Turn around to come to the same spot: Nothing specific to predict AMH decline

AMH decline after endometrioma surgery is NOT related to surgery.

Key Points

Highlights:

• Endometrioma surgery frightens surgeons and patients about ovarian reserve decline but the search for a predictive marker remains controversial.

Importance:

• The study talks about thinking twice about applying surgery on any patient with any size or laterality of endometrioma.
• As the decline in AMH is NOT related to anything we consider preoperatively, a patient-vise variation is probably on the scene.

What's done here:

• Women between 18 to 44 years old who would have endometrioma surgery between July 2020 and January 2021 were included prospectively.
• Patients were analyzed according to their demographic data, size, and laterality of endometrioma, disease stage, grade, pre-, and postoperative AMH, LH, FSH, Ca125, and Ca19-9 levels.
• The grade was defined according to ENZIAN scoring (grades 1 = mild to 4 = severe)*.
• Any relation between the above parameters and postoperative 3rd-month AMH decline was calculated by correlation analysis.
• Operations have been done by 2 expert excision surgeons.

Key Results:

• AMH and LH declined significantly in the postoperative 3rd month.
• In the multivariate analyses, comparing the decrease rate of AMH and other variables, only the grade of endometriosis showed a significant correlation.
• No significant correlation was found between FSH, demographic characteristics, laterality of endometrioma, tumor marker level, and AMH decline.

Limitations:

• Short follow-up duration and a small number of participants.
• Other than the long-term follow-up, adding the antral follicle count as a parameter would make the results more appropriate.

Lay Summary

Endometriomas are challenging lesions as they might cause a decline in ovarian function either only by their presence or related to their surgery. Thus, any preoperative parameter that might give a vision to a surgeon for postoperative results is crucial.

In the prospective study conducted in Tehran by Maliheh Fakehi et al, the parameters related to endometrioma have been checked by multivariate analysis to examine the correlation between the postoperative AMH decline. Women between 18 to 44 years old who would have endometrioma surgery between July 2020 and January 2021 were included prospectively. Patients with previous adnexal surgery, under hormonal therapy, who have an endocrine disorder, or with ovarian mass suspicious of malignancy, polycystic ovaries, or endometriomas smaller than 3 centimeters in diameter have been excluded.

All patients were analyzed according to their demographic data, size, and laterality of endometrioma, disease stage, grade*, pre-, and postoperative AMH, LH, FSH, Ca125, and Ca19-9 levels. The relation between these parameters and postoperative 3rd-month AMH decline was calculated. All operations were performed by 2 expert excision surgeons.

AMH and LH declined significantly in the postoperative 3rd month. In the multivariate analyses, comparing the decrease rate of AMH and other variables, the authors found "the grade of endometriosis" only showed a significant correlation. No significant correlation was found between FSH, demographic characteristics, laterality of endometrioma, tumor marker level, and AMH decline.  While the study shows only the short-term effects of the operation on the AMH level it still makes one think that a multiway or personalized change is occurring on AMH levels.

This article was published in the August 2022 issue of the "International Journal of Fertility & Sterility".

* Although the term "grade of endometriosis" is not detailed in the paper,  when we mailed and asked the authors they replied that it is "ENZIAN grade" and was scored as (grades 1 = mild to 4 = severe)*.

Research Source: https://pubmed.ncbi.nlm.nih.gov/36029052/