Apoptotic Pathways and Anti-Müllerian Hormone affects the Ovarian Tissue Damage during Endometrioma Cystectomy

Tanzil al Hair, Wachyu Hadisaputra, Soegiharto Soebijanto, Primariadewi Rustamadji
In: Journal of Angiotherapy · 2024 · vol. 8(5) · doi:10.25163/angiotherapy.859690 · W4400806355
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study found that larger endometriomas (>4 cm) exhibit increased apoptotic factors and are associated with greater post-operative AMH decline, suggesting TNF-α initiates apoptosis via the intrinsic pathway.

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

This study evaluated 32 women with endometrioma who underwent laparoscopic cystectomy (Feb 2018–Dec 2019) by measuring serum anti-Müllerian hormone (AMH) using ELISA before surgery and one month after surgery, and by assessing immunohistochemical expression of apoptotic-related factors on the inner endometrioma epithelium. AMH levels declined after cystectomy in both endometrioma size groups (≤4 cm and >4 cm), with a significant decline in the >4 cm group, alongside increased Bax expression in >4 cm lesions and correlations suggesting a positive relationship between TNFR1 and caspase-3. Multivariate analysis indicated an association between apoptotic factor gene expression and reduced AMH levels, and the authors conclude TNF-α initiates apoptosis via an intrinsic pathway, while noting timing/size recommendations as part of their conclusion. This paper is centrally about endometriosis—specifically endometrioma cystectomy timing, AMH decline, and apoptosis-related gene expression (including TNF-α/TNFR1) in relation to ovarian tissue damage.

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Abstract

Background: Endometriomas are cysts caused by endometriosis that can impair ovarian function and fertility. Anti-Müllerian hormone (AMH) is an important marker for ovarian reserve. This study aimed to determine the optimal timing of operative management for endometrioma by evaluating the impact of cyst size on ovarian tissue damage and hormone levels. Methods: The study included 32 endometrioma patients who underwent laparoscopic cystectomy between February 2018 and December 2019 at Women and Children’s YPK Hospital, Jakarta. Patient characteristics were recorded, including age, parity, BMI, and cyst diameter. Serum AMH levels were measured using ELISA before and one month after cystectomy. Immunohistochemical examination assessed apoptotic factor gene expression on the inner surface epithelium of endometriomas. Results: AMH levels declined post-cystectomy in both endometriomas ≤4 cm and >4 cm, with significant differences in the latter group. Additionally, there was increased Bax expression in >4 cm endometriomas. Correlation tests revealed a strong positive relationship between TNFR1 and Caspase-3 in both groups. Multivariate analysis suggested a connection between apoptotic factor gene expression and reduced AMH levels. Conclusion: TNF-α appears to initiate apoptosis in endometriomas through the intrinsic pathway. It is advisable to perform endometrioma surgery when the diameter is ≤4 cm and before the age of 30 to achieve optimal outcomes.

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endometriosisendometrioma

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