Evaluation of factors predicting diminished ovarian reserve before and after laparoscopic cystectomy for ovarian endometriomas: a prospective cohort study

Rie Ozaki, Jun Kumakiri, Andrea Tinelli, Grigoris Grimbizis, Grigoris F Grimbizis, Mari Kitade, Satoru Takeda
Journal of ovarian research · 2016 · vol. 9(1) , pp. 37 · doi:10.1186/s13048-016-0241-z · PMID:27329142 · PMC4915097 · W2467742455
article OA: gold CC0 ⤵ 27 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study found that older age and higher FSH levels predicted pre-surgical diminished ovarian reserve, while bilateral cystectomy and lower pre-surgical AMH predicted post-surgical diminished ovarian reserve in women with ovarian endometriomas.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This prospective cohort study evaluated risk factors for diminished ovarian reserve (DOR) using serum anti-Müllerian hormone (AMH) in 143 women with symptomatic ovarian endometriomas undergoing laparoscopic cystectomy, measuring AMH preoperatively and again at 3 and 6 months postoperatively. Pre-surgical adverse DOR (aDOR) was defined as AMH 1.1 ng/mL preoperatively and a drop to <1.1 ng/mL at either 3 or 6 months, according to Bologna criteria; age and higher baseline FSH were associated with pre-surgical aDOR, and bilateral cystectomy and lower pre-surgical AMH were associated with post-surgical aDOR. A limitation explicitly stated by the design is that AMH-based classification at 3–6 months provides a biochemical marker rather than long-term outcomes, and follow-up was limited to this early postoperative window. Relevance to endometriosis: the study focuses on ovarian endometriomas in women with endometriosis and quantifies DOR changes following laparoscopic cystectomy for these lesions.

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Abstract

BACKGROUND: Ovarian endometriomas affect a substantial proportion of women of reproductive age who may have a potential risk of diminished ovarian reserve (DOR) after ovarian cystectomy. Here, we investigated the risk factors for pre-surgical DOR in patients with ovarian endometriomas and for DOR after laparoscopic ovarian cystectomy for endometriomas and evaluated the feasibility of the pre-surgical prediction of post-surgical DOR based on the Bologna criteria. METHODS: A total of 143 patients with ovarian endometriomas who underwent laparoscopic cystectomy from January 2009 to May 2015 at our hospital were prospectively enrolled and evaluated. Serum anti-Müllerian hormone (AMH) concentrations were measured pre-surgically and at 3 and 6 months after surgery. In accordance with the Bologna criteria, the patients whose AMH concentrations were <1.1 ng/mL before surgery and 3 or 6 months after surgery were classified into pre- and post-surgical adverse DOR (aDOR) groups, respectively. RESULTS: Thirty-one (21.7 %) of 143 patients were classified as pre-surgical aDOR. Patient age and serum follicle-stimulating hormone level were significantly positively correlated with pre-surgical aDOR [odds ratios (ORs), 1.26 and 1.16; p < 0.001 and p = 0.003, respectively]. Among the remaining 112 patients, 38 patients (33.9 %) had post-surgical aDOR 3 and 6 months after surgery. Bilateral cystectomy was positively correlated with post-surgical aDOR (at 3 months: OR, 4.7; p = 0.001; at 6 months: OR, 3.71; p = 0.006); conversely, pre-surgical serum AMH concentrations were negatively correlated with post-surgical aDOR (at 3 months: OR, 0.65; p = 0.005; at 6 months: OR, 0.43; p < 0.001). The optimal cut-off point of pre-surgical AMH concentrations for predicting aDOR at 3 and 6 months in the patients undergoing unilateral cystectomy was 2.1 ng/mL. In contrast, the optimal cut-off points at 3 and 6 months in the patients undergoing bilateral cystectomy were 3.0 and 3.5 ng/mL, respectively. CONCLUSIONS: Our data suggest that the pre-surgical serum AMH concentrations and bilateral cystectomy are significant factors for the risk of aDOR following surgery and that predicting post-surgical aDOR according to the Bologna criteria could be feasible using pre-operative measurements of serum AMH concentrations.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Laparoscopy Ovarian Diseases Ovarian Reserve Ovariectomy Ovariectomy Adult Biomarkers Endometriosis Female Fertility Humans Ovarian Diseases Perioperative Period Prospective Studies Risk Factors ROC Curve Time-to-Pregnancy Treatment Outcome

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