Longterm follow-up of anti-müllerian hormone levels in patients who had surgery for endometrioma
Thesis (Mphil)--Stellenbosch University, 2019.
Introduction: Endometriosis is highly prevalent among women of reproductive age increasing up to 50% in those presenting with infertility. Ovarian endometriosis, known as endometriomas, is found in up to 44% of women with endometriosis. Excisional surgery for endometrioma in the form of cystectomy is associated with a reduction in ovarian reserve as measured by anti-Müllerian hormone (AMH). Although there are reports of recovery of AMH levels following cystectomy, the long-term effects of this surgery on ovarian reserve is unknown. Objective and Methods: The primary objective is to investigate whether there is recovery of serum anti- Müllerian hormone (AMH) level in the long-term (more than 1 year) after cystectomy for endometriomas, with a secondary objective to determine the on-going pregnancy rate in the group of patients trying to conceive. We performed a longitudinal cohort study in a tertiary referral unit evaluating fifty-nine patients that underwent laparoscopic cystectomy for suspected endometrioma. We analysed data on serum- AMH levels of samples collected before or on the day of surgery, 6 months after surgery and at a mean final follow-up of 23.3 months after surgery. For our secondary outcome we determined a documented clinical pregnancy in patients that whished to conceive Results: The serum AMH levels declined in 92% of patients at final follow-up. A significant decline in serum AMH of -1.23ng/ml and -1.47ng/ml was detected at 6 months and final follow-up respectively. We demonstrated an on-going pregnancy rate of 38% in the groups trying to conceive. Conclusion: The reduction in ovarian reserve following cystectomy as measured by serum AMH does not recover in the overwhelming majority of patients. Patients need to be counselled regarding this possibility and alternative fertility sparing options should be considered in the management of endometriomas in women still wishing to conceive