Impact of Endometrioma Surgery on Fertility: A Prospective Cohort Study (Preprint)

Amal mouzali, F. Makhlouf, Mohamed Ziad Cheikh El Ghanama
2024 · doi:10.2196/preprints.56857 · W4391346474
preprint OA: gold CC0
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⚙ AI-generated summary by claude@2026-06, 2026-06-14 ⓘ

Endometrioma cystectomy in infertile women increased antral follicle count but decreased AMH levels, with a 47.5% spontaneous pregnancy rate observed post-surgery.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-14 · read from full text ⓘ

This prospective, longitudinal monocentric cohort study followed 40 infertile women aged 21–40 with ovarian endometriomas ≥4 cm (with good tubal patency and normal partner spermogram) to assess changes in ovarian reserve markers 3 and 12 months after endometrioma cystectomy, alongside spontaneous pregnancy rates. Using antral follicle count (AFC), FSH, and AMH, the study found AFC significantly increased at 12 months, mean FSH did not increase, and AMH significantly decreased at both 3 and 12 months. When stratified, decreased AMH after surgery was significantly associated with cystectomy performed alongside other procedures, particularly in the presence of deep endometriosis, and follicles retrieved from cysts correlated with preoperative AMH but not postoperative AMH. The authors report the study as a preprint that is unreviewed (not yet peer-reviewed), which limits confidence in the findings, and it does not clearly state other methodological constraints in the provided text. This paper is centrally about endometriosis — it evaluates the effects of endometrioma cystectomy on ovarian reserve markers and spontaneous pregnancy in infertile patients with ovarian endometriomas.

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Abstract

BACKGROUND Endometrioma is often associated with infertility. While cystectomy can improve the pregnancy rate, it may also affect the ovarian reserve. OBJECTIVE This study aimed to investigate the impact of endometrioma cystectomy on ovarian reserve markers at 3 and 12 months after surgery in infertile women and to determine the postoperative pregnancy rate. METHODS This prospective, longitudinal, monocentric cohort study included 40 infertile patients aged 21–40 years with ovarian endometriomas measuring ≥4 cm in diameter and with good tubal patency and normal spermogram test results of the husband at the Gharafa Clinic, a gynecological and obstetric clinic annexed to the Bab El Oued University Hospital in Algiers. The main outcome measures were ovarian reserve (Antral Follicle Counts [AFC] follicle-stimulating hormone [FSH], and anti-Müllerian hormone [AMH] levels). We also calculate the number of follicles retrieved from cysts to evaluate their impact on the ovarian reserve and the spontaneous pregnancy rate. RESULTS After endometrioma cystectomy, the antral follicle count significantly increased at 12 months postoperatively (7.7±0.6 follicles before surgery vs. 8.5±0.5 follicles after surgery, p<0.001). The mean FSH levels did not increase; however, the AMH levels significantly decreased at 3 and 12 months postoperatively (2.29±0.26 ng/mL before surgery vs. 1.47±0.23 ng/mL at 3 months, p<0.001 and 1.46±0.20 ng/mL at 12 months, p<0.001). After stratification into three groups, decreased AMH levels after surgery showed a significant association with cystectomy associated with other surgical procedures, particularly in the presence of deep endometriosis. The number of follicles retrieved from cysts correlated with AMH levels preoperatively, but not postoperatively. Overall, 47.5% of patients had spontaneous pregnancies despite having low AMH levels; hence, surgery was considered to be effective. CONCLUSIONS Cystectomy can reduce the AMH level in cases of associated endometrioma but not in isolated endometrioma, the CFA increase and FSH doesn’t change. In fact this cystectomy can improve spontaneous pregnancy in half of cases.
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Abstract

Background: Endometrioma is often associated with infertility. While cystectomy can improve the pregnancy rate, it may also affect the ovarian reserve.

Objective

This study aimed to investigate the impact of endometrioma cystectomy on ovarian reserve markers at 3 and 12 months after surgery in infertile women and to determine the postoperative pregnancy rate.

Methods

This prospective, longitudinal, monocentric cohort study included 40 infertile patients aged 21–40 years with ovarian endometriomas measuring ≥4 cm in diameter and with good tubal patency and normal spermogram test results of the husband at the Gharafa Clinic, a gynecological and obstetric clinic annexed to the Bab El Oued University Hospital in Algiers. The main outcome measures were ovarian reserve (Antral Follicle Counts [AFC] follicle-stimulating hormone [FSH], and anti-Müllerian hormone [AMH] levels). We also calculate the number of follicles retrieved from cysts to evaluate their impact on the ovarian reserve and the spontaneous pregnancy rate.

Results

After endometrioma cystectomy, the antral follicle count significantly increased at 12 months postoperatively (7.7±0.6 follicles before surgery vs. 8.5±0.5 follicles after surgery, p<0.001). The mean FSH levels did not increase; however, the AMH levels significantly decreased at 3 and 12 months postoperatively (2.29±0.26 ng/mL before surgery vs. 1.47±0.23 ng/mL at 3 months, p<0.001 and 1.46±0.20 ng/mL at 12 months, p<0.001). After stratification into three groups, decreased AMH levels after surgery showed a significant association with cystectomy associated with other surgical procedures, particularly in the presence of deep endometriosis. The number of follicles retrieved from cysts correlated with AMH levels preoperatively, but not postoperatively. Overall, 47.5% of patients had spontaneous pregnancies despite having low AMH levels; hence, surgery was considered to be effective.

Conclusions

Cystectomy can reduce the AMH level in cases of associated endometrioma but not in isolated endometrioma, the CFA increase and FSH doesn’t change. In fact this cystectomy can improve spontaneous pregnancy in half of cases. Citation Request queued. Please wait while the file is being generated. It may take some time. Copyright © The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.

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endometriosisendometriomainfertility

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