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

Yıl 2023, Cilt: 9 Sayı: 3, 542 - 549, 31.08.2023

Fatma Tanılır Çağıran Zercan Kalı

https://doi.org/10.19127/mbsjohs.1266532

Öz

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.

Anahtar Kelimeler

: Endometrioma, Cystectomy, AMH, FSH, Estradiol

Endometrioma cerrahisinde kistektomi over rezervini olumsuz etkiler: Kistektomi öncesi ve sonrası serum FSH, AMH ve AFC'nin karşılaştırılması

Öz

Anahtar Kelimeler

Endometrioma, Kistektomi, AMH, FSH, Estradiol

Kaynakça

• Biacchiardi CP, Piane LD, Camanni M, Deltetto F, Delpiano EM, Marchino GL, Gennarelli G, Revelli A. Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons. Reprod Biomed Online. 2011 Dec;23(6):740-6.
• Kitajima M, Khan KN, Harada A, Taniguchi K, Inoue T, Kaneuchi M, Miura K, Masuzaki H. Association between ovarian endometrioma and ovarian reserve. Front Biosci (Elite Ed). 2018 Jan 1;10(1):92-102. doi: 10.2741/e810. PMID: 28930606.
• Brosens I, Gordts S, Puttemans P, Benagiano G. Pathophysiology proposed as the basis for modern management of the ovarian endometrioma. Reprod Biomed Online. 2014 Feb;28(2):232-8.
• Donnez J, Nisolle M, Gillet N, Smets M, Bassil S, Casanas-Roux F. Large ovarian endometriomas. Hum Reprod. 1996 Mar;11(3):641-6.
• Donnez J, Nisolle M, Gillet N, Smets M, Bassil S, Casanas-Roux F. Large ovarian endometriomas. Hum Reprod. 1996 Mar;11(3):641-6.
• Kitajima M, Defrère S, Dolmans MM, Colette S, Squifflet J, Van Langendonckt A, Donnez J. Endometriomas as a possible cause of reduced ovarian reserve in women with endometriosis. Fertil Steril. 2011 Sep;96(3):685-91.
• Celik O, Celik N, Zan E, Dalkilic S, Saglam A, Yurci A, Senturk S, Sahin E, Sahin ME. Genome-wide expression analysis of endometrium before and after endometrioma surgery. Eur J Obstet Gynecol Reprod Biol. 2020 Oct;253:141-147.
• Canis M, Pouly JL, Tamburro S, Mage G, Wattiez A, Bruhat MA. Ovarian response during IVF-embryo transfer cycles after laparoscopic ovarian cystectomy for endometriotic cysts of >3 cm in diameter. Hum Reprod. 2001 Dec;16(12):2583-6.
• Legendre G, Catala L, Morinière C, Lacoeuille C, Boussion F, Sentilhes L, Descamps P. Relationship between ovarian cysts and infertility: what surgery and when? Fertil Steril. 2014 Mar;101(3):608-14. doi: 10.1016/j.fertnstert.2014.01.021. PMID: 24559614.
• Visser JA, de Jong FH, Laven JS, Themmen AP. Anti-Müllerian hormone: a new marker for ovarian function. Reproduction. 2006 Jan;131(1):1-9.
• Kahapola Arachchige KM, Wardrop R, Lim EM, Stuckey B, Hadlow N. Waiting for an elevated FSH--too late a marker of reduced ovarian reserve? Aust N Z J Obstet Gynaecol. 2012 Oct;52(5):460-4.
• Dokras A, Habana A, Giraldo J, Jones E. Secretion of inhibin B during ovarian stimulation is decreased in infertile women with endometriosis. Fertil Steril. 2000 Jul;74(1):35-40.
• Hock DL, Sharafi K, Dagostino L, Kemmann E, Seifer DB. Contribution of diminished ovarian reserve to hypofertility associated with endometriosis. J Reprod Med. 2001 Jan;46(1):7-10.
• Tang Y, Li Y. Evaluation of Serum AMH, INHB Combined with Basic FSH on Ovarian Reserve Function after Laparoscopic Ovarian Endometriosis Cystectomy. Front Surg. 2022 18;9:906020.
• Bedenk J, Vrtačnik-Bokal E, Virant-Klun I. The role of anti-Müllerian hormone (AMH) in ovarian disease and infertility. J Assist Reprod Genet. 2020;37(1):89-100.
• Sadruddin S, Barnett B, Ku L, Havemann D, Mucowski S, Herrington R, Burggren W. Maternal serum concentration of the anti-müllerian hormone is a better predictor than basal follicle-stimulating hormone of successful blastocysts development during IVF treatment. PLoS One. 2020;15(10):e0239779.