Skip to main content
SpringerLink
Log in

Ovarian Reserve Reduction With Surgery Is Not Correlated With the Amount of Ovarian Tissue Inadvertently Excised at Laparoscopic Surgery for Endometriomas

  • Published:
Reproductive Sciences Aims and scope Submit manuscript

Abstract

The aim of the present study was to evaluate the effect of laparoscopic cystectomy on ovarian reserve by means of anti-Müllerian hormone (AMH) serial measurements and to compare AMH values with the number of inadvertently removed follicles in histological specimens. Fifty-two women were enrolled: 34 patients with endometriomas (group 1) and 18 patients with other benign ovarian cysts (group 2). All patients underwent laparoscopic cystectomy performed by a single experienced surgeon. The AMH was measured before, and 1, 3, and 6 months after cystectomy in group 1, and before and 6 months after surgery in group 2. Preoperative AMH levels (mean [standard deviation, SD]) in group 1 (3.39 [2.43] ng/mL) were not significantly different from group 2 (3.74 [2.57] ng/mL; P =.68). In group 1, a significant decrease in AMH levels of 43.4% was observed at 1 month (1.93 [1.36]; P =.003), and of 63.1% at 3 months (1.25 [1.00]; P =.007) postoperatively. The AMH increased not significantly between the third and sixth months in group 1 (+9.4%). Six months after surgery, AMH was reduced by 59.3% compared to baseline values in group 1 (P =.012), and by 29.5% in group 2 (P =.200). A significant difference in the AMH decrease was present between bilateral and monolateral endometriomas (P =.006). There was no correlation between the reduction rate of AMH and the number of follicles inadvertently removed in patients with endometriomas (P =.669). In conclusion, AMH decreases significantly after surgical excision of ovarian endometriomas. The postoperative decrease does not appear to correlate with the amount of ovarian tissue inadvertently excised with the endometrioma wall.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Chapron C, Vercellini P, Barakat H, Vieira M, Dubuisson JB. Management of ovarian endometriomas. Hum Reprod Update. 2002;8(6):591–597.

    Article  CAS  Google Scholar 

  2. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012;98(3):591–598.

    Article  Google Scholar 

  3. Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometrio-sis: a committee opinion. Fertil Steril. 2014;101(4):927–935.

    Article  Google Scholar 

  4. Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Randomized clinical trial oftwo laparoscopic treatments ofendo-metriomas: cystectomy versus drainage and coagulation. Fertil Steril. 1998;70(6):1176–1180.

    Article  CAS  Google Scholar 

  5. Alborzi S, Momtahan M, Parsanezhad ME, Dehbashi S, Zolghadri J, Alborzi S. A prospective, randomized study comparing laparo-scopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril. 2004;82(6): 1633–1637.

    Article  Google Scholar 

  6. Hart RJ, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev. 2008;16(2):CD004992.

    Google Scholar 

  7. Carmona F, Martínez-Zamora MA, Rabanal A, Martinez-Roman S, Balasch J. Ovarian cystectomy versus laser vaporization in the treatment of ovarian endometriomas: a randomized clinical trial with a five-year follow-up. Fertil Steril. 2011;96(1): 251–254.

    Article  Google Scholar 

  8. Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012;97(9): 3146–3154.

    Article  CAS  Google Scholar 

  9. Block E. Quantitative morphological investigations of the folli-cular system in women; variations at different ages. Acta Anat (Basel). 1952;14(1–2):108–123.

    Article  CAS  Google Scholar 

  10. Hehenkamp WJ, Looman CW, Themmen AP, De Jong FH, Te Velde ER, Broekmans FJ. Anti-Mullerian hormone levels in the spontaneous menstrual cycle do not show substantial fluctuation. J Clin Endocrinol Metab. 2006;91(10):4057–4063.

    Article  CAS  Google Scholar 

  11. La Marca A, Stabile G, Artenisio AC, Volpe A. Serum anti-Mullerian hormone throughout the human menstrual cycle. Hum Reprod. 2006;21(12):3103–3107.

    Article  CAS  Google Scholar 

  12. Tsepelidis S, Devreker F, Demeestere I, Flahaut A, Gervy C, Englert Y. Stable serum levels of anti-Mullerian hormone during the menstrual cycle: a prospective study in normo-ovulatory women. Hum Reprod. 2007;22(7):1837–1840.

    Article  CAS  Google Scholar 

  13. Tsolakidis D, Pados G, Vavilis D, et al. The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study. Fertil Steril. 2010;94(1):71–77.

    Article  CAS  Google Scholar 

  14. Ercan CM, Sakinci M, Duru NK, Alanbay I, Karasahin KE, Baser I. Antimullerian hormone levels after laparoscopic endo-metrioma stripping surgery. Gynecol Endocrinol. 2010;26(6): 468–472.

    Article  CAS  Google Scholar 

  15. Iwase A, Hirokawa W, Goto M, et al. Serum anti-Mullerian hormone level is a useful marker for evaluating the impact oflaparo-scopic cystectomy on ovarian reserve. Fertil Steril. 2010;94(7): 2846–2849.

    Article  CAS  Google Scholar 

  16. Biacchiardi CP, Piane LD, Camanni M, et al. A Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons. Reprod Biomed Online. 2011;23(6):740–746.

    Article  Google Scholar 

  17. Ercan CM, Duru NK, Karasahin KE, Coksuer H, Dede M, Baser I. Ultrasonographic evaluation and anti-mullerian hormone levels after laparoscopic stripping of unilateral endometriomas. Eur J Obstet Gynecol Reprod Biol. 2011;158(2):280–284.

    Article  CAS  Google Scholar 

  18. Hirokawa W, Iwase A, Goto M, et al. The post-operative decline in serum anti-Mullerian hormone correlates with the bilaterality and severity of endometriosis. Hum Reprod. 2011; 26(4):904–910.

    Article  CAS  Google Scholar 

  19. Hwu YM, Wu FS,Li SH,Sun FJ, Lin MH, Lee RK. The impact of endometrioma and laparoscopic cystectomy on serum anti-Müllerian hormone levels. Reprod Biol Endocrinol. 2011;9:80.

    Article  CAS  Google Scholar 

  20. Kitajima M, Khan KN, Hiraki K, Inoue T, Fujishita A, Masuzaki H. Changes in serum anti-Mullerian hormone levels may predict damage to residual normal ovarian tissue after laparoscopic surgery for women with ovarian endometrioma. Fertil Steril. 2011;95(8):2589–2591.

    Article  CAS  Google Scholar 

  21. Lee DY, Kim NY, Kim MJ, Yoon BK, Choi DS. Effects of laparoscopic surgery on serum anti-Mullerian hormone levels in reproductive-aged women with endometrioma. Gynecol Endocri-nol. 2011;27(10):733–736.

    Article  CAS  Google Scholar 

  22. Chen Y, Pei H, Chang Y, et al. The impact of endometrioma and laparoscopic cystectomy on ovarian reserve and the exploration of related factors assessed by serum anti-Mullerian hormone: a prospective cohort study. J Ovarian Res. 2014;7:108.

    Article  Google Scholar 

  23. Ding Y, Yuan Y, Ding J, Chen Y, Zhang X, Hua K. Comprehensive assessment of the impact of laparoscopic ovarian cystectomy on ovarian reserve. J Minim Invasive Gynecol. 2015;22(7): 1252–1259.

    Article  Google Scholar 

  24. Ergun B, Ozsurmeli M, Dundar O, Comba C, Kuru O, Bodur S. Changes in markers of ovarian reserve after laparoscopic ovarian cystectomy. J Minim Invasive Gynecol. 2015;22(6): 997–1003.

    Article  Google Scholar 

  25. Chun S, Cho HJ, Ji YI. Comparison of early postoperative decline of serum antiMullerian hormone levels after unilateral laparo-scopic ovarian cystectomy between patients categorized according to histologic diagnosis. Taiwan JObstet Gynecol. 2016;55(5): 641–645.

    Article  Google Scholar 

  26. Goodman LR, Goldberg JM, Flyckt RL, Gupta M, Harwalker J, Falcone T. Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls. Am J Obstet Gynecol. 2016;215(5):589.

    Article  Google Scholar 

  27. Muzii L, Angioli R, Zullo M, Panici PB. The unexpected ovarian malignancy found during operative laparoscopy: incidence, management, and implications for prognosis. JMinim Invasive Gynecol. 2005;12(1):81–89.

    Article  Google Scholar 

  28. Leyland N, Casper R, Laberge P, Singh SS; SOGC. Endometrio- sis: diagnosis and management. J Obstet Gynaecol Can. 2010; 32(7 suppl 2):S1–S32.

    Article  Google Scholar 

  29. Dunselman GA, Vermeulen N, Becker C, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400–402.

    Article  CAS  Google Scholar 

  30. Muzii L, Di Tucci C, Di Mascio D, et al. Current management of ovarian endometriomas. Minerva Ginecol. 2018;70(3): 286–294.

    PubMed  Google Scholar 

  31. Muzii L, Di Tucci C, Di Feliciantonio M, et al. Management of endometriomas. Semin Reprod Med. 2017;35(1):25–30.

    PubMed  Google Scholar 

  32. Somigliana E, Berlanda N, Benaglia L, Vigano P, Vercellini P, Fedele L. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimiillerian hormone level modifications. Fertil Steril. 2012;98(6):1531–1538.

    Article  CAS  Google Scholar 

  33. Muzii L, Bianchi A, Croce C, Manci N, Panici PB. Laparoscopic excision of ovarian cysts: is the stripping technique a tissue-sparing procedure?. Fertil Steril. 2002;77(3):609–614.

    Article  Google Scholar 

  34. Muzii L, Miller CE. The singer, not the song. J Minim Invasive Gynecol. 2011;18(5):666–667.

    Article  Google Scholar 

  35. Muzii L, Marana R, Angioli R, et al. Histologic analysis ofspeci-mens from laparoscopic endometrioma excision performed by different surgeons: does the surgeon matter?. Fertil Steril. 2011;95(6):2116–2119.

    Article  Google Scholar 

  36. Yu HT, Huang HY, Soong YK, Lee CL, Chao A, Wang CJ. Laparoscopic ovarian cystectomy of endometriomas: surgeons' experience may affect ovarian reserve and live-born rate in infertile patients with in vitro fertilization-intracytoplasmic sperm injection. Eur J Obstet Gynecol Reprod Biol. 2010;152(2): 172–175.

    Article  Google Scholar 

  37. Uncu G, Kasapoglu I, Ozerkan K, Seyhan A, Oral Yilmaztepe A, Ata B. Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve. Hum Reprod. 2013;28(8):2140–2145.

    Article  CAS  Google Scholar 

  38. Vignali M, Mabrouk M, Ciocca E, et al. Surgical excision of ovarian endometriomas: does it truly impair ovarian reserve?. Long term anti-Mullerian hormone (AMH) changes after surgery. J Obstet Gynaecol Res. 2015;41(11):1773–1778.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, “Sapienza” University of Rome, Viale del Policlinico 155, Rome, 00161, Italy

    Ludovico Muzii, Chiara Di Tucci, Mara Di Feliciantonio, Giulia Galati, Maria Grazia Piccioni & Pierluigi Benedetti Panici

  2. Department of Pathology, “Sapienza” University of Rome, Rome, Italy

    Irene Pecorella

  3. Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, “Sapienza” University of Rome, Rome, Italy

    Antonio Radicioni & Antonella Anzuini

  4. Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy

    Felice Patacchiola

Authors
  1. Ludovico Muzii
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chiara Di Tucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mara Di Feliciantonio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giulia Galati
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Irene Pecorella
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio Radicioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Antonella Anzuini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maria Grazia Piccioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Felice Patacchiola
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Pierluigi Benedetti Panici
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ludovico Muzii.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Muzii, L., Di Tucci, C., Di Feliciantonio, M. et al. Ovarian Reserve Reduction With Surgery Is Not Correlated With the Amount of Ovarian Tissue Inadvertently Excised at Laparoscopic Surgery for Endometriomas. Reprod. Sci. 26, 1493–1498 (2019). https://doi.org/10.1177/1933719119828055

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1177/1933719119828055

Keywords

Search

Navigation