Is ovarian reserve reduction following endometriotic cystectomy predicted? The implication for fertility preservation counseling
This opinion piece discusses the predictability of ovarian reserve reduction after endometriotic cystectomy and its implications for fertility preservation counseling.
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This paper reviews and reanalyzes evidence on how ovarian reserve changes after endometriotic cystectomy, focusing on whether preoperative serum AMH can predict the magnitude of AMH decline, and places this question in the context of fertility preservation counseling for women with ovarian endometriosis. Drawing on prior meta-analytic findings of substantial postoperative AMH reductions and a reanalysis of included studies (783 women) using coefficients of variation, the authors report a wide and largely unpredictable dispersion in individual AMH reduction after unilateral and bilateral surgery, even though bilateral cystectomy is consistently associated with greater harm on average; they also note that extreme ovarian damage is uncommon and that predictive guidance is currently limited. The paper additionally discusses literature on oocyte vitrification outcomes from retrospective cohorts, including correlations between AMH and cumulative live birth in ART in low-reserve groups, while acknowledging that many fertility-preservation studies are not definitive. This paper is centrally about endometriosis — it evaluates ovarian reserve (AMH) after endometriotic cystectomy and how that uncertainty should shape counseling and potential fertility preservation in women with ovarian endometriosis.
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