Second Opinion · Endometriosis Decisions
Has anyone told you what your endometriosis operation will cost your ovaries — or measured what they hold before spending it? The ovaries are where this surgery's invisible price is paid: endometrioma removal takes healthy tissue along with the cyst wall, and in severe disease the word “oophorectomy” sometimes enters the plan with less justification than it needs. You can send your reports via WhatsApp for review by Assoc. Prof. Dr. Cengiz Andan.
The online consultation puts the ovaries at the center of the plan rather than its margins: whether your reserve has been measured before anyone operates on it, whether the planned technique is the reserve-sparing kind, whether an endometrioma needs removal at all right now, and — where removal of an ovary itself is proposed — whether the justification survives scrutiny. The review follows the assessment approach of the Assoc. Prof. Dr. Cengiz Andan Clinic in Nişantaşı, Şişli, Istanbul.
Fast response, fast appointment: once your reports arrive on WhatsApp, your request is reviewed promptly and your online consultation is scheduled at the earliest suitable time.
Online second opinion
If you would like a specialist second opinion about the diagnosis, treatment or surgery proposed for “Ovary Preservation in Endometriosis Surgery: A”, your ultrasound scans, MRI results, medical reports and other documents can be reviewed in detail by Assoc. Prof. Dr. Cengiz Andan.
During the online second-opinion consultation, our doctor:
There is no predetermined fixed time limit for the online consultation. The consultation ends after all submitted reports and test results have been reviewed, your questions have been answered and the doctor has completed the necessary explanations. The aim is not to fill a fixed appointment time, but to provide the information you need to understand your condition, treatment options and next steps.
Support also continues after the consultation. For one month after the online consultation, you may send follow-up questions through WhatsApp about the condition and treatment discussed during the appointment and receive written consultation support at no additional charge.
You can watch a short example of how the online second-opinion consultation works in the video beside this text.
Message us on WhatsApp for an online consultation
This video shows a short example of an online video consultation between the doctor and a patient.
The decision you are actually facing
The first question is whether ovarian sites need surgery now at all: not every endometrioma must come out, and timing interacts with fertility plans. The second is how: cystectomy technique — what is stripped, what is spared, how bleeding is controlled — measurably changes what remains of the reserve afterwards. The third is the heaviest: whether an ovary itself should be removed, a step that before menopause means hormonal consequences for decades and should rest on findings, not on operative convenience. A second opinion answers all three before the anesthesia does.
Size, growth, symptoms, suspicion on imaging and fertility timing decide whether an endometrioma earns an operation or scheduled surveillance. The review checks which side of that line yours sits on — because the cheapest reserve is the kind never spent.
The same cyst can cost little or much depending on hands and method: careful stripping planes, restraint with energy near the ovarian hilus, suturing over cautery where possible. The review checks whether your plan — and your surgeon's answers — reflect that discipline.
A destroyed, non-functional ovary densely fused into deep disease can genuinely warrant removal. “It was easier” cannot. Before menopause, this decision carries decades of hormonal consequence; the review weighs the stated justification against your imaging and your age.
What should you send?
This review reads your reserve and your plan together. The baseline measurement matters as much as the imaging.
Why the baseline must come first
An AMH value taken before the operation does three jobs: it grounds the surgery-versus-surveillance decision, it calibrates how conservative the technique must be, and it makes the operation's true cost visible afterwards instead of deniable. A plan that schedules ovarian surgery without a baseline is spending from an account no one has looked at.
What the review looks for
In ovary-preservation reviews, these are the patterns that most often rewrite the consent form.
Your options, side by side
The table separates the bundled decisions — the consultation locates your findings on each row.
| Decision | Typically considered when | What the second opinion clarifies |
|---|---|---|
| Surveillance, no surgery now | Stable, quiet, unsuspicious cyst | Whether watching with scheduled imaging is defensible for your findings and plans. |
| Reserve-sparing cystectomy | Cyst needs removal, fertility matters | Whether the planned technique minimizes the reserve cost — and what to ask your surgeon. |
| Fertility preservation first | Low reserve or bilateral disease before surgery | Whether freezing eggs or embryos belongs in your sequence before the operation. |
| Oophorectomy | Ovary destroyed or oncological concern | Whether the justification holds on imaging — and what removal means at your age. |
| Do surgery, spare ovaries entirely | Deep disease without ovarian involvement | Whether your ovaries can be left untouched while the rest is excised. |
Doctor's approach
In the online consultation with Assoc. Prof. Dr. Cengiz Andan, the ovaries get the file's full attention: your baseline reserve is established or its absence flagged, each planned ovarian step is tested for necessity and technique, and any proposed removal is weighed against the imaging that must justify it — with the questions worth putting to your surgeon written out for you.
The ovary plan lives inside the whole operation — whether the surgery as a package aims at complete excision in the right hands is reviewed on the endometriosis second opinion page, and the two reviews belong together.
If your reserve is already low, your disease bilateral, or your timeline long, freezing options before surgery deserve their own review — the fertility preservation second opinion covers exactly that sequencing decision.
Frequently asked questions
Measurably some, in nearly every case: AMH values typically drop after cystectomy, because healthy tissue clings to the cyst wall being stripped and because bleeding control near the hilus can harm what remains. The size of the drop varies with cyst size, whether both ovaries are involved and — critically — technique. That variability is exactly why the review examines how yours will be done.
It depends on three numbers and one date: your AMH, your age, whether the disease is bilateral, and when — if ever — you plan to conceive. For low reserve or double-sided disease with time before pregnancy, preservation-before-surgery is a sequence worth serious consideration. The review runs your numbers rather than answering in general.
Flexibility for genuine intraoperative findings is normal; a pre-authorized removal without imaging justification is not. The defensible version sounds like: “based on your MRI we expect to preserve it; removal only if we find X.” The review checks whether your imaging predicts anything that could justify removal — so “we'll see” has boundaries you agreed to.
With a healthy ovary remaining, hormone production continues and natural pregnancy remains possible — the body compensates substantially. What changes is margin: your reserve now lives in one place, and any future event or surgery on that side carries higher stakes. Losing both before menopause is a different matter entirely — immediate surgical menopause — which is why bilateral plans get the strictest review.
Yes, recurrence is a documented reality over the years after cystectomy, and each repeat operation costs reserve the previous one already taxed. This mathematics is precisely why the first operation's technique matters and why re-operation decisions deserve more scrutiny than first ones. If that is your situation, the recurrence question has its own dedicated review.
Your AMH with its date — or the honest statement that it was never measured — your imaging with the endometrioma's details, the plan's exact wording, previous ovarian surgery notes if any, and your fertility timeline. The baseline plus the plan's wording carry most of this review.
Then you consent with the numbers on the table: a measured baseline, a technique that respects it, removal off the table unless defined findings appear. The consultation confirms each piece in writing and gives you the short list of questions that keep it all true in the operating room.
Write to us directly on WhatsApp and send the reports you already have. The online second opinion, provided through the Assoc. Prof. Dr. Cengiz Andan Clinic in Nişantaşı, Şişli, Istanbul, establishes what your ovaries hold, what the planned operation would cost them, whether any proposed removal is justified, and whether freezing belongs in your sequence first.
