Serum AMH Levels in Women: Differences Between Endometrioma and Non-Endometrioma Cases

& Objective: The link between endometrioma and serum Anti - Müllerian Hormone (AMH) levels is crucial in predicting outcomes and informing clinical management strategies for affected individuals. Endometrioma may reduce ovarian reserve due to damage to ovarian tissue, which in turn affects AMH secretion. Clinically, AMH is a widely recognized marker for assessing ovarian reserve and is frequently utilized in diagnosing and forecasting infertility and reproductive conditions. This study was conducted with aim to investigate the differences in serum AMH levels between women with and without endometrioma.

& Methods : This cross -sectional analytical study was conducted on reproductive-aged women diagnosed with endometrioma at Hasan Sadikin Hospital, Bandung, from August 2022 to July 2024. The control group consisted of women without endometrioma, selected consecutively according to specific eligibility criteria, as AMH was not routinely measured in this population. A total of 50 participants were recruited, with 25 women in each group. All subjects underwent serum AMH testing, and diagnoses were confirmed via histopathol ogical examination. P<0.05 was considered statistically significant.

Women with endometrioma exhibited significantly lower average serum AMH levels compared to those without endometrioma (0.96±0.82 ng/ml vs. 2.05±1.00 ng/ml, P<0.001). There were no notable differences in age or body mass index between the two groups (23.44±3.65 kg/m² vs. 24.45±4.49 kg/m²). The statistical analysis confirmed a significant disparity in AMH levels between the two groups (P<0.001).

The study identified a significant correlation between the presence of endometrioma and reduced serum AMH levels, suggesting that endometrioma is associated with a decline in ovarian reserve.

Anti-mullerian hormone, AMH, endometrioma, Non -endometrioma Received: 2025/07/03 Accepted: 2025/09/08 Published Online: 03 Feb. 2026 Corresponding Information: Arry Soryadharma, Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia Email: [email protected] Copyright © 2025, This is an original open -access article distributed under the terms of the Creative Commons Attribution-noncommercial 4.0 International License which permits copy and redistribution of the material just in noncommercial usages with proper citation . 1. Introduction Endometriosis is an inflammatory condition where endometrial tissue grows abnormally outside it. The resulting cystic lesions also called endometrioma typically occur in the ovaries and affects about 10% of women of reproductive age (1,2). This condition often manifests as chronic pain, painful during intercourse, menstrual pain, and infertility. Although endometriosis typically develops in the pelvic area, particularly around the ovaries, endometriomas represent the most frequent ovarian form of the condition. This condition often called chocolate cysts because of the dark brown color of their fluid and affects 17 to 44% of women with endometriosis. The occurrence of endometriomas signifies a more advanced stage of endometriosis and may re sult in complications like diminished ovarian reserve (3-5). Anti-Müllerian Hormone (AMH) is a dimeric glycoprotein that is part of the Transforming Growth Factor β (TGF -β) superfamily. AMH is secreted by granulosa cells of small, developing ovarian follicles. Since serum AMH levels closely reflect the quantity of these growing follicles, it has gained prominence as a reliable indicator of ovarian reserve (6,7). In women with removed ovaries, AMH levels in the serum become undetectable because serum levels primarily reflect its secretion from the gonads, but it is also produced in both endometrial and endometriotic cells, its serum levels primarily reflect its s ecretion from the gonads. Moreover, ovarian aging is characterized by a noticeable decline in circulating AMH and inhibin B levels. Research has shown that age significantly 219 AMH Levels in Women with and Without Endometrioma Volume 11, March 2026 Journal of Obstetrics, Gynecology and Cancer Research impacts AMH levels, with concentrations decreasing by approximately 0.384 μg/L per year (8,9). The relationship between endometrioma and AMH levels reflects the broader impact of endometriosis on ovarian function. Endometriomas can lead to reduced AMH levels due to the damaging effects of inflammation and oxidative stress on ovarian follicles. Monitoring AMH levels can provide insights into the extent of ovarian damage and help in managing fertility concerns in women with endometriosis. The relationship between endometrioma and serum AMH levels serves as an important reference for assessing prognosis and guiding the management of the condition. Endometrioma can impair ovarian reserve by damaging ovarian tissue, thereby reducing AMH production. In clinical practice, serum AMH is widely used to evaluate ovarian reserve and acts as a key marker for the d iagnosis and prognosis of infertility and other reproductive disorders. (10-12). This study was conducted with aim to assess the relationship between serum AMH levels in women diagnosed with endometrioma and those without the condition. 2. Materials and Methods This case-control analytical study was conducted on reproductive-aged women diagnosed with endometrioma at Hasan Sadikin Hospital, Bandung, from August 2022 to July 2024. The research adhered to the principles outlined in the Declaration of Helsinki for medical research involving human subjects. Ethical approval was granted by the Padjadjaran University Ethics Committee under registration number DP.24.25/D.XIV.6.5/344/2025, and informed consent was obtained from all participants prior to the commencement of the study. Consecutive sampling was used to recruit women of reproductive age who met the inclusion criteria. Participants were selected from those diagnosed with endometrioma at Hasan Sadikin Hospital, Bandung, between August 2022 and July 2024. Eligible subjects were consecutively enrolled and subsequently divided into two groups: endometrioma (n=25) and control (n=25). The inclusion criteria comprised women of reproductive age, defined by the World Health Organization (WHO) as individuals between 15 and 49 years old. In both groups, a laboratory examination of serum AMH level was carried out and confirmation of diagnosis was done by histopathological examination. The examination of serum AMH levels was done by taking venous blood as much as 3 cc and measured using the Human AMH Enzyme-Linked Immunosorbent Assay (ELISA) kit (Elabscience, USA). Potential confounding factors in this study included age and Body Mass Index (BMI). To minimize bias, the significance of these characteristics was assessed between the two groups to ensure group homogeneity. Quantitative variables, such as age and serum AMH levels, were summarized using mean, standard deviation, and range. A norm ality test was conducted to determine the data distribution. Age was analyzed using an independent t -test, as it was normally distributed, while serum AMH levels, which were not normally distributed, were analyzed using the Mann - Whitney test. P<0.05 was considered statistically significant. 3. Results A total of 50 subjects were enrolled in this study, divided into two groups: 25 in the endometrioma group and 25 in the control group. Analysis showed no significant differences between the two groups in key characteristics, including age (P=1.000) and Body Mass Index (BMI) (P=0.100). The mean age for both groups was 31.76 years, while the mean BMI was 23.4 kg/m² for the endometrioma group and 24.5 kg/m² for the control group. Statistical analysis confirmed that these baseline characteristics were homogeneo us (P>0.05), allowing for valid comparisons and further analyses to explore the relationships between variables (Table 1). Table 1. The characteristicsof the subjects in two groups Characteristics Group P-value Endometrioma (n=25) Non-Endometrioma (n=25) Age (years) Mean±SD 31.76±5.4 31.76±5.4 1.000 Range 26-44 26-44 )2BMI (kg/m Mean±SD 23.4±3.65 24.5±4.48 0.100 Range 14.48-29.67 17.04-33.32 Endometrioma Laterality (n%) Unilateral 17(68%) Bilateral 8(32%) Abbreviations: n: number of samples; SD: standard deviation Arry Soryadharma, et al. 220 Volume 11, March 2026 Journal of Obstetrics, Gynecology and Cancer Research The mean serum AMH level was significantly lower in the endometrioma group compared to the non - endometrioma group (0.96±0.82 ng/ml vs. 2.05±1.00 ng/ml, P<0.001). These results demonstrated a statistically significant difference between the two groups in AMH levels (P<0.001) (Table 2). Table 2. Comparison of serum AMH level in endometrioma and non-endometrioma women Group P-value Endometrioma (n=25) Non-Endometrioma (n=25) Serum AMH Level (ng/mL) Mean±SD 0.96±0.82 2.05±1.00 <0.001 Range 0.1-3.51 0.54-4.45 Abbreviations: n: number of samples; SD: standard deviation 4. Discussion Based on the results of the comparison of the characteristics of the two groups, since there were no statistically significant differences in the baseline characteristics between the two groups, both were suitable for analysis of serum AMH levels. The purpose of the present study was to explore the relationship between serum AMH levels in women with and without endometrioma. The findings revealed a significant difference, with serum AMH levels being notably lower in the endometrioma group compared to the no n-endometrioma group (13-16). Shebl et al. , reported that women with endometriosis exhibited lower serum AMH levels, which were also linked to disease severity (17). The definitive diagnosis of endometriosis, including endometriomas, can only be confirmed through surgical evaluation involving direct visualization and histological examination of tissue samples. The biopsy must contain both endometrial glands and stroma to confirm the presence of endometriosis in the tissue. Anti-Müllerian Hormone (AMH) is a glycoprotein secreted by granulosa cells in small preantral and antral follicles. Its levels provide an accurate indication of ovarian function, making it a more sensitive marker of ovarian reserve compared to chronological age. AMH is involved in the development of menstrual disorders and fertility problems associated with obesity and polycystic ovary syndrome. Additionally, AMH levels are regarded as a dependable mar ker of a woman’s remaining egg supply and serve as a valuable tool for prognosis in infertility counseling. Therefore, AMH is widely used as a marker to monitor changes in ovarian function both naturally and due to treatment over time in women (18–20). Consistent with the findings of this study, previous research has shown that women with endometrioma generally have lower AMH levels. Muzii et al. , conducted a recent systematic review and meta - analysis combining data from 17 studies, which included 968 women with endometriomas and 1,874 controls. Their analysis demonstrated that AMH levels were significantly reduced in the endometrioma group compared to women with non -endometriotic benign ovarian cysts or healthy ovaries, suggesting that endometrioma prese nce is linked to decreased AMH levels (21). Kasapoglu et al., investigated the decline in AMH levels over six months in 40 women with endometriomas compared to 40 age -matched healthy controls and found that AMH levels declined more rapidly in the endometrioma group (22). Uncu et al. , (23) also reported similar findings, suggesting that the accelerated decline in AMH levels may explain the lower AMH concentrations observed in endometrioma patients in earlier studies, in which faster decline may help explain the lower AMH levels observed in endometrioma patients (24–26). Although endometrioma is commonly linked to reduced ovarian reserve, some studies suggest that surgical intervention may lead to an additional decline in serum AMH levels, indicating further deterioration of ovarian function. Hirokawa et al. , reported a continued decrease in AMH levels after endometrioma surgery, with a significantly greater reduction observed in bilateral cases compared to unilateral ones (27). This finding is consistent with the results of other studies, which also reported a reduction in serum AMH levels after laparoscopic ovarian cystectomy (28,29). The proposed explanation for reduced AMH levels and diminished ovarian reserve in women with endometriosis involves the chronic inflammation and immune system changes associated with the condition. Inflammation is known to cause damage and impair function in ovarian follicles, as seen in other conditions like autoimmune primary ovarian insufficiency. In such cases, the immune system produces steroidogenic autoantibodies and triggers an inflammatory response that can accelerate follicular damage and lead to early menopause. Similarly, in endometriosis, the persistent inflammatory environment may disrupt follicle 221 AMH Levels in Women with and Without Endometrioma Volume 11, March 2026 Journal of Obstetrics, Gynecology and Cancer Research function and reduce both the quality and number of ovarian follicles. This mechanism may account for the findings that women with endometriosis had lower average AMH levels regardless of their age (19,20). The advancement and use of appropriate immunoassays are crucial for improving the prediction of follicle count, early menopause, and reduced fertility in women, especially those with endometrioma (30). One challenge with measuring AMH serum levels is the lack of an internationally accepted standard for sample preparation, storage, and AMH testing. This gap creates significant challenges in applying AMH measurements in clinical settings. The issue was a lso linked to the unrepresentative distribution of data, with samples showing highly varied data distributions. There is currently insufficient data to account for potential bias such as smoking history, environmental conditions, and the activities of the subjects in relation to serum AMH levels. One limitation of this study was the relatively small sample size. This may contribute to the absence of some significant findings, potentially due to the sample not fully representing the broader population as seen in previous research. Future studies with larger sample size are necessary to overcome this limitation. 5. Conclusion In this study, there was a significant difference between the two groups, where patients with endometrioma had lower AMH levels compared to patients without endometrioma, considering other factors such as similar age and BMI. 6. Declarations Acknowledgments None. Ethical Considerations Ethical approval was obtained from the Ethics Committee of Dr. Hasan Sadikin General Hospital under the following registration number DP.24.25/D.XIV.6.5/344/2025. Written informed consent was not needed in our institution due to the research design being r etrospective from medical record data. This study was conducted in accordance with the principles of the Declaration of Helsinki. All data were collected and analyzed anonymously to ensure participant confidentiality, and no identifying information was disclosed at any stage of the study. Authors' Contributions A.S, C.J, and M.A.R participated in the design and planning of the research. A.S and H.H.S performed the measurements and data collection. C.J and M.A.R conducted the statistical analysis. All authors drafted the manuscript and interpreted the results. Conflict of Interest The authors declared no conflict of interest. Fund or Financial Support There is no funding to report. 1. La Marca A, Volpe A. Anti-Müllerian hormone (AMH) in female reproduction: is measurement of circulating AMH a useful tool? Clin Endocrinol (Oxf). 2006;64(6):603 –10. [doi:10.1111/j.1365-2265.2006.02533.x] 2. Clement PB. The pathology of endometriosis: a survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects. Adv Anat Pathol. 2007;14(4):241–60. [doi:10.1097/pap.0b013e3180ca7d7b] 3. Broer SL, Broekmans FJM, Laven JSE, Fauser BCJM. Anti -Müllerian hormone: ovarian reserve testing and its potential clinical implications. 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J Assist Reprod Genet. 2020;37(1):89 –100. [doi:10.1007/s10815-019-01622-7] How to Cite This Article: Soryadharma A, Rijal Ch, Amarullah Ritonga M, Husni Syam H. Serum AMH Levels in Women: Differences Between Endometrioma and Non-Endometrioma Cases. J Obstet Gynecol Cancer Res. 2026;11(3):218-223. Download citation: RIS | EndNote | Mendeley |BibTeX |