Understanding the Effect of Surgery on Ovarian Reserve in Women with Endometriomas and Endometriosis

Endometriomas are one of the most common ovarian cysts. These may be associated with pelvic pain or infertility. Surgical removal is common. There are several controversies surrounding the management of these cysts.

For example, the removal of an endometriotic cyst is known to improve spontaneous fertility, but it may not improve outcomes with in vitro fertilization. In any event, it is unclear whether the presence of the cyst or its removal is associated with decreased ovarian reserve (loosely defined as the quantity of oocytes remaining in the ovary). There are several potential measures for ovarian reserve, of which anti-müllerian hormone (AMH) is the most frequently used.

Study design

Our group recently published a study in which we posed two questions: Is the presence of an intrinsic endometrioma associated with decreased ovarian reserve, and does its surgical removal decrease reserve further? This was a prospective study of women aged 18 to 43 years presenting with pelvic pain and/or infertility undergoing surgical management for suspected endometriosis (N = 58) or endometriomas (N = 58). Based on surgical findings, the suspected endometriosis group was further separated into those with evidence of peritoneal disease (N = 29) and those with no evidence of endometriosis (N = 29).

Highlights of our findings

Baseline AMH values were significantly lower in the endometrioma group versus the negative laparoscopy group. Only patients with endometriomas had a significant decline in ovarian reserve at one month. Six months after surgery, AMH hormone values were no longer significantly different from baseline, demonstrating some recovery from surgery.

We concluded that, at baseline, patients with endometriomas had significantly lower AMH values compared with women without endometriosis. Surgical excision of endometriomas appears to have temporary detrimental effects on ovarian reserve. Clinically, this means that we should consider carefully the long-term impact on fertility when we remove an endometrioma.