Longterm follow-up of anti-müllerian hormone levels in patients who had surgery for endometrioma
Date
2019-04
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
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
Description
Thesis (Mphil)--Stellenbosch University, 2019.
Keywords
Endometriosis, anti-Müllerian hormone, UCTD, Laparoscopic surgery, Human reproduction