The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometriomas

Capsule:
Ovarian reserve is negatively affected by laparoscopic cystectomy of endometriomas demonstrated by decreased antim€ullerian hormone and increased FSH levels, especially in those older than 38 years and with bilateral cysts.

Authors:
Saeed Alborzi, M.D., Pegah Keramati, M.D., Masoomeh Younesi, M.D., Alamtaj Samsami, M.D., Nasrin Dadras, M.D.

Volume 101, Issue 2, Pages 427-434, February 2014

Abstract:

Objective:
To evaluate the effects of laparoscopic cystectomy on ovarian reserve in patients with endometriomas.

Design:
Prospective study.

Setting:
Private and university hospitals.

Patient(s):
A total of 193 patients with endometriomas undergoing laparoscopic cyctectomy.

Intervention(s):
Serum levels of antimüllerian hormone (AMH), FSH, and E2, as well as antral follicle count (AFC) were measured preoperatively and 1 week, 3 and 9 months postoperatively for AMH, and 3 months for other values.

Main Outcome Measure(s):
Ovarian reserve based on the comparison of AMH alterations. The secondary end points are changes in FSH, E2, and AFC.

Result(s):
Serum AMH level decreased significantly from the baseline (3.86 ± 3.58 ng/mL) to 1 week (1.66 ± 1.92 ng/mL), 3 months (2.06 ± 2.5 ng/mL), and 9 months (1.77 ± 1.76 ng/mL) postoperatively. Those patients with bilateral endometriomas had significantly lower levels of AMH, 1 week, 3 and 9 months after operation. Also, patients older than 38 years had lower postoperative AMH levels. The FSH levels increased significantly from baseline to 3 months postoperatively. The AFC level increased significantly from baseline to 3 months after operation.

Conclusion(s):
The AMH level decreased and the FSH level increased after laparoscopic cystectomy for endometriomas, especially in older patients and those with bilateral cysts.

  • Lauren Johnson

    I congratulate the authors on publication of this manuscript. I read this article
    with interest as our group recently reviewed the literature regarding impact of
    ovarian cystectomy for endometriomas on ovarian reserve. Several recent publications have suggested that OCPs and Lupron reduce AMH levels, and since women with endometriosis are often treated with these agents after surgery, I wonder how much of the observed decline in AMH is from surgery vs. suppression with these agents.

    I was wondering if the authors would be willing to comment on whether any of the subjects were treated post-operatively with OCPs or Lupron. If so, it would be
    interesting to compare the change in AMH between hormone users and non-users as
    the change among non-users may give the best estimate of the potential impact on ovarian reserve.

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