Surgical excision of endometriomas and ovarian reserve : a systematic review on serum antimüllerian hormone level modifications

OBJECTIVE: To evaluate serum antimüllerian hormone (AMH) level modification after surgical excision of ovarian endometriomas. DESIGN: Systematic review. MEDLINE search from January 1990 to April 2012 using the combination of medical terms endometriosis, endometrioma, endometriotic cyst, and AMH or antimüllerian hormone, MIF or müllerian inhibiting factor. Reference lists of selected studies were checked for additional potential contributions. SETTING: Not applicable. PATIENT(S): Women with ovarian endometriomas requiring surgery. INTERVENTION(S): Serum AMH level assessment. MAIN OUTCOME MEASURE(S): Serum AMH level modifications. RESULT(S): Eleven articles satisfied our selection criteria. Data pooling were deemed inopportune owing to the heterogeneity of the study designs and of the reported parameters. Nine of 11 studies documented a statistically significant reduction of serum AMH level after surgery. The two studies failing to document this decrease were published by the same study group and partly overlapped. The magnitude of the decline was more evident in women operated on for bilateral endometriomas. CONCLUSION(S): Evidence deriving from the evaluation of serum AMH level modifications after surgical excision of endometriomas supports a surgery-related damage to ovarian reserve