Long-Term Follow-Up Of Anti-Mullerian Hormone Levels After Laparoscopic Endometrioma Cystectomy

Abstract

Objective: The study aims to evaluate long-term ovarian reserve change by serum anti-Mullerian hormone (AMH) level and determine the factors that affect the changes after laparoscopic endometrioma cystectomy. Methods: In a prospective longitudinal study, 104 patients with unilateral (n=77) and bilateral (n=27) endometrioma underwent laparoscopic endometrioma cystectomy. AMH levels were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Multivariate linear regression analysis was performed to determine factors related to AMH level changes. Results: Median preoperative AMH levels significantly declined from 3.77 ng/mL to 1.60 ng/mL (P<0.001), 1.66 ng/mL (P<0.001), 1.67 ng/mL (P<0.001), and 1.72 ng/mL (P<0.001) at 1, 3, 6, and 12 months postoperatively, respectively. The rate of decrease in AMH was unchanged six months after surgery, 52.2%, 53.7%, 54.8% at 1, 3, 6 months, respectively, and declined to 43.2% at 12 months. Although most factors were associated with AMH level changes in monovariant linear regression, multivariant linear regression analysis showed only three factors that reached the statistical significance, including bilateral endometriomas, mean size of the endometrioma, and preoperative AMH levels. Conclusions: Serum AMH levels decline significantly after laparoscopic cystectomy of endometriomas but recovered at 12 months compared with the first 6 months with unilateral endometrioma. Bilateral endometriomas, size of the cyst, and preoperative AMH levels might independently affect AMH levels at 12 months after surgery.

Keywords: anti-mullerian hormone; cyst size; cystectomy; endometrioma.

Figure 1

Longitudinal follow-up of AMH levels after laparoscopic endometrioma cystectomy. (A) Median AMH levels assessed before and after surgery. AMH0: Serum AMH levels before surgery; AMH1, AMH3, AMH6, AMH12: Serum AMH levels at 1 month, 3 months, 6 months, and 12 months after surgery, respectively, (#) P<0.001 when compared with other groups. (B) Rate of decrease in AMH levels (dAMH) after surgery. dAMH1, dAMH3, dAMH6, dAMH12: rate of decrease in AMH levels (dAMH) at 1 month, 3 months, 6 months, and 12 months after surgery, respectively.

Figure 2

Pre-operative AMH level cut-off to predict diminished ovarian reserve after surgery. The cut-off values of AMH levels before surgery to predict diminished ovarian reserve (DOR) 1 month (A), 3 months (B), 6 months (C) and 12 months (D) after surgery in patients with unilateral endometriomas. Cut-off values, sensitivity, specificity, area under the curve (AUC) and 95%CI are presented on the figures.