Effect of Laparoscopic Cystectomy for Ovarian Endometriomas on Ovarian Reserve, as Measured by Anti-Müllerian Hormone: A Prospective Cohort Study

Author(s): Vaughan Marshall*, Thomas Ignatius Siebert.

Journal Name: Current Women`s Health Reviews

Volume 15 , Issue 3 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Background: Cystectomy for ovarian endometriomas is commonly performed, however recent publications have shown a deleterious effect of cystectomy on ovarian reserve.

Objectives: The study aimed to evaluate what effect laparoscopic cystectomy for ovarian endometriomas has on the ovarian reserve.

Methods: This is a prospective cohort study performing standard laparoscopic cystectomies for ovarian endometriomas. The primary outcome was the assessment of the ovarian reserve using Anti-Müllerian hormone (AMH), done pre- and six months postoperatively. Secondary outcome was spontaneous pregnancy during follow up.

Results: We enrolled 59 participants. Twenty-five participants were lost to follow up and a further 3 were excluded from the analysis. The average age was 33.1 years. Thirty-one participants completed the six months follow up. The mean preoperative and postoperative AMH value was 3.21ng/mL [95% CI: 2.24 - 4.18ng/mL, SD 2.64] and 1.48ng/mL [95% CI: 1.06 - 1.91ng/mL, SD 1.17] respectively: equating to a 53.89% decline, P=0.002. Twenty participants had unilateral cysts whilst the remaining 11 had bilateral endometriomas. The mean preoperative and postoperative AMH for unilateral cysts was 3.22ng/mL [95% CI:1.93 - 4.51ng/mL, SD 2.76] and 1.82ng/mL [95% CI: 1.23 – 2.41ng/mL, SD 1.26] respectively, representing a 43.48% decrease, P=0.072. Of the 11 with bilateral endometriomas, the mean preoperative AMH was 3.19ng/mL [95% CI: 1.49 - 4.89ng/mL, SD 2.54] with 0.88ng/mL [95% CI: 0.43 - 1.33ng/mL, SD 0.67] representing the postoperative AMH, equating to a 72.41% reduction, P=0.005.

Conclusion: Serum AMH is negatively affected by laparoscopic cystectomy for ovarian endometriomas, with a significant decline in ovarian reserve as measured six months postoperatively. A greater decline was seen in patients with bilateral endometriomas compared to unilateral disease.

Keywords: Anti-Müllerian hormone, AMH, cystectomy, endometrioma, endometriosis, ovarian reserve, three-step technique.

Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005; 20(10): 2698-704.
Giudice LC, Kao LC. Endometriosis. Lancet 2004; 364(9447): 1789-99.
Brown J, Farquhar C. Endometriosis: an overview of Cochrane reviews. Cochrane Database Syst Rev 2014; 3: CD009590.
Jenkins S, Olive DL, Haney AF. Endometriosis: pathogenetic implications of the anatomic distribution. Obstet Gynecol 1986; 67(3): 335-8.
Donnez J, Nisolle M, Gillet N, Smets M, Bassil S, Casanas-Roux F. Large ovarian endometriomas. Hum Reprod 1996; 11(3): 641-6.
Hughesdon PE. The structure of endometrial cysts of the ovary. J Obstet Gynaecol 1957; 65(44): 481-7.
Brosens IA, Van Ballaer P, Puttemans P, Deprest J. Reconstruction of the ovary containing large endometriomas by an extraovarian endosurgical technique. Fertil Steril 1996; 66(4): 517-21.
Van Rooij IA, Broekmans FJ, te Velde ER, et al. Serum ante-Müllerian hormone levels: A novel measure of ovarian reserve. Hum Reprod 2002; 17(12): 3065-71.
Visser JA, de Jong FH, Laven JSE, Themmen APN. Anti-Müllerian hormone: A new marker for ovarian function. Rev Reprod 2006; 131(1): 1-9.
Wilson CA, di Climente N, Ehrenfels C, et al. Mullerian inhibiting substance requires its N-terminal domain for maintenance of biological activity, a novel finding within the transforming growth factor-beta superfamily. Mol Endocrinol 1993; 7(2): 247-57.
Hart RJ, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 2008; 16: CD004992. [Review].
Raffi E, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: A systematic review and meta-analysis. J Clin Endocrinol Metab 2012; 97(9): 3146-54.
Somigliana E, Berlanda N, Benaglia L, Vigano P, Vercellini P, Fedele L. Surgical excision of endometriomas and ovarian reserve: A systematic review on serum antimüllerian hormone level modifications. Fertil Steril 2012; 98(6): 1531-8.
Tsepelidis S, Devreker F, Demeestere I, Flahaut A. Gervy ChEnglert Y. Stable serum levels of anti-Müllerian hormone during the menstrual cycle: A prospective study in normo-ovulatory women. Hum Reprod 2007; 22(7): 1837-40.
Pearson K, Long M, Prasad J, Wu YY, Bonifacio M. Assessment of the access AMH assay as an automated, high performance replacement for the AMH generation II manual ELISA. Reprod Biol Endocrinol 2016; 14(8): 1-9.
Nelson SM, Pastuszek E, Kloss G, et al. Two new automated, compared with two enzyme-linked immunosorbent, antimüllerian hormone assays. Fertil Steril 2015; 104(4): 1016-21.
Vignali M, Mabrouk M, Ciocca E, et al. Surgical excision of ovarian endometriomas: Does it truly impair ovari nreserve? Long term anti-Müllerian hormone (AMH) changes after surgery. J Obstet Gynaecol Res 2015; 41(11): 1773-8.
Su HI, Maas K, Sluss PM, Chang RJ, Hall JE, Joffe H. The impact of depot GnRH agonist on AMH levels in healthy reproductive-aged women. J Clin Endocrinol Metab 2013; 98(12): E1961-6.
Marschalek J, Ott J, Husslein H, et al. The impact of GnRH agonist in patients with endometriosis on prolactin and sex hormone levels: A pilor study. Eur J Obstet Gynecol Reprod Biol 2015; 195: 156-9.
Kashi AM, Chaichian S, Ariana S, et al. The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometrioma. Obstet Gynecol Int J 2017; 136(2): 200-4.
Muzii L, Marana R, Angioli R, et al. Histologic analysis of specimens from laparoscopic endometrioma excision performed by different surgeons: Does the surgeon matter. Fertil Steril 2011; 95(6): 2116-9.
Kitajima M, Khan KN, Hiraki K, Inoue T, Fujishita A, Masuzaki H. Changes in serum anti-Müllerian hormone levels may predict damage to residual normal ovarian tissue after laparoscopic surgery for women with ovarian endometrioma. Fertil Steril 2011; 95(8): 2589-91.
Tsolakidis D, Pados G, Vavilis D, et al. The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: A prospective randomized study. Fertil Steril 2010; 94(1): 71-7.
Shao MJ, Hu M, He YQ, Xu XJ. AMH trend of laparoscopic cystectomy and ovarian suturing in patients with endometriomas. Arch Gynecol Obstet 2016; 293(5): 1049-52.
Lee DY, Kim NY, Kim MJ, Yoon BK, Choi D. Effects of laparoscopic surgery on serum anti-müllerian hormone levels in reproductive-aged women with endometrioma. Gynecol Endocrinol 2011; 27(10): 733-6.
Chang HJ, Han SH, Lee JR, et al. Impact of laparoscopic cystectomy on ovarian reserve: Serial changes of serum anti-Müllerian hormone levels. Fertil Steril 2010; 94(1): 343-9.

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Page: [207 - 213]
Pages: 7
DOI: 10.2174/1573404814666180724125608
Price: $58

Article Metrics

PDF: 51