Excision of Endometriomas, But Not Endometriosis, Activates a Proinflammatory Response

An innovative study of inflammatory cytokine levels in patients undergoing surgery for pelvic pain or infertility has revealed that the excision of endometriomas increases proinflammatory cytokine levels, while surgery to remove peritoneal endometriosis has a neutral effect.

“Our finding is the first characterization of cytokine levels following excisional surgery for endometriomas, and this may have implications on ovarian function and subsequently on ovarian reserve,” says Alexander Kotlyar, MD, a Cleveland Clinic ob/gyn resident who conducted the study under the guidance of Tommaso Falcone, MD, Chairman, Ob/Gyn & Women’s Health Institute.

Dr. Kotlyar presented the study at the 2017 American Society of Reproductive Medicine (ASRM) Scientific Congress & Expo meeting.

The study was initiated to increase understanding of the impact of endometrial surgery on the immune system.

“It has been theorized that cytokines may cause or worsen endometriosis. We wanted to see what surgery did to the immune system by measuring systemic cytokine activity,” Dr. Kotlyar explains.

The researchers gathered plasma samples from 39 patients ages 18-43 prior to and following surgery for pelvic pain and/or fertility presumed to be caused by endometriosis or endometrioma. Of the 39, endometriosis was confirmed in eight patients and endometrioma in 24. Seven had no pathology.

12 proinflammatory cytokines assessed

Levels of 12 proinflammatory cytokines were measured at two time points, and pre- and postoperative levels were compared. Preoperative cytokine levels did not differ significantly among controls or patients with endometriosis or endometriomas. However, levels of three cytokines—IL-1B, IL-12 and TNF-alpha—were significantly elevated following endometrioma surgery.

“This finding adds to our understanding about how surgery to alleviate symptoms may impact fertility in patients with endometriomas,” says Dr. Kotlyar. “Overall, surgery does not appear to change the systemic immune reaction. Further studies are needed to see if these surgeries decrease ovarian reserve.”