{"paper_id":"8758fc33-6073-407c-80a2-c0898681d81d","body_text":"Orginal Article  | JOGCR. 2026; 11(3): 218-223 \n     Volume 11, March 2026       Journal of Obstetrics, Gynecology and Cancer Research \n Journal of Obstetrics, Gynecology and Cancer Research | ISSN: 2476-5848 \n \n \nSerum AMH Levels in Women: Differences Between Endometrioma and \nNon-Endometrioma Cases \n \nArry Soryadharma* , Chairul Rijal , Mulyanusa Amarullah Ritonga ,  \nHanom Husni Syam  \n \nDepartment of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia  \nArticle Info  ABSTRACT \n  \n 10.24200/jogcr.11.3.218 \n \n \n \nBackground & Objective:  The link between endometrioma and serum Anti -\nMüllerian Hormone (AMH) levels is crucial in predicting outcomes and informing \nclinical management strategies for affected individuals. Endometrioma may reduce \novarian reserve due to damage to ovarian tissue, which in turn affects AMH secretion. \nClinically, AMH is a widely recognized marker for assessing ovarian reserve and is \nfrequently utilized in diagnosing and forecasting infertility and reproductive conditions. \nThis study was conducted with aim to investigate the differences in serum AMH levels \nbetween women with and without endometrioma. \nMaterials & Methods : This cross -sectional analytical study was conducted on \nreproductive-aged women diagnosed with endometrioma at Hasan Sadikin Hospital, \nBandung, from August 2022 to July 2024. The control group consisted of women \nwithout endometrioma, selected consecutively according to specific eligibility criteria, \nas AMH was not routinely measured in this population. A total of 50 participants were \nrecruited, with 25 women in each group. All subjects underwent serum AMH testing, \nand diagnoses were confirmed via histopathol ogical examination. P<0.05 was \nconsidered statistically significant. \nResults: Women with endometrioma exhibited significantly lower average serum \nAMH levels compared to those without endometrioma (0.96±0.82 ng/ml vs. 2.05±1.00 \nng/ml, P<0.001). There were no notable differences in age or body mass index between \nthe two groups (23.44±3.65 kg/m² vs. 24.45±4.49 kg/m²). The statistical analysis \nconfirmed a significant disparity in AMH levels between the two groups (P<0.001). \nConclusion: The study identified a significant correlation between the presence of \nendometrioma and reduced serum AMH levels, suggesting that endometrioma is \nassociated with a decline in ovarian reserve. \nKeywords: Anti-mullerian hormone, AMH, endometrioma, Non -endometrioma  \n \nReceived: 2025/07/03 \nAccepted: 2025/09/08 \nPublished Online: 03 Feb. 2026 \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Information:  \nArry Soryadharma, \nDepartment of Obstetrics and Gynecology, \nFaculty of Medicine, Padjadjaran University, \nBandung, Indonesia \n \nEmail: arry10002@mail.unpad.ac.id \n \n \nCopyright © 2025, This is an original open -access article distributed under the terms of the Creative Commons Attribution-noncommercial \n4.0 International License which permits copy and redistribution of the material just in noncommercial usages with proper citation . \n \n \n \n1. Introduction\nEndometriosis is an inflammatory condition where \nendometrial tissue grows abnormally outside it. The \nresulting cystic lesions also called endometrioma \ntypically occur in the ovaries and affects about 10% of \nwomen of reproductive age (1,2). This condition often \nmanifests as chronic pain, painful during intercourse, \nmenstrual pain, and infertility. Although endometriosis \ntypically develops in the pelvic area, particularly \naround the ovaries, endometriomas represent the most \nfrequent ovarian form of the condition. This condition \noften called chocolate cysts because of the dark brown \ncolor of their fluid and affects 17 to 44% of women \nwith endometriosis. The occurrence of endometriomas \nsignifies a more advanced stage of endometriosis and \nmay re sult in complications like diminished ovarian \nreserve (3-5). \nAnti-Müllerian Hormone (AMH) is a dimeric \nglycoprotein that is part of the Transforming Growth \nFactor β (TGF -β) superfamily. AMH is secreted by \ngranulosa cells of small, developing ovarian follicles. \nSince serum AMH levels closely reflect the quantity of \nthese growing follicles, it has gained prominence as a \nreliable indicator of ovarian reserve (6,7). In women \nwith removed ovaries, AMH levels in the serum \nbecome undetectable because serum levels primarily \nreflect its secretion from the gonads, but it is also \nproduced in both endometrial and endometriotic cells, \nits serum levels primarily reflect its s ecretion from the \ngonads. Moreover, ovarian aging is characterized by a \nnoticeable decline in circulating AMH and inhibin B \nlevels. Research has shown that age significantly \n\n\n219 AMH Levels in Women with and Without Endometrioma \n      Volume 11, March 2026       Journal of Obstetrics, Gynecology and Cancer Research \nimpacts AMH levels, with concentrations decreasing \nby approximately 0.384 μg/L per year (8,9). \nThe relationship between endometrioma and AMH \nlevels reflects the broader impact of endometriosis on \novarian function. Endometriomas can lead to reduced \nAMH levels due to the damaging effects of \ninflammation and oxidative stress on ovarian follicles. \nMonitoring AMH levels can provide insights into the \nextent of ovarian damage and help in managing fertility \nconcerns in women with endometriosis. The \nrelationship between endometrioma and serum AMH \nlevels serves as an important reference for assessing \nprognosis and guiding the management of the \ncondition. Endometrioma can impair ovarian reserve \nby damaging ovarian tissue, thereby reducing AMH \nproduction. In clinical practice, serum AMH is widely \nused to evaluate ovarian reserve and acts as a key \nmarker for the d iagnosis and prognosis of infertility \nand other reproductive disorders. (10-12). This study \nwas conducted with aim to assess the relationship \nbetween serum AMH levels in women diagnosed with \nendometrioma and those without the condition. \n \n2. Materials and Methods \nThis case-control analytical study was conducted on \nreproductive-aged women diagnosed with \nendometrioma at Hasan Sadikin Hospital, Bandung, \nfrom August 2022 to July 2024. The research adhered \nto the principles outlined in the Declaration of Helsinki \nfor medical research involving human subjects. Ethical \napproval was granted by the Padjadjaran University \nEthics Committee under registration number  \nDP.24.25/D.XIV.6.5/344/2025, and informed consent \nwas obtained from all participants prior to the \ncommencement of the study. \nConsecutive sampling was used to recruit women of \nreproductive age who met the inclusion criteria. \nParticipants were selected from those diagnosed with \nendometrioma at Hasan Sadikin Hospital, Bandung, \nbetween August 2022 and July 2024. Eligible subjects \nwere consecutively enrolled and subsequently divided \ninto two groups: endometrioma (n=25) and control \n(n=25). \nThe inclusion criteria comprised women of \nreproductive age, defined by the World Health \nOrganization (WHO) as individuals between 15 and 49 \nyears old. In both groups, a laboratory examination of \nserum AMH level was carried out and confirmation of \ndiagnosis was done by histopathological examination. \nThe examination of serum AMH levels was done by \ntaking venous blood as much as 3 cc and measured \nusing the Human AMH Enzyme-Linked \nImmunosorbent Assay  (ELISA) kit (Elabscience, \nUSA).  \nPotential confounding factors in this study included \nage and Body Mass Index (BMI). To minimize bias,  \nthe significance of these characteristics was assessed \nbetween the two groups to ensure group homogeneity. \nQuantitative variables, such as age and serum AMH \nlevels, were summarized using mean, standard \ndeviation, and range. A norm ality test was conducted \nto determine the data distribution. Age was analyzed \nusing an independent t -test, as it was normally \ndistributed, while serum AMH levels, which were not \nnormally distributed, were analyzed using the Mann -\nWhitney test. P<0.05 was considered statistically \nsignificant. \n \n3. Results \nA total of 50 subjects were enrolled in this study, \ndivided into two groups: 25 in the endometrioma group \nand 25 in the control group. Analysis showed no \nsignificant differences between the two groups in key \ncharacteristics, including age (P=1.000) and Body \nMass Index (BMI) (P=0.100). The mean age for both \ngroups was 31.76 years, while the mean BMI was 23.4 \nkg/m² for the endometrioma group and 24.5 kg/m² for \nthe control group. Statistical analysis confirmed that \nthese baseline characteristics were homogeneo us \n(P>0.05), allowing for valid comparisons and further \nanalyses to explore the relationships between variables \n(Table 1). \n \nTable 1. The characteristicsof the subjects in two groups \nCharacteristics \nGroup \nP-value Endometrioma \n(n=25) \nNon-Endometrioma \n(n=25) \nAge (years)    \nMean±SD 31.76±5.4 31.76±5.4 1.000 \nRange 26-44 26-44  \n)2BMI (kg/m    \nMean±SD 23.4±3.65 24.5±4.48 0.100 \nRange 14.48-29.67 17.04-33.32  \nEndometrioma Laterality (n%)    \nUnilateral 17(68%)   \nBilateral 8(32%)   \nAbbreviations: n: number of samples; SD: standard deviation \n\nArry Soryadharma, et al. 220 \n      Volume 11, March 2026       Journal of Obstetrics, Gynecology and Cancer Research \nThe mean serum AMH level was significantly lower \nin the endometrioma group compared to the non -\nendometrioma group (0.96±0.82 ng/ml vs. 2.05±1.00 \nng/ml, P<0.001). These results demonstrated a \nstatistically significant difference between the two \ngroups in AMH levels (P<0.001) (Table 2). \n \n \nTable 2. Comparison of serum AMH level in endometrioma and non-endometrioma women \n \nGroup \nP-value \nEndometrioma (n=25) Non-Endometrioma (n=25) \nSerum AMH Level (ng/mL)    \nMean±SD 0.96±0.82 2.05±1.00 <0.001 \nRange 0.1-3.51 0.54-4.45  \nAbbreviations: n: number of samples; SD: standard deviation \n \n4. Discussion \nBased on the results of the comparison of the \ncharacteristics of the two groups, since there were no \nstatistically significant differences in the baseline \ncharacteristics between the two groups, both were \nsuitable for analysis of serum AMH levels. The \npurpose of the present study was to explore the \nrelationship between serum AMH levels in women \nwith and without endometrioma. The findings revealed \na significant difference, with serum AMH levels being \nnotably lower in the endometrioma group compared to \nthe no n-endometrioma group (13-16). Shebl et al. , \nreported that women with endometriosis exhibited \nlower serum AMH levels, which were also linked to \ndisease severity (17). \nThe definitive diagnosis of endometriosis, including \nendometriomas, can only be confirmed through \nsurgical evaluation involving direct visualization and \nhistological examination of tissue samples. The biopsy \nmust contain both endometrial glands and stroma to \nconfirm the presence of endometriosis in the tissue. \nAnti-Müllerian Hormone (AMH) is a glycoprotein \nsecreted by granulosa cells in small preantral and antral \nfollicles. Its levels provide an accurate indication of \novarian function, making it a more sensitive marker of \novarian reserve compared to chronological age. AMH \nis involved in the development of menstrual disorders \nand fertility problems associated with obesity and \npolycystic ovary syndrome. Additionally, AMH levels \nare regarded as a dependable mar ker of a woman’s \nremaining egg supply and serve as a valuable tool for \nprognosis in infertility counseling. Therefore, AMH is \nwidely used as a marker to monitor changes in ovarian \nfunction both naturally and due to treatment over time \nin women (18–20). \nConsistent with the findings of this study, previous \nresearch has shown that women with endometrioma \ngenerally have lower AMH levels. Muzii et al. , \nconducted a recent systematic review and meta -\nanalysis combining data from 17 studies, which \nincluded 968 women with endometriomas and 1,874 \ncontrols. Their analysis demonstrated that AMH levels \nwere significantly reduced in the endometrioma group \ncompared to women with non -endometriotic benign \novarian cysts or healthy ovaries, suggesting that \nendometrioma prese nce is linked to decreased AMH \nlevels (21). Kasapoglu et al., investigated the decline in \nAMH levels over six months in 40 women with \nendometriomas compared to 40 age -matched healthy \ncontrols and found that AMH levels declined more \nrapidly in the endometrioma group (22). Uncu et al. , \n(23) also reported similar findings, suggesting that the \naccelerated decline in AMH levels may explain the \nlower AMH concentrations observed in endometrioma \npatients in earlier studies, in which faster decline may \nhelp explain the lower AMH levels observed in \nendometrioma patients (24–26).  \nAlthough endometrioma is commonly linked to \nreduced ovarian reserve, some studies suggest that \nsurgical intervention may lead to an additional decline \nin serum AMH levels, indicating further deterioration \nof ovarian function. Hirokawa et al. , reported a \ncontinued decrease in AMH levels after endometrioma \nsurgery, with a significantly greater reduction observed \nin bilateral cases compared to unilateral ones (27). This \nfinding is consistent with the results of other studies, \nwhich also reported a reduction in serum AMH levels \nafter laparoscopic ovarian cystectomy (28,29). \nThe proposed explanation for reduced AMH levels \nand diminished ovarian reserve in women with \nendometriosis involves the chronic inflammation and \nimmune system changes associated with the condition. \nInflammation is known to cause damage and impair \nfunction in ovarian follicles, as seen in other conditions \nlike autoimmune primary ovarian insufficiency. In \nsuch cases, the immune system produces steroidogenic \nautoantibodies and triggers an inflammatory response \nthat can accelerate follicular damage and lead to early \nmenopause. Similarly, in endometriosis, the persistent \ninflammatory environment may disrupt follicle \n\n221 AMH Levels in Women with and Without Endometrioma \n      Volume 11, March 2026       Journal of Obstetrics, Gynecology and Cancer Research \nfunction and reduce both the quality and number of \novarian follicles. This mechanism may account for the \nfindings that women with endometriosis had lower \naverage AMH levels regardless of their age (19,20).  \nThe advancement and use of appropriate \nimmunoassays are crucial for improving the prediction \nof follicle count, early menopause, and reduced fertility \nin women, especially those with endometrioma (30). \nOne challenge with measuring AMH serum levels is \nthe lack of an internationally accepted standard for \nsample preparation, storage, and AMH testing. This \ngap creates significant challenges in applying AMH \nmeasurements in clinical settings. The issue was a lso \nlinked to the unrepresentative distribution of data, with \nsamples showing highly varied data distributions. \nThere is currently insufficient data to account for \npotential bias such as smoking history, environmental \nconditions, and the activities of the subjects in relation \nto serum AMH levels. One limitation of this study was \nthe relatively small sample size. This may contribute to \nthe absence of some significant findings, potentially \ndue to the sample not fully representing the broader \npopulation as seen in previous research. Future studies \nwith larger sample size are necessary to overcome this \nlimitation. \n \n5. Conclusion \nIn this study, there was a significant difference \nbetween the two groups, where patients with \nendometrioma had lower AMH levels compared to \npatients without endometrioma, considering other \nfactors such as similar age and BMI. \n \n6. Declarations \nAcknowledgments \nNone. \n \nEthical Considerations \nEthical approval was obtained from the Ethics \nCommittee of Dr. Hasan Sadikin General Hospital \nunder the following registration number \nDP.24.25/D.XIV.6.5/344/2025. Written informed \nconsent was not needed in our institution due to the \nresearch design being r etrospective from medical \nrecord data. This study was conducted in accordance \nwith the principles of the Declaration of Helsinki. All \ndata were collected and analyzed anonymously to \nensure participant confidentiality, and no identifying \ninformation was disclosed at any stage of the study. \n \nAuthors' Contributions \nA.S, C.J, and M.A.R participated in the design and \nplanning of the research. A.S and H.H.S performed the \nmeasurements and data collection. C.J and M.A.R \nconducted the statistical analysis. All authors drafted \nthe manuscript and interpreted the results. \n \nConflict of Interest \nThe authors declared no conflict of interest. \n \nFund or Financial Support \nThere is no funding to report. \n \n \n \n \n \n1. La Marca A, Volpe A. Anti-Müllerian hormone \n(AMH) in female reproduction: is measurement \nof circulating AMH a useful tool? Clin \nEndocrinol (Oxf). 2006;64(6):603 –10. \n[doi:10.1111/j.1365-2265.2006.02533.x] \n2. Clement PB. The pathology of endometriosis: a \nsurvey of the many faces of a common disease \nemphasizing diagnostic pitfalls and unusual and \nnewly appreciated aspects. Adv Anat Pathol. \n2007;14(4):241–60. \n[doi:10.1097/pap.0b013e3180ca7d7b] \n3. Broer SL, Broekmans FJM, Laven JSE, Fauser \nBCJM. Anti -Müllerian hormone: ovarian \nreserve testing and its potential clinical \nimplications. Hum Reprod Update. \n2014;20(5):688–701. \n[doi:10.1093/humupd/dmu020] \n4. 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Bedenk J, Vrtačnik -Bokal E, Virant -Klun I. \nRole of AMH in ovarian disease and infertility. \nJ Assist Reprod Genet. 2020;37(1):89 –100. \n[doi:10.1007/s10815-019-01622-7] \n \n How to Cite This Article:  \nSoryadharma A, Rijal Ch, Amarullah Ritonga  M, Husni Syam H.  Serum AMH Levels in Women: Differences \nBetween Endometrioma and Non-Endometrioma Cases. J Obstet Gynecol Cancer Res. 2026;11(3):218-223. \nDownload citation:                             RIS | EndNote | Mendeley |BibTeX |","source_license":"CC0","license_restricted":false}