Impacts of endometrioma type and two-different techniques of laparoscopic cystectomyon ovarian reserve by measuring anti-mullerian hormone concentration

Ida Bagus Putra Adnyana
In: Bali Medical Journal · 2018 · vol. 7(2) , pp. 530 · doi:10.15562/bmj.v7i2.1149 · W2906747296
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study found that partial excision laparoscopic cystectomy significantly preserves ovarian reserve, as measured by AMH levels, compared to stripping laparoscopic cystectomy.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

This experimental pre-test/post-test study evaluated how endometrioma type (unilateral vs bilateral) and two laparoscopic cystectomy excision techniques affected ovarian reserve, measured by serum anti-Mullerian hormone (AMH). Patients with >3 cm endometrioma on transvaginal ultrasound were allocated to stripping cystectomy (control) or partial excision laparoscopic cystectomy (intervention), and AMH was measured before surgery and at 1 and 3 months after, with statistical analysis using independent t-tests. The paper found no significant AMH differences between unilateral and bilateral endometriomas at baseline or after 1 or 3 months, but AMH was significantly higher after partial excision than stripping at 1 and 3 months. This paper is centrally about endometriosis — specifically, it compares endometrioma type and laparoscopic cystectomy excision methods using AMH changes to assess ovarian reserve.

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Abstract

 Purpose: This study aims to understand the impact of the type of endometrioma and two different laparoscopic cystectomy excision techniques (“stripping” or complete excision vs partial excision) on the ovarian reserve by measuring the anti-mullerian hormone (AMH) levels in patients with endometrioma.Method: This is an experimental study in the form of “pre test – post test group design”. The subjects were patients with >3 cm endometrioma detected via transvaginal USG which were classified into two different groups, i.e. the “stripping” laparoscopic cystectomy group as control and partial excision laparoscopic cystectomy as a intervention group. Cystectomy techniques were chosen based on “formuted block sampling”. The AMH levels measurements were performed before the operation (pre-test) and post-operation levels were measured at one and three months after the procedures on both groups. The study was conducted in Bali Royal Hospital (BROS), Denpasar, Indonesia, between January 2012 and January 2018. T-independent test was used to analyse the collected data.Results: No significant difference in the age and length of marriage between the two groups (p>0.05). Unilateral endometrioma had higher concentration of AMH compared to bilateral endometrioma before the laparoscopy (2.09±1.33 vs 1.99±1.25 ng/ml; p=0.768), 1 month after the laparoscopy (1.20±0.59 vs 1.12±0.72 ng/ml; p=0.647), as well as 3 months after the laparoscopy (1.79±0.97 vs 1.44±0.87 ng/ml; p=0.148), but they were not statistically significant (p>0.05). Based on the laparoscopy techniques, AMH concentration in partial excision laparoscopic cystectomy was significantly greater (p<0.05) than in the stripping laparoscopic cystectomy, whether before laparoscopy (1.87±1.23 vs 2.36±1.13; p= 0.119), 1 month after (1.33±0.62 vs 0.98±0.67 ng/ml; p=0.038), as well as 3 months (1.88±0.97 vs 1.29±0.77; p=0.011) after the surgery.Conclusion: Unilateral and bilateral endometriomas have no significant difference in AMH levels. The partial excision laparoscopic cystectomy had significantly less effect on the AMH level compared with stripping laparoscopic cystectomy. Â
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Method

This is an experimental study in the form of “pre test – post test group designâ€. The subjects were patients with >3 cm endometrioma detected via transvaginal USG which were classified into two different groups, i.e. the “stripping†laparoscopic cystectomy group as control and partial excision laparoscopic cystectomy as a intervention group. Cystectomy techniques were chosen based on “formuted block samplingâ€. The AMH levels measurements were performed before the operation (pre-test) and post-operation levels were measured at one and three months after the procedures on both groups. The study was conducted in Bali Royal Hospital (BROS), Denpasar, Indonesia, between January 2012 and January 2018. T-independent test was used to analyse the collected data.

Results

No significant difference in the age and length of marriage between the two groups (p>0.05). Unilateral endometrioma had higher concentration of AMH compared to bilateral endometrioma before the laparoscopy (2.09±1.33 vs 1.99±1.25 ng/ml; p=0.768), 1 month after the laparoscopy (1.20±0.59 vs 1.12±0.72 ng/ml; p=0.647), as well as 3 months after the laparoscopy (1.79±0.97 vs 1.44±0.87 ng/ml; p=0.148), but they were not statistically significant (p>0.05). Based on the laparoscopy techniques, AMH concentration in partial excision laparoscopic cystectomy was significantly greater (p<0.05) than in the stripping laparoscopic cystectomy, whether before laparoscopy (1.87±1.23 vs 2.36±1.13; p= 0.119), 1 month after (1.33±0.62 vs 0.98±0.67 ng/ml; p=0.038), as well as 3 months (1.88±0.97 vs 1.29±0.77; p=0.011) after the surgery.

Conclusion

Unilateral and bilateral endometriomas have no significant difference in AMH levels. The partial excision laparoscopic cystectomy had significantly less effect on the AMH level compared with stripping laparoscopic cystectomy.   - Bulleti C, Coccia ME, Battistoni S, Borini A. Endometriosis and Infertility. J Assist Reprod Genet. 2010. 27:441-447. - Stilley JAW, Birt JA, Sharpe-Timms KL. Celluler and Molecular basis for endometriosis-associated infertility. Cell Tissue Res. (Published online 3 February 2012). - Tarek AG, Luciano, GN. Evidence Based Management of Endometrioma. Reproductive BioMedicine online. 2011; 23: 15-24. - Dunselman G.A.J., Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, et al. ESHERE guideline: management of women with endometriosis, Human Reproduction, vol.29, No.3 pp.400-412, 2014 - Ziegler D de, Borghese B, Chapron C. Endometriosis and infertility: patho physiology and Management. Lancet. 2010; 376:730-738. - Yoo JH, at al. Serum anti-Mulerian Hormon is a better predictor of ovarian respone than FSH and age in IVF patients with endometriosis. Clin Exp Reprod Med. 2011; 38(4):222-227. - Hwu YM et al. The Impact of Endometrioma and Laparoscopic Cystectomy on Serum Anti-Mullerian Hormone Levels. Reproductive Biology and Endocrinology. 2011 - Saeed Alborzi, Afsoon Zarei, Soroosh Alborzi, and Mehrnoosh Alborzi: Management of Ovarian Endometrioma, Clinical Obstetrics and Gynecology,Vol. 49, No.3, 480-491, 2006 - Akamatsu N, Hirai T, Mosaoka H,et al, Ultra sonically guide puncture of endometriomal cyst- aspiration of contens and infusion of ethanol, Nippon Sanka Funjinka Gakki Zasshi 1988,40: 187-197 - Jadoul P, Kitajima M, Donnez O, Jean Squifflet, and Donnez J. Surgical treatment of ovarian endometriomas : state of the art ?, Fertil steril, Vol 98, No 3: 556-63, 2012 - Celik, HG. Effect of Laparoscopic Excision of Endometriomas on ovarian Reserve: Serial Changes in the Serum Antimullerian Hormone levels. Fertil Steril. 2012 Jun; 97(6): 1472-1478.. - Somigliana E, Berlanda N, Benaglia L, Vigano P, Vercellini P, Fedele L. Surgical Excision of Endometriomas and Ovarian Reserve: a Systematic review on Serum Antimullerian Hormone level Modifications. Fertility and Sterility 2012; 98(6):1531-1538. - Tiarma, Sumapraja K, Hadisaputra W, Sopiyudin. The Effect of Analog GnRH Before Laparoscopic Cystectomy to Ovarian Reserve Which was Measured with anti Mullerian Hormon at Bilateral Endometriosis Cyst. Indones J. Obstet Gynecol. 2011; 35 (1):14-17. - Berlanda N, Vercellini P, Somigliana E, Frattaruolo MP, Buggio L, Gattei U. Role of Surgery in Endometriosis-Associated Subfertility, Semin Reprod Med. 2013; 31(2); 133-143 - Donnez J, Jean-Christophe L, Jadoul P, Donnez O, and Jean Squifflet. Laparoscopic management of endometrioas using a combined technique of excisional (cystectomy) and ablative surgery, Fertility and Sterility,Vol 94,No. 1 ; 28-32, 2010. - Abdelmgid MS, Mahmoud AG, Ahmed MA, Walid MA. Laparoscopic treatment of ovarian endometriomas : Cystectomy versus Fenestrationand coagulation, Z.U.M.J. Vol.19; N.3; May; 2013 Adnyana, I. B. P. (2018). Impacts of endometrioma type and two-different techniques of laparoscopic cystectomyon ovarian reserve by measuring anti-mullerian hormone concentration. Bali Medical Journal, 7(2), 530–534. https://doi.org/10.15562/bmj.v7i2.1149 - Bali Medical Journal, Bali-Indonesia - +62 812-3999-2269 - +62 812-3999-2269 - [email protected] Copyright © DiscoverSys Inc

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