C.R. Costache, D.M. Mandi, G.P. Gorecki, M.C. Costache-Outas, M. Mitran, R.M. Sima, T. Burcos
Rezumat: Objective. This study was designed to analyze the deleterious
effect of endometriosis on ovarian reserve after surgery by studying anti-Müllerian hormone (AMH) levels. Materials and method. This is a systematic review that included observational studies and randomized clinical trials published in English between 2015 and 2019. We included 17 studies that reported AMH levels in patients undergoing
laparoscopic surgery for endometrioma, measured
preoperatively and postoperatively. Results. Seventeen
studies met the inclusion criteria. A significant decrease
in AMH levels was observed in the short-, medium- and
long-term postoperative periods compared to baseline
AMH levels. However, there were no differences between
postoperatively immediately and one year after surgery.
Postoperative AMH levels were significantly reduced in bilateral
endometriomas compared to unilateral cases. Also,
patients with endometriomas, compared to patients with
other benign ovarian conditions, had a more important
decline in AMH levels. The same was observed in cases of
bilateral cystectomy compared to vaporization with bipolar
energy or laser. A greater decrease in postsurgical AMH was
also observed with bipolar energy hemostasis compared to
suture and hemostatic agents. Conclusions. Endometrioma
surgery has a negative effect on postoperative AMH levels.
Bilateral endometriomas and those greater than 7 cm are
associated with a significant decrease in AMH. The mechanical
removal of healthy tissue and the destruction of the
ovarian cortex may explain the reduction in ovarian reserve. Cuvinte cheie: anti-Müllerian hormone, endometriosis,
endometrioma, laparoscopic surgery, ovarian reserve.