The duration of impairment of ovarian reserve after laparoscopic surgery

Effect of laparoscopic endometrioma removal on anti-mullerian hormone levels.

Key Points

Highlights:

• Several pre-operative characteristics are associated with the duration of impairment for ovarian reserve after laparoscopic surgery.

Key results:

• Women undergoing laparoscopic ovarian cystectomy (LOC) for endometrioma removal should be aware of possible ovarian reserve decline following surgery.
• At 1,3, and 6 months, antimullerian hormone levels significantly decreased after surgery. However, during the 12-month period, this difference did not exist. 
• In patients with bilateral cyst removal, >7cm cysts, or stage IV endometriosis, impairment of AMH levels lasted for longer than one year

What’s done here?

• 171 women aged 17-42 years old with no history of endocrine disorders, previous adnexal surgery, or infertility were included in the study.
• Patients were assessed regarding cyst size, age, type of surgery, endometriosis rASRM class, and uni-/bilaterally.
• AMH levels were followed 1 day before and 1, 3, 6, and 12 months postoperatively.

Limitations:

• This study solely used AMH as a marker for ovarian reserve. No assessment of fertility was included in the study.

Lay Summary

Endometriosis is a chronic medical condition characterized by ectopic endometrial tissue that grows and invades extra-uterine tissues. It is a significant contributor to chronic pelvic pain in women of reproductive age. Endometriosis involving the ovaries and causing a cystic growth is called an "endometrioma". Laparoscopic ovarian cystectomy (LOC) for endometriomas has been widely used but may be associated with decreased ovarian reserve. Several hormonal markers including anti-mullerian hormone (AMH) have been used to assess ovarian reserve. In the present study, the authors aim to assess whether the diminished ovarian reserve is temporary or long-lasting, by following patients who underwent LOC for endometriomas.

Wang et. al from several research institutions in Beijing, China recently published this study entitled, “Effect of laparoscopic endometrioma cystectomy on anti-Mullerian hormone (AMH) levels” in the Journal of Gynecological Endocrinology. In this study, several key results were established concerning AMH levels before and after surgery.

171 women aged 17-42 years-old with no history of endocrine disorders, previous adnexal surgery, or infertility were included in the study. Patients were then assessed regarding cyst size, age, type of surgery, endometriosis rASRM class, and uni-/bilaterally. Patients suspected of endometriomas were diagnosed with transvaginal ultrasound and were subsequently treated with LOC with either suturing or bipolar coagulation. In addition, AMH levels were followed 1 day before and 1, 3, 6, and 12 months postoperatively.

The majority of women included in this study were below 35 years of age (121 out of 171). AMH levels were found to be significantly decreased after surgery in those with bilateral cysts, cyst size >7cm, and stage IV endometriosis. On average AMH levels did not change drastically pre and post-operatively. Thus, the authors explain that for most women undergoing LOC, recovery of ovarian reserve is achievable, especially in patients below the age of 35. At 1,3, and 6 months, AMH levels were significantly decreased after surgery however at the 12-month period, this difference did not exist. Possible causes for impaired ovarian deserve after surgery include damage to the normal ovarian tissue and vasculature. In patients with bilateral cyst removal, >7cm cysts, or stage IV endometriosis, AMH levels were impaired for longer than one year.

Thus, this article has revealed that some pre-operative characteristics may mean a higher likelihood of impaired ovarian reserve after LOC, as seen by persistent decreases in AMH levels.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/30732484