thickness and proportions of the excised ovarian tissue showed no significant difference between the groups.
Conclusion: Although vasopressin injection did not prevent a decrease in AMH levels after endometrioma surgery, it reduced cyst stripping and bleeding control times.
Trial registration: NCT04372836 (https://clinicaltrials.gov/ct2/show/NCT04372836)
Date of registration and enrollment of the first subject: October 29, 2018