The presence of an endometrioma can often be accompanied by a clinical dilemma during the course of fertility treatment. The aim of this study was to evaluate anti-Müllerian hormone (AMH) levels and spontaneous pregnancy rate in infertility patients with endometriomas depending of initial AMH levels and cyst type.
This prospective cohort study included infertility patients with unilateral endometrioma (3–5 s m in diameter) aged 25–35. A total of them underwent laparoscopic cystectomy. All patients were divided into two groups due to AMH levels and cyst type during surgery. We investigated AMH levels and spontaneous pregnancy rate in 1,3 and 12 months after surgery.
The majority of patients with normal AMH level had type II endometriomas (70%) compared with low AMH level group (30%). There were no significant differences between AMH levels in all the patients with type II endometriomas after surgery. AMH level decreased significantly at 1 month in patients with normal AMH level and type I endometriomas (P = 0.018). But at 3 months the AMH level was compared with initial parameters. Women with low AMH levels before surgery and type I cysts had a significant decrease of AMH level at 1 and at 3 months after surgery. All patients with a time interval of 6 months after surgery had the best outcomes with significantly higher pregnancy rate (PR) in patients with normal AMH level and type II cysts (P = 0.036) and with AMH less than 2 ng/ml and type I cysts (P = 0.021). The group with normal AMH level and type II endometriomas had a significantly higher ongoing cumulative PR than others (59.4%).
Our data suggest that laparoscopic surgery could affect ovarian reserve in case of initial low AMH levels and type I of endometriomas. We believe that the good surgical technique helps to increase pregnancy rate in infertility patients with endometriomas. Good prognosis group are the infertility patients with normal AMH level and type II endometriomas.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Obstetrics and Gynecology and Reproductive Biology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Endometriosis: pathogenetic implications of the anatomic distribution.Obstet Gynecol. 1986; 67: 335-338
- Classification of ovarian endometriotic cysts.Int J Gynecol Pathol. 2001; 20: 147-154
- Influence of ovarian endometrioma on expression of steroid receptor RNA activator, estrogen receptors, vascular endothelial growth factor, and thrombospondin 1 in the surrounding ovarian tissues.Reprod Sci. 2014; 21: 183-189
- The distinguishing cellular and molecular features of the endometriotic ovarian cyst: from pathophysiology to the potential endometrioma-mediated damage to the ovary.Hum Reprod Update. 2014; 20: 217-230
- Volpe A: Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART).Hum Reprod Update. 2010; 16: 113-130
- Mittal M on behalf of the Royal College of Obstetricians and Gynecologist. The Effect of Surgery for Endometriomas on Fertility.BJOG. 2017; 125: e19-e28
- The use of alternative experimental models on microsurgery technique’s training for medicine undergradute students.Periodico Tche Quimica. 2017; 14: 117-122
- Laparoscopic surgery for endometriosis.Cochrane Database Syst Rev. 2014; 4CD011031
- Laparoscopic cystectomy of endometrioma: good surgical technique does not adversely affect ovarian reserve.J Hum Reprod Sci. 2014; 7: 125-129
- Rao Laparoscopic cystectomy of endometrioma: good surgical technique does not adversely affect ovarian reserve.J Hum Reprod Sci. 2014; 7: 125-129
- Endometriomas: classification and surgical management.OBG Manag. 2017; 29: 38-43
- Clinical and histologic classification of endometriomas. Implications for a mechanism of pathogenesis.J Reprod Med. 1992; 37: 771-776
- A fresh look at ovarian endometriomas.Contemp Ob Gyn. 1994; 39: 81-94
- Classification of endometriosis. Improving the classification of endometriotic ovarian cysts.Hum Reprod. 1994; 9: 2212-2213
- Utilisation of the Bologna criteria: a promise unfulfilled? A review of published and unpublished/ongoing trials.Fertil Steril. 2018; 109: 104-109
- Molecular characterisation of corona radiata cells from patients with diminished ovarian reserve using microarray and microfluidic-based gene expression profiling.Hum Reprod. 2012; 27: 829-843
- Contents of endometriotic cysts, especially the high concentration of free iron, are a possible cause of carcinogenesis in the cysts through the iron-induced persistent oxidative stress.Clin Cancer Res. 2008; 14: 32-40
- The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis.J Clin Endocrinol Metab. 2012; 97: 3146-3154
- Removal of unilateral endometriomas is associated with immediate and sustained reduction in ovarian reserve.Reprod Biomed Online. 2013; 27: 212-216
- Ovarian abscess following puncture of an endometrioma during ultrasound-guided oocyte retrieval.Hum Reprod. 1993; 8 (1282–128)
- An update on surgical versus expectant management of ovarian endometriomas in infertile women.Biomed Res Int. 2015; : 204792https://doi.org/10.1155/2015/204792
- Histological assessment of impact of ovarian endometrioma and laparoscopic cystectomy on ovarian reserve.J Obstet Gynaecol Res. 2012; 38: 1187-1193
- “Aggressiveness” of cystectomy in endometrioid ovarian cysts.Vopr ginekol akus perinatol (Gynecol Obstetr Perinatol). 2018; 17 (In Russian): 5-12
- The presence of ovarian endometriomas is associated with a reduced responsiveness to gonadotropins.Fertil Steril. 2006; 86: 192-196
- Endometriotic ovarian cysts negatively affect the rate of spontaneous ovulation.Hum Reprod. 2009; 24: 2183-2186
- Effects of ovarian endometrioma on the number of oocytes retrieved for in vitro fertilization.Fertil Steril. 2011; 95: 525-527
- In vitro fertilization in normoresponder patients with endometriomas: comparison with basal simple ovarian cysts.Gynecol Obstet Invest. 2008; 65: 212-216
- Excisional surgery versus ablative surgery for ovarian endometriomata.Cochrane Database Syst Rev. 2008; 2CD004992
- Laparoscopic excision of ovarian cysts: Is the stripping technique a tissue-sparing procedure?.Fertil Steril. 2002; 77: 609-614
- The effect of laparoscopic ovarian cystectomy versus coagulation in bilateral endometriomas on ovarian reserve as determined by antral follicle count and ovarian volume: a prospective randomized study.Fertil Steril. 2011; 95: 2247-2250
- Direct proportional relationship between endometrioma size and ovarian parenchyma inadvertently removed during cystectomy, and its implication on the management of enlarged endometriomas.Hum Reprod. 2010; 25: 1428-1432
- Influence of endomeriotic cyst diameter and the severity of endometriosis on the ovarianparenchyma excised during laparoscopic cystectomy.J Clin Diagn Res. 2013; 7: 2241-2243
- Histologic analysis of specimens from laparoscopic endometrioma excision performed by different surgeons: does the surgeon matter?.Fertil Steril. 2011; 95: 2116-2119
- Surgical therapy of ovarian endometrioma: recurrence and pregnancy rates.JSLS. 2014; 18 (00223): e2014
- Adnexal adhesions: a prognostic staging and classification system based on a five-year survey of fertility surgery results at Chapel Hill, North Carolina.Am J Obstet Gynecol. 1982; 144
Published online: August 19, 2019
Accepted: August 17, 2019
Received in revised form: August 16, 2019
Received: April 20, 2019
© 2019 Elsevier B.V. All rights reserved.