Association of Serum Anti-Mullerian Hormone Level with Size of Ovarian Endometrioma

Abstract Background: Ovarian endometriomas (“chocolate cysts”) are cysts filled with hemosiderin associated with pelvic pain, dysmenorrhea, dyspareunia, and infertility, and they can diminish ovarian reserve through compression, inflammation, and oxidative stress. While anti-Müllerian hormone (AMH) indicates ovarian reserve, its association with the size of endometriomas remains uncertain. This research analyzes AMH levels in women with large (≥5 cm) versus small (<5 cm) endometriomas and explores their relationship. Methods & Materials: This cross-sectional study at Bangabandhu Sheikh Mujib Medical University, Dhaka (Oct 2022–Sep 2023), included 80 women (18–40 years) with ovarian endometriomas, divided into ≥5 cm (n=40) and <5 cm (n=40) groups. Data were collected, AMH measured by electrochemiluminescence immunoassay, and analyzed using t-test, chi-square, Pearson’s correlation, and odds ratio (p<0.05). Results: The mean age was similar between groups (24.75 ± 5.38 vs 26.20 ± 5.51 years; p=0.238), with no significant socio-demographic or reproductive differences. Overweight was more common in the large endometrioma group, while normal BMI predominated in the small group. Dysmenorrhea was the most frequent symptom, and most cysts were unilateral. Mean serum AMH was significantly lower in women with large endometriomas (2.05 ± 1.75 vs 2.83 ± 1.72 ng/mL; p=0.047), showing a negative correlation with cyst size (r = -0.253; p=0.024). Low AMH (<3.19 ng/mL) was associated with a 3.1-fold increased risk of large endometriomas. Conclusion: Serum AMH levels decline with increasing ovarian endometrioma size, suggesting that larger endometriomas are associated with reduced ovarian reserve. Monitoring AMH may guide clinical management and fertility preservation strategies in affected women. This work is licensed under a Creative Commons Attribution 4.0 International License. Copyright (c) 2026 The Planet