Ovarian reserve integrated damage (ORI) model for predicting ovarian function recovery after laparoscopic ovarian cystectomy for endometriosis: a randomized controlled trial

BACKGROUND: Laparoscopic ovarian cystectomy for endometriosis carries a substantial risk of diminished ovarian reserve. Optimal intraoperative hemostasis remains uncertain, and predictive tools for postoperative ovarian function are limited. METHODS: In this prospective, randomized controlled trial, 101 women undergoing laparoscopic ovarian cystectomy were assigned to oxidised cellulose polymer, bipolar coagulation, or suturing for hemostasis. Primary endpoints were postoperative changes in anti-Müllerian hormone (AMH), antral follicle count (AFC), and peak systolic velocity (PSV). Two logistic regression–based Ovarian Reserve Index (ORI) models were developed: ORI-PreOp, using preoperative variables only, and ORI-PeriOp, incorporating both preoperative and intraoperative factors. The study design and reporting followed CONSORT 2010 guidelines for randomized trials and TRIPOD guidelines for prediction model development. RESULTS: A total of 173 patients were randomized to three hemostatic methods, with 101 completing the study. At 6 months, oxidised cellulose polymer preserved ovarian reserve more effectively than bipolar coagulation (AMH decline 5.97% vs. 19.06%; AFC decline 14.0% vs. 30.7%; PSV decline 5.3% vs. 20.0%; all P < 0.001) or suturing. The ORI-PeriOp model outperformed ORI-PreOp in predicting poor ovarian function recovery at 6 months (AUC 0.936 vs. 0.794) and 1 month (AUC 0.809 vs. 0.546). Incorporation of intraoperative variables significantly improved predictive accuracy. CONCLUSIONS: Oxidised cellulose polymer offers superior preservation of ovarian reserve compared with bipolar coagulation or suturing in endometriosis-associated cystectomy. The ORI-PeriOp model provides reliable individualized risk stratification, facilitating tailored surgical planning and informed fertility counseling.