Effect of laparoscopic endometrioma cystectomy on anti-Müllerian hormone (AMH) levels

Abstract

Objective: To investigate temporary or long-term changes of AMH after laparoscopic endometrioma cystectomy and its dependency on characteristics of endometriomas.

Methods: One hundred and seventy-one women, open-labeled prospective study; five groups divided according age ≤/> 35, uni-/bilateral, cyst ≤/> 7 cm, coagulation/suture surgery, stage III/IV; between- and within-group analyses after 1, 3, 6, and 12 months.

Results: After 12 months, compared to pretreament, AMH decreased significantly for patients with bilateral cysts, cyst size >7 cm and endometriosis stage IV. In the between-group analysis all comparisons were significant, with exception of the surgery type. However, this was different performing the multiple linear regression analysis suggesting lower postoperative decrease using suturing technique. This analysis also showed higher age at pretreatment and bilateral cysts as risk factor for AMH decline.

Conclusions: Effects of endometrioma cystectomy on AMH are dependent on characteristics of the endometrioma, showing long-term a decrease in patients with larger, bilateral cysts and in stage IV endometriosis, but only short-time decrease in smaller, unilateral cysts and stage III which sometimes also can fully recover in AMH production within one year. In our study suture compared to coagulation surgery was protective, i.e. may lead to lower postoperative AMH decline.

摘要

目的：探讨腹腔镜子宫内膜异位囊肿切除术后AMH的短期及长期变化及其与子宫内膜异位囊肿特点的关系。

方法：171名女性, 采用开放性的前瞻性研究, 根据患者年龄≤35岁/大于35岁, 单侧/双侧, 囊肿≤7cm/>7cm, 手术中应用电凝/缝合, III期/IV期分为五组, 分别于1, 3, 6和12个月后进行组间及组内分析。

结果：12个月后, 双侧囊肿且囊肿>7cm子宫内膜异位症IV患者的AMH水平和治疗前相比明显降低。除手术类型外, 组间比较均有统计学意义。然而, 多元线性回归分析显示手术中应用缝合方法术后降低率不同。这项分析还显示治疗前年龄较大的、双侧囊肿是AMH下降的危险因素。

结论：子宫内膜异位囊肿切除术对AMH的影响取决于子宫内膜异位囊肿的特点, 大且双侧囊肿的IV期子宫内膜异位症的患者的AMH长期下降, 而小且单侧的III期的子宫内膜异位症的患者的AMH短期下降, 有时也能在1年内完全恢复。在我们的研究中, 和电凝相比手术中应用缝合方法具有保护作用, 即使患者术后AMH下降减少。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Endometrioma
• laparoscopic ovarian cystectomy
• ovarian reserve
• anti-Müllerian hormone (AMH)

Disclosure statement

All authors declare that they have no conflict of interest.

Additional information

Funding

This work was Supported by: Beijing Nature Science Foundation (Y181004), SAFEA: Project for Key Foreign Experts (20181100005), Beijing Municipality: Program for Overseas Talents Aggregation, Capital's Funds for Health Improvement and Research (No. 2016–1-2111), Supported by Beijing Obstetrics and Gynecology Hospital, Capital Medical University (fcyy201520), Beijing Municipal Administration of Hospitals Clinical medicine Development of special funding support (XMLX201710), Beijing Municipal Administration of Hospitals’Ascent Plan (DFL20181401).