BACKGROUND
Endometrioma is often associated with infertility. While cystectomy can improve the pregnancy rate, it may also affect the ovarian reserve.
OBJECTIVE
This study aimed to investigate the impact of endometrioma cystectomy on ovarian reserve markers at 3 and 12 months after surgery in infertile women and to determine the postoperative pregnancy rate.
METHODS
This prospective, longitudinal, monocentric cohort study included 40 infertile patients aged 21–40 years with ovarian endometriomas measuring ≥4 cm in diameter and with good tubal patency and normal spermogram test results of the husband at the Gharafa Clinic, a gynecological and obstetric clinic annexed to the Bab El Oued University Hospital in Algiers. The main outcome measures were ovarian reserve (Antral Follicle Counts [AFC] follicle-stimulating hormone [FSH], and anti-Müllerian hormone [AMH] levels). We also calculate the number of follicles retrieved from cysts to evaluate their impact on the ovarian reserve and the spontaneous pregnancy rate.
RESULTS
After endometrioma cystectomy, the antral follicle count significantly increased at 12 months postoperatively (7.7±0.6 follicles before surgery vs. 8.5±0.5 follicles after surgery, p<0.001). The mean FSH levels did not increase; however, the AMH levels significantly decreased at 3 and 12 months postoperatively (2.29±0.26 ng/mL before surgery vs. 1.47±0.23 ng/mL at 3 months, p<0.001 and 1.46±0.20 ng/mL at 12 months, p<0.001). After stratification into three groups, decreased AMH levels after surgery showed a significant association with cystectomy associated with other surgical procedures, particularly in the presence of deep endometriosis. The number of follicles retrieved from cysts correlated with AMH levels preoperatively, but not postoperatively. Overall, 47.5% of patients had spontaneous pregnancies despite having low AMH levels; hence, surgery was considered to be effective.
CONCLUSIONS
Cystectomy can reduce the AMH level in cases of associated endometrioma but not in isolated endometrioma, the CFA increase and FSH doesn’t change. In fact this cystectomy can improve spontaneous pregnancy in half of cases.