Restricted accessResearch articleFirst published online 2019-11
Ovarian Reserve Reduction With Surgery Is Not Correlated With the Amount of Ovarian Tissue Inadvertently Excised at Laparoscopic Surgery for Endometriomas
The aim of the present study was to evaluate the effect of laparoscopic cystectomy on ovarian reserve by means of anti-Müllerian hormone (AMH) serial measurements and to compare AMH values with the number of inadvertently removed follicles in histological specimens. Fifty-two women were enrolled: 34 patients with endometriomas (group 1) and 18 patients with other benign ovarian cysts (group 2). All patients underwent laparoscopic cystectomy performed by a single experienced surgeon. The AMH was measured before, and 1, 3, and 6 months after cystectomy in group 1, and before and 6 months after surgery in group 2. Preoperative AMH levels (mean [standard deviation, SD]) in group 1 (3.39 [2.43] ng/mL) were not significantly different from group 2 (3.74 [2.57] ng/mL; P = .68). In group 1, a significant decrease in AMH levels of 43.4% was observed at 1 month (1.93 [1.36]; P = .003), and of 63.1% at 3 months (1.25 [1.00]; P = .007) postoperatively. The AMH increased not significantly between the third and sixth months in group 1 (+9.4%). Six months after surgery, AMH was reduced by 59.3% compared to baseline values in group 1 (P = .012), and by 29.5% in group 2 (P = .200). A significant difference in the AMH decrease was present between bilateral and monolateral endometriomas (P = .006). There was no correlation between the reduction rate of AMH and the number of follicles inadvertently removed in patients with endometriomas (P = .669). In conclusion, AMH decreases significantly after surgical excision of ovarian endometriomas. The postoperative decrease does not appear to correlate with the amount of ovarian tissue inadvertently excised with the endometrioma wall.
ChapronCVercelliniPBarakatHVieiraMDubuissonJB. Management of ovarian endometriomas. Hum Reprod Update. 2002;8(6):591–597.
2.
Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012;98(3):591–598.
3.
Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril. 2014;101(4):927–935.
4.
BerettaPFranchiMGhezziFBusaccaMZupiEBolisP. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril. 1998;70(6):1176–1180.
5.
AlborziSMomtahanMParsanezhadMEDehbashiSZolghadriJAlborziS. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril. 2004;82(6):1633–1637.
6.
HartRJHickeyMMaourisPBuckettW. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev. 2008;16(2):CD004992.
7.
CarmonaFMartínez-ZamoraMARabanalAMartínez-RománSBalaschJ. Ovarian cystectomy versus laser vaporization in the treatment of ovarian endometriomas: a randomized clinical trial with a five-year follow-up. Fertil Steril. 2011;96(1):251–254.
8.
RaffiFMetwallyMAmerS. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012;97(9):3146–3154.
9.
BlockE. Quantitative morphological investigations of the follicular system in women; variations at different ages. Acta Anat (Basel). 1952;14(1-2):108–123.
10.
HehenkampWJLoomanCWThemmenAPde JongFHTe VeldeERBroekmansFJ. Anti-Mullerian hormone levels in the spontaneous menstrual cycle do not show substantial fluctuation. J Clin Endocrinol Metab. 2006;91(10):4057–4063.
11.
La MarcaAStabileGArtenisioACVolpeA. Serum anti-Mullerian hormone throughout the human menstrual cycle. Hum Reprod. 2006;21(12):3103–3107.
12.
TsepelidisSDevrekerFDemeestereIFlahautAGervyCEnglertY. Stable serum levels of anti-Mullerian hormone during the menstrual cycle: a prospective study in normo-ovulatory women. Hum Reprod. 2007;22(7):1837–1840.
13.
TsolakidisDPadosGVavilisD, 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):71–77.
IwaseAHirokawaWGotoM, et al.Serum anti-Mullerian hormone level is a useful marker for evaluating the impact of laparoscopic cystectomy on ovarian reserve. Fertil Steril. 2010;94(7):2846–2849.
16.
BiacchiardiCPPianeLDCamanniM, et al.A Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons. Reprod Biomed Online. 2011;23(6):740–746.
17.
ErcanCMDuruNKKarasahinKECoksuerHDedeMBaserI. Ultrasonographic evaluation and anti-mullerian hormone levels after laparoscopic stripping of unilateral endometriomas. Eur J Obstet Gynecol Reprod Biol. 2011;158(2):280–284.
18.
HirokawaWIwaseAGotoM, et al.The post-operative decline in serum anti-Mullerian hormone correlates with the bilaterality and severity of endometriosis. Hum Reprod. 2011;26(4):904–910.
19.
HwuYMWuFSLiSHSunFJLinMHLeeRK. The impact of endometrioma and laparoscopic cystectomy on serum anti-Müllerian hormone levels. Reprod Biol Endocrinol. 2011;9:80.
20.
KitajimaMKhanKNHirakiKInoueTFujishitaAMasuzakiH. Changes in serum anti-Mullerian hormone levels may predict damage to residual normal ovarian tissue after laparoscopic surgery for women with ovarian endometrioma. Fertil Steril. 2011;95(8):2589–2591.
21.
LeeDYKimNYKimMJYoonBKChoiDS. Effects of laparoscopic surgery on serum anti-Mullerian hormone levels in reproductive-aged women with endometrioma. Gynecol Endocrinol. 2011;27(10):733–736.
22.
ChenYPeiHChangY, et al.The impact of endometrioma and laparoscopic cystectomy on ovarian reserve and the exploration of related factors assessed by serum anti-Mullerian hormone: a prospective cohort study. J Ovarian Res. 2014;7:108.
23.
DingYYuanYDingJChenYZhangXHuaK. Comprehensive assessment of the impact of laparoscopic ovarian cystectomy on ovarian reserve. J Minim Invasive Gynecol. 2015;22(7):1252–1259.
24.
ErgunBOzsurmeliMDundarOCombaCKuruOBodurS. Changes in markers of ovarian reserve after laparoscopic ovarian cystectomy. J Minim Invasive Gynecol. 2015;22(6):997–1003.
25.
ChunSChoHJJiYI. Comparison of early postoperative decline of serum antiMüllerian hormone levels after unilateral laparoscopic ovarian cystectomy between patients categorized according to histologic diagnosis. Taiwan J Obstet Gynecol. 2016;55(5):641–645.
26.
GoodmanLRGoldbergJMFlycktRLGuptaMHarwalkerJFalconeT. Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls. Am J Obstet Gynecol. 2016;215(5):589.
27.
MuziiLAngioliRZulloMPaniciPB. The unexpected ovarian malignancy found during operative laparoscopy: incidence, management, and implications for prognosis. J Minim Invasive Gynecol. 2005;12(1):81–89.
DunselmanGAVermeulenNBeckerC, et al.ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400–402.
30.
MuziiLDi TucciCDi MascioD, et al.Current management of ovarian endometriomas. Minerva Ginecol. 2018;70(3):286–294.
31.
MuziiLDi TucciCDi FeliciantonioM, et al.Management of endometriomas. Semin Reprod Med. 2017;35(1):25–30.
32.
SomiglianaEBerlandaNBenagliaLViganoPVercelliniPFedeleL. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications. Fertil Steril. 2012;98(6):1531–1538.
33.
MuziiLBianchiACrocèCManciNPaniciPB. Laparoscopic excision of ovarian cysts: is the stripping technique a tissue-sparing procedure?Fertil Steril. 2002;77(3):609–614.
34.
MuziiLMillerCE. The singer, not the song. J Minim Invasive Gynecol. 2011;18(5):666–667.
35.
MuziiLMaranaRAngioliR, et al.Histologic analysis of specimens from laparoscopic endometrioma excision performed by different surgeons: does the surgeon matter?Fertil Steril. 2011;95(6):2116–2119.
36.
YuHTHuangHYSoongYKLeeCLChaoAWangCJ. Laparoscopic ovarian cystectomy of endometriomas: surgeons’ experience may affect ovarian reserve and live-born rate in infertile patients with in vitro fertilization-intracytoplasmic sperm injection. Eur J Obstet Gynecol Reprod Biol. 2010;152(2):172–175.
37.
UncuGKasapogluIOzerkanKSeyhanAOral YilmaztepeAAtaB. Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve. Hum Reprod. 2013;28(8):2140–2145.
38.
VignaliMMabroukMCioccaE, et al.Surgical excision of ovarian endometriomas: does it truly impair ovarian reserve? Long term anti-Müllerian hormone (AMH) changes after surgery. J Obstet Gynaecol Res. 2015;41(11):1773–1778.
