OVARIAN ENDOMETRIAL CYSTS - THE ROLE OF GONADOTROPIN-RELEASING-HORMONE AGONIST AND OR DRAINAGE/

Objective: To evaluate the role of GnRH agonist (GnRH-a) and/or draina ge in the management of large endometriomas. Design: This prospective clinical study was conducted in a parallel and randomized design. Sett ing: Department of Gynecology, Cliniques Universitaires St. Luc, Bruss els, Belgium. Patients: Eighty infertile women with laparoscopically c onfirmed ovarian endometriotic cysts. After laparoscopic drainage of t he ovarian cyst, patients were randomized. Patients in group I (n = 40 ) received no therapy. Patients in group II (n = 40) received GnRH-a t herapy for 12 weeks. A second-look laparoscopy was performed after 12 weeks in each woman. Results: After drainage, a quick recurrence of th e endometrial cyst was observed in only group I. Indeed, the score and the cyst size were similar to the values observed before the first la paroscopy. In group II, a significant decrease in score and cyst diame ter was observed. Ovarian biopsies revealed significant reduction in t he stromal vascularization and a significant reduction in the mitotic activity in the group of women treated with GnRH-a. Conclusion: The qu ick recurrence of the ovarian cyst after drainage proved that drainage alone is ineffective. Drainage followed by GnRH-a was effective in th e reduction of cyst size and the glandular mitotic activity.