Surgical removal of endometriomas adversely affects ovarian reserve: Comparison of serum FSH, AMH and AFC before and after cystectomy

Objective: Surgical removal of endometriomas, even if performed in experienced hands, leads to a decrease in ovarian reserve in varying degrees depending on age. This study was designed to determine the pre- and post-surgical changes of ovarian reserve markers in patients who underwent endometrioma cystectomy. Methods: Gözde Akademi Hospital gynecology outpatient clinic with the diagnosis of symptomatic ovarian endometrioma was included in the study. Fourteen normal-ovulatory women aged between 21-36 were included in the study. In addition to serum anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol levels, antral follicle count (AFC) was evaluated before and 3 months after cystectomy. Ovarian damage was avoided as much as possible during endometrioma surgery. Results: After endometrioma cystectomy, serum AMH levels were significantly decreased (3.21 ± 1.1 ng/mL vs 1.9 ± 0.6 ng/mL; p= 0.02). There was no significant change in serum FSH (5.97 ± 1.6 mIU/mL vs 7.34±0.55 mIU/mL, p=0.08) and estradiol (37.8 ±9.44 pg/mL vs 32.9 ±10.7 pg/mL, p=0.56) values measured three months after surgery. Similarly, there was no significant change in AFC values before and after surgery (4.12 ± 2.80 vs 4.89 ±3.06, p=0.24). Conclusion: Endometrioma cystectomy leads to a significant decrease in AMH levels, which is the main ovarian reserve marker, but does not affect AFC and FSH values.