{"paper_id":"3011a22b-a5c6-4051-a49f-1671b442b263","body_text":"Abstract\nIntroduction: Ovarian cystectomy is a common treatment for endometriomas; however, its long-term impact on ovarian reserve remains uncertain. This study aims to evaluate the longterm pattern of serum anti-Müllerian hormone (AMH) levels following cystectomy and to determine whether ovarian reserve recovers or continues to decline over time.\nMethods: This retrospective study analysed fifty patients who underwent laparoscopic cystectomy for suspected endometriomas, with a final mean follow-up of 23.3 months (95% CI, 20.90–25.80). Serum AMH levels were measured preoperatively, at 6 months postoperatively, and at the final follow- up. Changes in AMH levels were compared between patients with unilateral and bilateral endometriomas.\nResults: A significant decline in AMH levels was observed postoperatively. Mean AMH decreased from 2.60 ± 0.87 ng/mL at baseline to 1.37 ± 0.39 ng/mL at 6 months (decline of -1.23 ng/mL, P < 0.05) and further to 1.13 ± 0.43 ng/mL at final follow-up (cumulative decline of -1.47 ng/mL, P < 0.05). Patients with bilateral endometriomas experienced a significantly greater reduction in AMH (-2.79 ± 1.98 ng/mL, 72%) compared to those with unilateral endometriomas (-0.77 ± 0.49 ng/mL, 39%) (P < 0.05).\nDiscussion: Cystectomy for ovarian endometriomas reduces symptoms but significantly impairs ovarian reserve, particularly in bilateral cases, as indicated by a sustained drop in AMH levels. Fertility- preserving alternatives, such as hydro-dissection and partial excision with ablation, may limit ovarian damage. Complete excision is reserved for select high-risk cases. Limitations include a small sample size and the absence of a control group.\nConclusion: The decline in AMH following ovarian cystectomy is progressive and does not show evidence of recovery in most patients. Bilateral cystectomy has a more profound impact on ovarian reserve than unilateral surgery. Patients should be counselled about the potential long-term effects on fertility, and fertility-preserving strategies should be considered when managing endometriomas in women desiring future conception.\nKeywords: Endometriosis, minimally invasive surgery, endometrioma, cystectomy, ovarian reserve, anti-Müllerian hormone.\n[http://dx.doi.org/10.1097/AOG.0b013e3181e8b073] [PMID: 20567196]\n[http://dx.doi.org/10.1093/humupd/8.6.591] [PMID: 12498427]\n[http://dx.doi.org/10.1016/S0015-0282(99)00211-3] [PMID: 10439002]\n[http://dx.doi.org/10.1016/j.rbmo.2013.09.024] [PMID: 24365030]\n[http://dx.doi.org/10.1002/14651858.CD004992.pub3] [PMID: 18425908]\n[http://dx.doi.org/10.1016/j.ajog.2015.04.006] [PMID: 25882917]\n[http://dx.doi.org/10.1093/humupd/dmt062] [PMID: 24430863]\n[http://dx.doi.org/10.1093/humupd/dms041] [PMID: 23188168]\n[http://dx.doi.org/10.1016/j.fertnstert.2012.08.009] [PMID: 22975114]\n[http://dx.doi.org/10.1016/j.fertnstert.2010.06.010] [PMID: 20630505]\n[http://dx.doi.org/10.1016/j.fertnstert.2012.03.027] [PMID: 22521696]\n[http://dx.doi.org/10.1016/j.fertnstert.2013.10.043] [PMID: 24290000]\n[http://dx.doi.org/10.1186/s13048-014-0108-0] [PMID: 25424986]\n[http://dx.doi.org/10.1016/j.fertnstert.2013.03.032] [PMID: 23579006]\n[http://dx.doi.org/10.1111/jog.12830] [PMID: 26420658]\n[http://dx.doi.org/10.1016/j.fertnstert.2015.06.024] [PMID: 26183313]\n[http://dx.doi.org/10.1093/HUMREP/11.3.641]\n[http://dx.doi.org/10.1016/S0015-0282(97)00191-X] [PMID: 9341595]\n[http://dx.doi.org/10.1016/S0015-0282(16)56752-1] [PMID: 8194613]\n[http://dx.doi.org/10.1097/00004347-200104000-00006] [PMID: 11293160]\n[http://dx.doi.org/10.1016/S0015-0282(01)03203-4] [PMID: 11872220]\n[PMID: 26988540]\n[http://dx.doi.org/10.1016/j.fertnstert.2005.08.021] [PMID: 16500357]\n[http://dx.doi.org/10.1016/j.rbmo.2015.06.015] [PMID: 26283017]\n[http://dx.doi.org/10.1093/humupd/dmu020] [PMID: 24821925]\n[http://dx.doi.org/10.1016/j.fertnstert.2009.02.022] [PMID: 19345350]\n[http://dx.doi.org/10.1111/jog.13081] [PMID: 27527586]\n[http://dx.doi.org/10.1016/j.fertnstert.2016.12.013] [PMID: 28089574]\n[http://dx.doi.org/10.1093/humrep/den133] [PMID: 18441346]\n[http://dx.doi.org/10.1016/j.jmig.2009.11.004] [PMID: 20226404]\n[PMID: 25473628]\n[http://dx.doi.org/10.1016/j.jmig.2013.07.024] [PMID: 24075865]\n[http://dx.doi.org/10.1016/j.rbmo.2009.11.014] [PMID: 20113970]\n[http://dx.doi.org/10.1016/j.fertnstert.2009.02.065] [PMID: 19361793]\n[http://dx.doi.org/10.1093/humupd/dmv035] [PMID: 26168799]\n[http://dx.doi.org/10.1371/journal.pone.0177426] [PMID: 28574993]\n[PMID: 16437491]\n[http://dx.doi.org/10.1007/s10815-016-0646-z] [PMID: 26768141]\n[http://dx.doi.org/10.1093/humrep/den398] [PMID: 19056774]\n[http://dx.doi.org/10.1016/j.ygyno.2011.10.001] [PMID: 22032835]\n[http://dx.doi.org/10.2214/AJR.09.2985] [PMID: 20093596]\n[http://dx.doi.org/10.1016/j.fertnstert.2016.07.1077] [PMID: 27543889]\n[http://dx.doi.org/10.1111/jog.13372] [PMID: 28718209]\n[http://dx.doi.org/10.1016/j.fertnstert.2022.08.860] [PMID: 36334993]","source_license":"CC0","license_restricted":false}