Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls

Linnea R Goodman, Jeffrey M Goldberg, Rebecca L Flyckt, Flyckt RL, Rebecca Flyckt, Gupta M, Manjula Gupta, Manjula K. Gupta, Jyoti Harwalker, Harwalker J, Tommaso Falcone, Falcone T
American journal of obstetrics and gynecology · 2016 · vol. 215(5) , pp. 589.e1–589.e6 · doi:10.1016/j.ajog.2016.05.029 · PMID:27242204 · W2406323930
article OA: closed CC0 ⤵ 128 in-corpus citations
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This study investigated the impact of surgery on ovarian reserve in women with endometriomas, endometriosis, and control groups.

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Abstract

BackgroundMany women who experience endometriosis and endometriomas also encounter problems with fertility.ObjectiveThe purpose of this study was to determine the impact of surgical excision of endometriosis and endometriomas compared with control subjects on ovarian reserve.Study designThis was a prospective cohort study of 116 women aged 18-43 years with pelvic pain and/or infertility who underwent surgical treatment of suspected endometriosis (n=58) or endometriomas (n=58). Based on surgical findings, the suspected endometriosis group was further separated into those with evidence of peritoneal disease (n=29) and those with no evidence of endometriosis (n=29). Ovarian reserve was measured by anti-Müllerian hormone and compared before surgery and at 1 month and 6 months after surgery.ResultsBaseline anti-Müllerian hormone values were significantly lower in the endometrioma vs negative laparoscopy group (1.8 ng/mL [95% confidence interval, 1.2-2.4 ng/mL] vs 3.2 ng/mL [95% confidence interval, 2.0-4.4 ng/mL]; P<.02), but the peritoneal endometriosis group was not significantly different than either of these groups. Only patients with endometriomas had a significant decline in ovarian reserve at 1 month (-48%; 95% confidence interval, -54 to -18%; P<.01; mean anti-Müllerian hormone baseline value, 1.77-1.12 ng/mL at 1 month). Six months after surgery, anti-Müllerian hormone values continued to be depressed from baseline but were no longer significantly different. The rate of anti-Müllerian hormone decline was correlated positively with baseline preoperative anti-Müllerian hormone values and the size of endometrioma that was removed. Those with bilateral endometriomas (n=19) had a significantly greater rate of decline (53.0% [95% confidence interval, 35.4-70.5%] vs 17.5% [95% confidence interval, 3.2-31.8%]; P=.002).ConclusionAt baseline, patients with endometriomas had significantly lower anti-Müllerian hormone values compared with women without endometriosis. Surgical excision of endometriomas appears to have temporary detrimental effects on ovarian reserve.

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Anti-Mullerian Hormone Endometriosis Ovarian Diseases Ovarian Reserve Peritoneal Diseases Adolescent Adult Anti-Mullerian Hormone Case-Control Studies Cohort Studies Endometriosis Endometriosis Female Humans Infertility, Female Infertility, Female Infertility, Female Ovarian Diseases Ovarian Diseases Ovary

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References (30)

Cited by (50)

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