Low-pressure pneumoperitoneum reduces influence on ovarian hormones in infertile women: a randomised trial

Abstract

Background: Pneumoperitoneum is commonly used in laparoscopic gynecological surgery. This study investigated the effect of carbon dioxide (CO2) pneumoperitoneum pressure on ovarian function following laparoscopic surgery in infertile women.

Methods: A total of 424 infertile patients were allocated to 4 groups according to different CO2 pneumoperitoneum pressures undergo laparoscopic surgery. Complications and the levels of serum estradiol (E2), progesterone (P), luteinizing hormone (LH), testosterone (T), and follicle-stimulating hormone (FSH) were observed and measured. Ovarian function was also evaluated by using mean ovarian volume, maximal ovarian volume, mean follicle number, and maximal follicle diameter.

Results: A total of 118 cases were included and their data were retrospectively analyzed. Complications were observed in all groups with the highest incidence in participants receiving 15-16 mmHg CO2. Pneumoperitoneum increased the levels of E2, FSH, and LH (P<0.05) with increasing pressure, especially in the first menstrual period after surgery, and these levels had returned to normal by the third menstruation; the levels of P and T were not affected.The MOV, MFD and MFN remained unchanged after surgery in four groups, and the menstrual cycle after surgery at 1 month in group D delayed (P<0.05).

Conclusions: The use of CO2 for pneumoperitoneum affects the levels of E2, LH, and FSH during the first menstruation after laparoscopic surgery in a pressure-dependent manner and the impact vanishes by the third menstruation.

Trial registration: Chinese Clinical Trial Registry ChiCTR2100046221.

Keywords: Carbon dioxide (CO2); laparoscopic surgery; ovarian hormones; pneumoperitoneum.