IMR Press / CEOG / Volume 48 / Issue 1 / DOI: 10.31083/j.ceog.2021.01.5528
Open Access Original Research
Anti-Müllerian hormone levels following laparoscopic ovarian cystectomy with subcutaneous abdominal wall lifting for ovarian endometriomas
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1 Department of Obstetrics & Gynecology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, Japan
2 Department of Obstetrics & Gynecology, Social Welfare Foundation St. John Society Sakuramachi Hospital, 1-2-20 Sakuramachi, Koganei, Tokyo, Japan
Clin. Exp. Obstet. Gynecol. 2021 , 48(1), 91–97; https://doi.org/10.31083/j.ceog.2021.01.5528
Submitted: 8 March 2020 | Revised: 14 August 2020 | Accepted: 15 August 2020 | Published: 15 February 2021
Abstract

Purpose of investigation: To examine changes in anti-Müllerian hormone (AMH) levels following laparoscopic ovarian endometriotic cystectomy with abdominal wall lifting. Materials and methods: This prospective cohort study analyzed 32 patients with endometriomas who underwent laparoscopic surgery between October 2014 and December 2016 in private and university hospitals. We measured blood AMH levels at baseline and at 1, 3, 6, and 9 months following a cystectomy. We also examined the correlations of AMH levels with age at time of surgery, bilateral cysts, cyst diameter, and Douglas fossa occlusion. Main outcome measures include the ovarian reserve based on AMH levels. Results: Compared to baseline (2.14 ± 1.66 ng/mL), AMH levels were significantly reduced at 1 (1.22 ± 1.08 ng/mL) and 3 (1.18 ± 1.02 ng/mL) months post-surgery. However, there were no significant differences between baseline and 6 (1.35 ± 1.02 ng/mL) or 9 (1.37 ± 0.95 ng/mL) months post-surgery. AMH levels were significantly reduced in patients aged 35 years (1.10 ± 0.98 versus 3.15 ± 1.85 ng/mL, P = 0.001), those with bilateral cysts (1.58 ± 0.98 versus 3.15 ± 1.85 ng/mL, P = 0.006), and those with pouch of Douglas occlusion (1.16 ± 0.90 versus 2.93 ± 1.60 ng/mL, P = 0.002). Conclusions: Abdominal wall lifting yielded the same AMH level changes as insufflation, suggesting that their effects on recurrence and preservation of the ovarian reserve following ovarian cystectomy are comparable. Abdominal wall lifting should be proactively considered when performing laparoscopic surgery for patients with endometriosis. If the ovarian reserve is preserved in the long term despite transient postoperative reduction in the ovarian reserve, physicians should consider surgery with consideration of postoperative artificial reproductive therapy for these patients who desire to have children.

Keywords
Cyst
Endometriosis
Fertility
Patients
Pouch
Figures
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