Comparison of ovarian reserve after laparoscopic cystectomy in patients with ovarian endometriosis differ in cyst size: A systematic review and meta-analysis

Weihe Liu, Tingting Zhao, Zhao T, Zheng Z, Zetong Zheng, Huang J, Jia Huang, Jifan Tan
International Journal of Gynecology & Obstetrics · 2025 · vol. 170(1) , pp. 86–100 · doi:10.1002/ijgo.16147 · PMID:39829175
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This meta-analysis found that larger ovarian endometriomas were associated with significantly lower AMH levels one month after laparoscopic cystectomy, particularly when cysts exceeded 5 or 7 cm.

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This systematic review and meta-analysis evaluated whether the size of ovarian endometriomas influences pre- and post-operative ovarian reserve in patients undergoing laparoscopic cystectomy. The authors analyzed data from seven prospective trials involving 603 participants, focusing on serum anti-Müllerian hormone (AMH) levels and antral follicle counts at various time points after surgery. Results indicated that while AMH levels were significantly lower in patients with large cysts one month postoperatively, these levels recovered to match those of the small cyst group by six months, with no significant differences observed in antral follicle counts. This paper is centrally about endometriosis — specifically examining the impact of endometrioma size on ovarian reserve following surgical removal.

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Abstract

BACKGROUND: Whether cyst size affects ovarian reserve before and after surgery remains controversial. OBJECTIVE: The objective of this study is to determine whether cyst size causes differences in pre- and post-ovarian reserve impairment among patients with endometrioma. SEARCH STRATEGY: PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure were searched from inception to October 13, 2023. SELECTION CRITERIA: We included prospective studies comparing the ovarian reserve parameters of patients with endometrioma preoperatively and at different time points postoperatively between large and small groups, determined by self-defined cut-off values in eligible studies. DATA COLLECTION AND ANALYSIS: Bias was assessed using the Newcastle-Ottawa Scale. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were used for outcome measures. MAIN OUTCOME MEASURE(S): The main outcome measures are serum anti-Müllerian hormone (AMH) and antral follicle count (AFC) preoperatively and at different time points postoperatively (primary and secondary aims). MAIN RESULTS: Seven trials (603 participants) were included, all of which qualified for meta-analysis. Irrespective of the cut-off values, the SMD showed that the serum AMH level was significantly lower in large groups at 1 month postoperatively (SMD = -0.515 ng/mL, 95% CI [-0.858, -0.172], P = 0.003, I 2 = 44.3%). Subgroup analyses indicated that when the cut-off values were limited to 5 cm in diameter, the AMH levels were significantly lower in large groups (SMD = -0.822 ng/mL, 95% CI [-1.605, -0.039], P = 0.040, I 2 = 58.3%) 1 month after the surgery, and when cut-off values were limited to 7 cm, even at 3 months postoperatively, the serum AMH levels of patients with large endometrioma were still significantly lower than those with small endometrioma (SMD = -0.531 ng/mL, 95% CI [-0.818, -0.245], P = 0.000, I 2 = 0.0%). However, when cut-off values were not limited, the serum AMH levels did not differ significantly (P > 0.05) between the groups preoperatively and at 3, 6, and 12 months postoperatively. Additionally, there were no significant differences (P > 0.05) in the AFC between the groups preoperatively and 1 month postoperatively. CONCLUSION: AMH in patients with different endometrioma sizes recovered to the same level at 6 months postoperatively. Our study provides guidance for the clinical prognostic assessment of patients with large endometriomas after laparoscopic cystectomy. SYSTEMATIC REVIEW REGISTRATION: CRD42023481967(PROSPERO).
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Abstract

Background Whether cyst size affects ovarian reserve before and after surgery remains controversial.

Objective

The objective of this study is to determine whether cyst size causes differences in pre- and post-ovarian reserve impairment among patients with endometrioma. Search Strategy PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure were searched from inception to October 13, 2023. Selection Criteria We included prospective studies comparing the ovarian reserve parameters of patients with endometrioma preoperatively and at different time points postoperatively between large and small groups, determined by self-defined cut-off values in eligible studies. Data Collection and Analysis Bias was assessed using the Newcastle–Ottawa Scale. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were used for outcome measures. Main Outcome Measure(s) The main outcome measures are serum anti-Müllerian hormone (AMH) and antral follicle count (AFC) preoperatively and at different time points postoperatively (primary and secondary aims). Main Results Seven trials (603 participants) were included, all of which qualified for meta-analysis. Irrespective of the cut-off values, the SMD showed that the serum AMH level was significantly lower in large groups at 1 month postoperatively (SMD = −0.515 ng/mL, 95% CI [−0.858, −0.172], P = 0.003, = 44.3%). Subgroup analyses indicated that when the cut-off values were limited to 5 cm in diameter, the AMH levels were significantly lower in large groups (SMD = −0.822 ng/mL, 95% CI [−1.605, −0.039], P = 0.040, = 58.3%) 1 month after the surgery, and when cut-off values were limited to 7 cm, even at 3 months postoperatively, the serum AMH levels of patients with large endometrioma were still significantly lower than those with small endometrioma (SMD = −0.531 ng/mL, 95% CI [−0.818, −0.245], P = 0.000, = 0.0%). However, when cut-off values were not limited, the serum AMH levels did not differ significantly (P > 0.05) between the groups preoperatively and at 3, 6, and 12 months postoperatively. Additionally, there were no significant differences (P > 0.05) in the AFC between the groups preoperatively and 1 month postoperatively.

Conclusion

AMH in patients with different endometrioma sizes recovered to the same level at 6 months postoperatively. Our study provides guidance for the clinical prognostic assessment of patients with large endometriomas after laparoscopic cystectomy. Systematic review registration: CRD42023481967(PROSPERO). CONFLICT OF INTEREST STATEMENT The authors report no conflict of interest. DATA AVAILABILITY STATEMENT Data is available from the authors upon reasonable request.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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