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
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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

BACKGROUND: Many women who experience endometriosis and endometriomas also encounter problems with fertility. OBJECTIVE: The purpose of this study was to determine the impact of surgical excision of endometriosis and endometriomas compared with control subjects on ovarian reserve. STUDY DESIGN: This 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. RESULTS: Baseline 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). CONCLUSION: At 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 Ovarian Reserve Peritoneal Diseases Adolescent Adolescent Adult Adult Anti-Mullerian Hormone Anti-Mullerian Hormone Case-Control Studies Case-Control Studies Cohort Studies Cohort Studies Endometriosis Endometriosis Endometriosis Female

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (30)

Cited by (50)

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