Aims of Tr of ovarian tumour in very yoing women/ teenagers:-Ovarian tissue conservation Factors Likely to Affect the Choice of Therapy Infertility If ovarian surgery for cysts, fibromas, adhesions or adnexal tumours is indicated in infertility patients, the major goal of any surgical intervention is to preserve as much undamaged ovarian tissue as possible. Many comparisons of laparoscopic ovarian cyst enucleation versus minilaparotomy or laparotomy have been carried out and the outcome clearly shows that no matter what type of ovarian surgery is performed, it should be with ovarian tissue conservation. For individual patients and their reproductive outcome, the size of abdominal incision, laparoscopy, laparotomy or even vaginal surgery seems to be less important than ovarian functionality. Therefore, every surgeon should apply the method he can best perform with the goal of preserving as much ovarian tissue as possible. It is generally thought that laparoscopy is superior to laparotomy in the manage¬ment of benign adnexal cysts as it is associated with shorter hospital stay, less post¬operative pain, a better cosmetic outcome and a faster recovery. However, minilaparotomy also requires no sophisticated equipment or very specialised training but utilises basic, classical techniques and is a patient- friendly technology. In situations where laparoscopic ovarian cyst enucleation is technically not possible, Laparotomy is still a safe technique. A comparison of the laparoscopic and laparoscopic approach regarding outcome, infection, pain and consecutive fertility revealed an advantage of laparoscopy over laparotomy, especially in terms of perioperative morbidity and post-operative pain .Operating time and intraoperative complications were similar for both approaches. At present, laparoscopy should definitely be considered the gold standard for the management of benign adnexal disease. Intraoperative spillage can be avoided in both laparoscopy and laparotomy. Tubal pathology in benign cases, such as ectopic pregnancies, Hydro or pyosalpinx, should be surgically treated without lacerating or extirpating the ovary in women of reproductive age. Adnexectomy in cases of ectopic pregnancy is usually not indicated and must be left as tubectomy in specific cases

Ovarian Dysfunction and Amenorrhoea

During the reproductive age, the normal cyclic function of the ovary is characterised by recruitment of the follicular cohort, selection of the dominant follicle, ovulation with consecutive corpus luteum formation, corpus luteum func­tion and the final regression of the corpus luteum. In this cycle, the central nervous system, the limbic system, the hypothalamus, the hypophysis and the ovary are partners. Disturbances of these interactions lead to ovarian dysfunction with follic­ular maturation disturbances, inadequate ovulation and inadequate functioning of the corpus luteum. The resulting bleeding abnormalities (poly-, oligo- or amenorrhoea and also pre, intra and post-ovulatory bleeding) have to be treated separately.  The 1973 WHO classification of ovarian dysfunction still gives the best general idea of diagnostic techniques and therapy .According to this classification, amenorrhoea may be the consequence of an ovarian insufficiency (group 2b), an anatomically caused amenorrhoea (group 4), hyperprolactinemia (groups 5 and 6) or a non-increase in gonadotropins (group 1). The pathophysiology reveals a lack of stimulation of the hypophyseal gonadotropin secretion. Groups 3 and 7 comprise patients with hypergonadotropic ovarian insufficiency.