Triple Steps Method in Managing Ovarian Endometrioma

Aims: Describe the principles and outcomes of duplex endometrioma management by the triple step method (TUGA, GnRH agonist, laparoscopic cystectomy). Method: A case report of a woman with duplex endometrioma who underwent a triple step procedure. Results: A 24-year-old female patient, P0, with a duplex endometrioma found on transvaginal ultrasonography. Right endometrioma size is 3, 3x3, 2 cm and left endometrioma is 3, 7x2, 6 cm and 4, 9x5, 2 cm. The patient's AMH level was 3, 770 ng/ml. In this patient, a triple step was carried out, namely ultrasound-guided aspiration cyst fluid (TUGA), followed by three cycles of GnRH agonist, then laparoscopic cystectomy. Right endometrioma fluid aspiration was 36 cc and the left endometrioma search was 108 cc. Therapy was continued by giving GnRH agonist (leuprolide acetate) 3.75 mg for three cycles of administration. Then proceed with the laparoscopic cystectomy procedure. Post aspiration cyst size and administration three cycles of GnRH: right endometrioma 2.12x2.5 cm and left endometrioma size 1.9x1.5 and 2.7 cm x 3.1 cm, aspiration fluid was examined with the results of brown fluid with an image of endometrial glands containing hemosiderin-laden macrophages. During laparoscopic, cystic masses was found with fibrotic walls, smooth surface of the ovary. A pathology study was performed after laparoscopic cystectomy, showing images of endometrium and stroma with hemosiderin infiltration. An AMH examination was performed after 3 months to obtain AMH levels of 1.75 ng/ml. Conclusion: The triple step method is an effective method for maintaining ovarian reserve in patients with endometrioma.