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

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. 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. 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. 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.