Retrospective Audit: The Irreversible Change in Ovarian Reserve After Formal Cystectomy for Ovarian Endometrioma

Gerhardus J. Hanekom, Thomas Ignatius Siebert, Vaughan Marshall, Ernst Otto Siebert, Ezann Siebert
In: Current Women s Health Reviews · 2025 · vol. 22(2) · doi:10.2174/0115734048361717250531092540 · W4411352709
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Ovarian cystectomy for endometriomas caused a significant and progressive decline in ovarian reserve, with bilateral surgeries having a more profound impact than unilateral procedures.

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This retrospective audit evaluated the long-term impact of laparoscopic cystectomy on ovarian reserve in fifty patients with suspected endometriomas, measuring serum anti-Müllerian hormone levels preoperatively and at six months and final follow-up. The results demonstrated a significant and progressive decline in AMH levels that did not recover over time, with patients undergoing bilateral cystectomy experiencing a substantially greater reduction than those with unilateral disease. The authors note limitations including a small sample size and the absence of a control group, while suggesting that fertility-preserving alternatives may be preferable for women desiring future conception. This paper is centrally about endometriosis — specifically the surgical management and iatrogenic consequences of removing ovarian endometriomas.

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Abstract

Introduction: 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. Methods: 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. Results: 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). Discussion: 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. Conclusion: 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.
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Abstract

Introduction: 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.

Methods

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.

Results

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).

Discussion

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.

Conclusion

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.

Keywords

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