The relationship of ovarian endometrioma and its size to the preoperative serum anti-Mullerian hormone level

Objectives: The aim of this study is to evaluate the impact of ovarian endometrioma according to its size on the serum anti-Mullerian hormone (AMH) levels compared to that of other benign ovarian cysts.

The current study retrospectively evaluated preoperative serum AMH level and its association to presenting ovarian cyst size which were measured in clinical setting. Women with surgically diagnosed endometrioma or other benign ovarian cysts were included. All patients underwent transvaginal or transrectal ultrasonography to determine the size of the ovarian cysts. Preoperative serum AMH level was checked and evaluated according to histologic type of the cyst, which were endometrioma or other benign ovarian cysts, respectively. Both groups were classified into ≤ 4 cm, > 4 cm and ≤ 8 cm, > 8 cm and ≤ 12 cm, > 12 cm according to the diameter of cyst and analyzed the difference of mean AMH levels in both groups.

There was no significant difference in preoperative serum AMH level between the two groups (3.36 ± 2.3 versus 3.76 ± 2.64, p = 0.331). The difference of preoperative AMH levels according to categorized cyst size also was not statistically significant in both groups.

Preoperative serum AMH levels were not statistically different between endometrioma and other benign ovarian cyst groups and were not related to the size of endometrioma.

AMHendometriosisendometriomaovarian cyst

- Li HW, Ng EH, Wong BP, et al. Correlation between three assay systems for anti-Müllerian hormone (AMH) determination. J Assist Reprod Genet. 2012; 29(12): 1443–1446. - Anderson RA, Nelson SM, Wallace WHB. Measuring anti-Müllerian hormone for the assessment of ovarian reserve: when and for whom is it indicated? Maturitas. 2012; 71(1): 28–33. - La Marca A, Stabile G, Artenisio AC, et al. Serum anti-Mullerian hormone throughout the human menstrual cycle. Hum Reprod. 2006; 21(12): 3103–3107. - Streuli I, Fraisse T, Pillet C, et al. Serum antimüllerian hormone levels remain stable throughout the menstrual cycle and after oral or vaginal administration of synthetic sex steroids. Fertil Steril. 2008; 90(2): 395–400. - Nardo LG, Gelbaya TA, Wilkinson H, et al. Circulating basal anti-Müllerian hormone levels as predictor of ovarian response in women undergoing ovarian stimulation for in vitro fertilization. Fertil Steril. 2009; 92(5): 1586–1593. - La Marca A, Papaleo E, Grisendi V, et al. Development of a nomogram based on markers of ovarian reserve for the individualisation of the follicle-stimulating hormone starting dose in in vitro fertilisation cycles. BJOG. 2012; 119(10): 1171–1179. - Iwase A, Nakamura T, Osuka S, et al. Anti-Müllerian hormone as a marker of ovarian reserve: What have we learned, and what should we know? Reprod Med Biol. 2016; 15(3): 127–136. - Song DoK, Oh JY, Lee H, et al. Differentiation between polycystic ovary syndrome and polycystic ovarian morphology by means of an anti-Müllerian hormone cutoff value. Korean J Intern Med. 2017; 32(4): 690–698. - Iliodromiti S, Kelsey TW, Anderson RA, et al. Can anti-Mullerian hormone predict the diagnosis of polycystic ovary syndrome? A systematic review and meta-analysis of extracted data. J Clin Endocrinol Metab. 2013; 98(8): 3332–3340. - Broer SL, Eijkemans MJC, Scheffer GJ, et al. Anti-mullerian hormone predicts menopause: a long-term follow-up study in normoovulatory women. J Clin Endocrinol Metab. 2011; 96(8): 2532–2539. - Kitajima M, Khan KN, Harada A, et al. Association between ovarian endometrioma and ovarian reserve. Front Biosci (Elite Ed). 2018; 10: 92–102. - Somigliana E, Marchese MA, Frattaruolo MP, et al. Serum anti-mullerian hormone in reproductive aged women with benign ovarian cysts. Eur J Obstet Gynecol Reprod Biol. 2014; 180: 142–147. - Streuli I, de Ziegler D, Gayet V, 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. - Chang HJ, Han SH, Lee JR, et al. Impact of laparoscopic cystectomy on ovarian reserve: serial changes of serum anti-Müllerian hormone levels. Fertil Steril. 2010; 94(1): 343–349. - Henes M, Engler T, Taran FA, et al. Ovarian cyst removal influences ovarian reserve dependent on histology, size and type of operation. Womens Health (Lond). 2018; 14: 1745506518778992. - Kwon SuK, Kim SH, Yun SC, et al. Decline of serum antimüllerian hormone levels after laparoscopic ovarian cystectomy in endometrioma and other benign cysts: a prospective cohort study. Fertil Steril. 2014; 101(2): 435–441. - Karadağ C, Yoldemir T, Karadağ SD, et al. The effects of endometrioma size and bilaterality on ovarian reserve. J Obstet Gynaecol. 2019; 40(4): 531–536. - Uncu G, Kasapoglu I, Ozerkan K, et al. Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve. Hum Reprod. 2013; 28(8): 2140–2145. - Kim JuY, Jee BC, Suh CS, et al. Preoperative serum anti-mullerian hormone level in women with ovarian endometrioma and mature cystic teratoma. Yonsei Med J. 2013; 54(4): 921–926. - Marcellin L, Santulli P, Bourdon M, et al. Serum antimüllerian hormone concentration increases with ovarian endometrioma size. Fertil Steril. 2019; 111(5): 944–952.e1. - Goodman LR, Goldberg JM, Flyckt RL, et al. Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls. Am J Obstet Gynecol. 2016; 215(5): 589.e1–589.e6. - Leone Roberti Maggiore U, Scala C, Venturini PL, et al. Endometriotic ovarian cysts do not negatively affect the rate of spontaneous ovulation. Hum Reprod. 2015; 30(2): 299–307. - Maggiore UL, Gupta J, Ferrero S. Treatment of endometrioma for improving fertility. Eur J Obstet Gynecol Reprod Biol. 2017; 209: 81–85. - Lee J, Park D, Kim ML, et al. Age-related distribution of anti-Müllerian hormone levels in 2,879 Korean women with regular menstruation. Korean Journal of Obstetrics & Gynecology. 2012; 55(12): 920. - Pacchiarotti A, Frati P, Milazzo GN, et al. Evaluation of serum anti-Mullerian hormone levels to assess the ovarian reserve in women with severe endometriosis. Eur J Obstet Gynecol Reprod Biol. 2014; 172: 62–64. - Halis G, Arici A. Endometriosis and inflammation in infertility. Ann N Y Acad Sci. 2004; 1034: 300–315. - Lande Y, Fisch B, Tsur A, et al. Short-term exposure of human ovarian follicles to cyclophosphamide metabolites seems to promote follicular activation in vitro. Reprod Biomed Online. 2017; 34(1): 104–114. - Sanchez AM, Viganò P, Somigliana E, et al. The distinguishing cellular and molecular features of the endometriotic ovarian cyst: from pathophysiology to the potential endometrioma-mediated damage to the ovary. Hum Reprod Update. 2014; 20(2): 217–230.