Increasing trend of serum antimullerian hormone level after long term follow up of endometrioma resection

Abstract

Background:

Endometriosis is a chronic disease mostly affecting women at reproductive age. Some evidence suggests that surgery of ovarian endometrioma may have a detrimental effect on ovarian reserve. The aim of this study was to evaluate the changes of serum antimullerian hormone (AMH) levels in patients with endometrioma after cystectomy.

Methods:

A prospective study was performed at Nikan hospital on 58 patients with endometrioma who underwent laparoscopic cystectomy. Of them, 30 had unilateral endometrioma and 28 had bilateral endometrioma. Complete excision was done, pelvic endometriosis implants as well as deep infiltrative endometriosis was resected. Sutures were made for the closure of ovarian parenchyma and bleeding control. We did not use any hot energy devices such as cautery on ovaries for ablation, coagulation or resection of endometrioma. Serum AMH levels were measured preoperatively, 3, 9, and 15 months postoperatively.

Results:

Serum AMH levels decreased significantly from the preoperative sample (2.98 ± 2.47 ng/ml) to 3 months after laparoscopy (1.07 ± 1.06 ng/ml), then gradually increased 9 months (1.47 ± 1.16 ng/ml) and 15 months (1.95 ± 1.85 ng/ml) after surgery, without returning to the preoperative levels during the follow-up time of study.

Conclusion:

There is a fluctuation pattern in AMH levels from preoperative to 15-month follow-up after endometrioma surgery using only suture for ovarian hemostasis. Firstly, there is decline in AMH level 3 months after surgery, then an increasing trend was observed gradually up to 15 months after surgery. Controlled studies are needed to compare the effects of various cystectomy methods on the ovarian reserve after endometrioma surgery

Keywords

Endometrioma antimullerian hormone laparoscopy cystectomy endometriosis fertility 33 preservation

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References

ACOG. Practice bulletin management of endometriosis. Obstet Gynecol 2010; 116(1): 223–236

de Ziegler

Borghese

Chapron

. Endometriosis and infertility: pathophysiology and management. Lancet 2010; 376(9742): 730–738.

Chapron

Vercellini

Barakat

, et al. Management of ovarian endometriomas. Hum Reprod Update 2002; 8(6):591–597.

Redwine

DB.

Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertil Steril 1999; 72: 310–315.

Geber

Ferreira

Prates

, et al. Effects of previous ovarian surgery for endometriosis on the outcome of assisted reproduction treatment. Reprod Biomed Online 2002; 5: 162–166.

Jirge

Ovarian reserve tests. J Hum Reprod Sci 2011; 4(3): 108–113.

Pfeifer

Butts

Dumesic

, et al. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril 2015; 103(3): e9–e17

Kasapoglu

Ata

Uyaniklar

, et al. Endometrioma-related reduction in ovarian reserve (ERROR): a prospective longitudinal study. Fertil Steril 2018; 110: 122–127.

Chang

Han

Lee

, et al. Impact of laparoscopic cystectomy on ovarian reserve: serial changes of serum anti-mullerian hormone levels. Fertil Steril 2010; 94: 343–349.

10.

Ercan

Sakinci

Duru

, et al. Antimullerian hormone levels after laparoscopic endometrioma stripping surgery. Gynecol Endocrinol 2010; 26: 468–472.

11.

Kitajima

Khan

Hiraki

, et al. 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: 2589–2591.e1.

12.

Lee

Kim

, et al. Effects of laparoscopic surgery on serum anti Mullerian hormone levels in reproductive-aged women with endometrioma. Gynecol Endocrinol 2011; 27: 733–736.

13.

Tsolakidis

Pados

Vavilis

, 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: 71–77.

14.

Iwase

Hirokawa

Goto

, et al. Serum anti-mullerian hormone level is a useful marker for evaluating the impact of laparoscopic cystectomy on ovarian reserve. Fertil Steril 2010; 94: 2846–2849.

15.

Biacchiardi

Piane

Camanni

, et al. Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons. Reprod Biomed Online 2011; 23: 740–746.

16.

Litta

D’Agostino

Conte

, et al. Anti-Müllerian hormone trend after laparoscopic surgery in women with ovarian endometrioma. Gynecol Endocrinol 2013; 29(5): 452–454.

17.

Hanege

Çekıç

Ata

Endometrioma and ovarian reserve: effects of endometriomata per se and its surgical treatment on the ovarian reserve. Facts Views Vis Obgyn 2019; 11(2): 151–157.

18.

Deckers

Ribeiro

Simões

RDS

, et al. Systematic review and meta-analysis of the effect of bipolar electrocoagulation during laparoscopic ovarian endometrioma stripping on ovarian reserve. Int J Gynecol Obstet 2018; 140: 11–17.

19.

Ding

Teng

The impact on ovarian reserve of haemostasis by bipolar coagulation versus suture following surgical stripping of ovarian endometrioma: a meta-analysis. Reprod Biomed Online 2015; 30: 635–642.

20.

Ata

Turkgeldi

Seyhan

, et al. Effect of hemostatic method on ovarian reserve following laparoscopic endometrioma excision; comparison of suture, hemostatic sealant, and bipolar dessication. A systematic review and meta-analysis. J Minim Invasive Gynecol 2015; 22: 363–372.

21.

Ferrero

Scala

Racca

, et al. Second surgery for recurrent unilateral endometriomas and impact on ovarian reserve: a case-control study. Fertil Steril 2015; 103(5): 1236–1243.

22.

Exacoustos

Zupi

Piccione

Ultrasound imaging for ovarian and deep infiltrating endometriosis. Semin Reprod Med 2017; 35: 5–24.

23.

Streuli

de Ziegler

Gayet

, et al. In women with endometriosis anti-Müllerian hormone levels are decreased only in those with previous endometrioma surgery. Hum Reprod 2012; 27(11): 3294–3303.

24.

Chiang

Lin

Huang

, et al. The impact of previous ovarian surgery on ovarian reserve in patients with endometriosis. BMC Womens Health 2015; 15: 74.

25.

Alborzi

Keramati

Younesi

, et al. The impact of laparoscopic cystectomy on 277 ovarian reserve in patients with unilateral and bilateral endometriomas. Fertil Steril 2014; 101(2): 427–34.

26.

Roman

Tarta

Pura

, et al. 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.

27.

Kovačević

Anđelić

Mitrović Jovanović

Changes in serum antimüllerian hormone levels in patients 6 and 12 months after endometrioma stripping surgery. Fertil Steril 2018; 110(6): 1173–1180.

28.

Alborzi

Momtahan

Parsanezhad

, et al. A prospective randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril 2004; 82: 1633–1637.

29.

Wang

Ruan

, et al. Effect of laparoscopic endometrioma cystectomy on antiMüllerian hormone (AMH) levels. Gynecol Endocrinol 2019; 35(6): 494–497.

30.

Turkcuoglu

Melekoglu

The long-term effects of endometrioma surgery on ovarian reserve: a prospective case-control study. Gynecol Endocrinol 2018; 34(7): 612–615.

31.

Celik

Dogan

Okyay

, et al. Effect of laparoscopic excision of endometriomas on ovarian reserve: serial changes in the serum antim€ullerian hormone levels. Fertil Steril 2012; 97: 1472–1478.

32.

Muzii

Di Tucci

Di Feliciantonio

, 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 2019; 26(11): 1493–1498.

33.

Kim

Cha

Kim

HO.

Serum anti-Müllerian hormone levels decrease after endometriosis surgery. J Obstet Gynaecol 2017; 37(3): 342–346.

34.

Hwu

, et al. The impact of endometrioma and laparoscopic cystectomy on serum anti-Mullerian hormone levels. Reprod Biol Endocrinol 2011; 9: 80.

35.

Henes

Engler

Taran

, et al. Ovarian cyst removal influences ovarian reserve dependent on histology, size and type of operation. Women’s Health (Lond) 2018; 14: 1745506518778992.

36.

Mehdizadeh Kashi

Chaichian

Ariana

. The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometrioma. Int J Gynaecol Obstet 2017; 136(2): 200–204.

37.

Elsemary

Mostafa

El Taher

, et al. Serum antimullerian hormone before and after laparoscopic excision of ovarian endometrioma. J Med Sci Res 2018; 1: 30–34.

38.

Younis

Shapso

Fleming

, et al. Impact of unilateral versus bilateral ovarian endometriotic cystectomy on ovarian reserve: a systematic review and meta-analysis. Hum Reprod 1; 25(3): 375–391.