Dissecting the reduced ovarian reserve seen with ovarian enometriomas with that caused by surgical excision of ovarian enometriomas-what comes first

Kulvinder Kochar Kaur
In: Surgical Medicine Open Access Journal · 2019 · vol. 2(3) · doi:10.31031/smoaj.2019.02.000536 · W2912684589
article OA: diamond CC0 ⤵ 2 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This paper investigates whether reduced ovarian reserve seen with endometriomas predates or results from their surgical removal.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 · read from full text ⓘ

This opinion piece discusses evidence on whether the reduced ovarian reserve seen with ovarian endometriomas is caused by the endometriomas themselves or by surgical excision, focusing on serum anti-Müllerian hormone (AMH) changes. It highlights a 2018 meta-analysis (Muzli et al.) reporting lower AMH in women with ovarian endometriomas versus controls and versus other ovarian cysts, but it notes the limitation that AMH reduction does not directly demonstrate ovarian reserve injury from endometriomas. The author emphasizes methodological caveats from meta-analytic studies (including heterogeneity and statistical handling of skewed AMH values) and argues that factors such as endometrioma size, timing/progression, and surgery-related variables may confound interpretation. This paper does not explicitly present new clinical data; it is centrally about ovarian endometriomas and their relationship to ovarian reserve, with the stated relevance to endometriosis.

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Abstract

There have been concerns raised regarding the possibility of surgical excision of the endometrioma causing damage to the ovarian reserve. Three recent systematic reviews reported a decrease in serum anti mullerian hormone (AMH) levels as compared to preoperative levels after endometrioma excision [1- 3]. But very recently Muzli et al.
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Conclusion

In conclusion although this study by Muzli et al. [4] tries to move further by showing that probably ovarian endometriomas might be the culprits in reducing ovarian reserve directly, but one should not jump to the conclusions that surgery per se does not have a detrimental effect. There is a need to keep working on to dissect the roles of each and the relationship of ovarian endometriomas, surgery and ovarian reserve. Further the role of time on deterioration of AMH with coexisting ovarian endometriomas and whether the effect of reduced ovarian reserve is permanent or temporary with either ovarian endometriomas itself or surgery per se and other factors associated with surgery with ovarian endometriomas like involvement of mesosalpinx in this reduction [8], and how one can prevent the decreased in ovarian reserve either by conservative

Methods

or preventing surgery induced reduction in ovarian reserve.

References

1. Raffi F, Metwally M, Amer S (2012) The impact of excision of ovarian endometrioma on ovarian reserve: A systematic review and meta- analyses. J Clin Endocrol Metab 97(9): 3146-3154. 2. Somigliana E, Berlanda N, Benaglia L, Vigano P , Vercellani P , et al. (2012) Surgical excision of endometriomas and ovarian reserve. A systematic review on serum anti mullerian hormone level modifications. Fertil Steril 98(6): 1531-1538. 3. Hamdan M, Dunselman G, Li TC, Cheng Y (2015) The impact of endometrioma on IVF/ICSI outcomes: A systematic review and meta- analyses. Hum Reprod Update 21(6): 809-825. 4. Muzli L, Di Tucci C, Di Feliciantonio M, Galali G, Di Donato V, et al. (2018) Antimullerian hormone is reduced in the presence of ovarian endometriomas: A systematic review and meta-analyses. Fertil Steril 110(5): 932-940. 5. Benaglia L, Castiglioni M, Paffoni A, Sarais V, Vercellini P , et al. (2017) Is endometrioma-associated damage to ovarian reserve progressive? Insights from IVF cycles. Eur J Obstet Gynecol Reprod Biol 217: 101-105. 6. Kasapoglu I, Ata B, Uyanklar O, Seyhan A, Orhan A, et al. (2018) Endometrioma-related reduction in ovarian reserve (ERROR): A progressive longitudinal study. Fertil Steril 110(1): 122-127. 7. Ferrrero S, Scala C, Tafi E, Racca A, Venturini PL, et al. (2017) Impact of large ovarian endometriomas on the response to superovulation for in vitro fertilization: A retrospective study. Eur J Obstet Gynecol Reprod Biol 213: 17-21. 8. Saito A, Iwase A, Nakamura T , Osuka S, Murase T , et al. (2016) Involvement of mesosalpinx in endometrioma is a possible risk factor for decrease of ovarian reserve after cystectomy: A retrospective cohort study. Reprod Biol and Endocrinol 14: 72. For possible submissions Click Here Submit Article Creative Commons Attribution 4.0 International License Surgical Medicine Open Access Journal Benefits of Publishing with us • High-level peer review and editorial services • Freely accessible online immediately upon publication • Authors retain the copyright to their work • Licensing it under a Creative Commons license • Visibility through different online platforms

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Condition tags

endometrioma

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