ORIGINAL ARTICLE Infertility
endometriomas and their removal on
rate of decline in ovarian reserve†
Gurkan Uncu1, Isil Kasapoglu1, Kemal Ozerkan1, Ayse Seyhan2,
Arzu Oral Yilmaztepe3, and Baris Ata1,*
1Department of Obstetrics and Gynecology, Uludag University School of Medicine, Gorukle, Bursa 16059, Turkey2Soranus IVF Centre, Bursa,
Turkey3Department of Biochemistry, Uludag University School of Medicine, Gorukle, Bursa 16059, Turkey
*Correspondence address. Uludag Universitesi Hastanesi Tup Bebek Merkezi, Gorukle, Bursa 16059, Turkish Republic.
Submitted on January 10, 2013; resubmitted on March 27, 2013; accepted on April 3, 2013
serum anti-Mu ¨llerian hormone (AMH) levels?
6 months after surgery.
whatis knownalready: NopreviouscomparisonofserumAMHlevelsbetweenwomenwithandwithoutendometriomahasbeen
reported. However, studies have suggested a decline in serum AMH levels 1–3 months after endometrioma excision but long-term data are
studydesign,size,duration: Aprospectivecohortstudyincluding30womenwithendometrioma .2 cmwereagematchedwith
30 healthy women without ovarian cysts.
participants/materials, setting, methods: Womenwithendometriomaunderwentlaparoscopicexcisionwiththestrip-
lyses were undertaken in order to identify determinants of surgery-related change in ovarian reserve.
(4.2+2.3 versus 2.8+2.2 ng/ml, respectively, P ¼ 0.02) and AFC (14.7+4.1 versus 9.7+4.8, respectively, P , 0.01). Serum AMH levels
were further decreased 6 months after surgery (2.8+2.2 versus 1.8+1.3 ng/ml, P ¼ 0.02), while AFC remained unchanged (9.7+4.8
versus 10.4+4.2, P ¼ 0.63). The rate of decline in AMH was not correlated with age, laterality of endometrioma, cyst diameter or the
number of primordial follicles on the surgical specimens. The preoperative serum AMH level was positively correlated with the rate of decline
in serum AMH after surgery (r ¼ 0.47, P ¼ 0.02).
limitations, reasons for caution: The absence of a non-treated group of women with endometriomas as a further control
prevents comment on the presence of a progressive decline in ovarian reserve related to endometrioma per se. The sample size may be too
small for detection of factors correlated with the extent of ovarian damage.
wider implications of the findings: Whilethefindingsaremostlyinagreementwithpreviousstudies,thepresentstudyisthe
firsttoshowthatthe presence ofendometrioma perse isassociated withadecrease in ovarianreserve.The extent ofsurgery-relateddecline in
avoid surgical excision as far as is possible if subsequent fertility is a concern. Additional studies are required to further investigate whether the
endometrioma-related decline in ovarian reserve per se is progressive in nature and whether it exceeds the surgery-related decline.
†Preliminary results of this study have been presented (orally and as a poster) at the 27th Annual Meeting of ESHRE.
& The Author 2013. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.
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Human Reproduction, Vol.28, No.8 pp. 2140–2145, 2013
Advanced Access publication on April 26, 2013doi:10.1093/humrep/det123
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