Author:
Costache Cosmina-Raluca,Mandi Draga-Maria,Gorecki Gabriel-Petre,Costache-Outas Mariana-Cristina,Mitran Mihai,Sima Romina-Marina,Burcos Traean
Abstract
Objective. This study was designed to analyze the deleterious effect of endometriosis on ovarian reserve after surgery by studying anti-Müllerian hormone (AMH) levels. Materials and method. This is a systematic review that included observational studies and randomized clinical trials published in English between 2015 and 2019. We included 17 studies that reported AMH levels in patients undergoing laparoscopic surgery for endometrioma, measured preoperatively and postoperatively. Results. Seventeen studies met the inclusion criteria. A significant decrease in AMH levels was observed in the short-, medium- and long-term postoperative periods compared to baseline AMH levels. However, there were no differences between postoperatively immediately and one year after surgery. Postoperative AMH levels were significantly reduced in bilateral endometriomas compared to unilateral cases. Also, patients with endometriomas, compared to patients with other benign ovarian conditions, had a more important decline in AMH levels. The same was observed in cases of bilateral cystectomy compared to vaporization with bipolar energy or laser. A greater decrease in postsurgical AMH was also observed with bipolar energy hemostasis compared to suture and hemostatic agents. Conclusions. Endometrioma surgery has a negative effect on postoperative AMH levels. Bilateral endometriomas and those greater than 7 cm are associated with a significant decrease in AMH. The mechanical removal of healthy tissue and the destruction of the ovarian cortex may explain the reduction in ovarian reserve.