Anti-Mullerian hormone levels following laparoscopic ovarian cystectomy with subcutaneous abdominal wall lifting for ovarian endometriomas

Purpose of investigation: To examine changes in anti-Mallerian hormone (AMH) levels following laparoscopic ovarian endometriotic cystectomy with abdominal wall lifting. Materials and methods: This prospective cohort study analyzed 32 patients with endometriomas who underwent laparoscopic surgery between October 2014 and December 2016 in private and university hospitals. We measured blood AMH levels at baseline and at1,3, 6, and 9 months following a cystectomy. We also examined the correlations of AMH levels with age at time of surgery, bilateral cysts, cyst diameter, and Douglas fossa occlusion. Main outcome measures include the ovarian reserve based on AMH levels. Results: Compared to baseline (2.14 +/- 1.66 ng/mL), AMH levels were significantly reduced at 1 (1.22 +/- 1.08 ng/mL) and 3 (1.18 +/- 1.02 ng/mL) months post-surgery. However, there were no significant differences between baseline and 6 (1.35 +/- 1.02 ng/mL) or 9 (1.37 +/- 0.95 ng/mL) months post-surgery. AMH levels were significantly reduced in patients aged >= 35 years (1.10 0.98 versus 3.15 +/- 1.85 ng/mL, P = 0.001), those with bilateral cysts (1.58 +/- 0.98 versus 3.15 +/- 1.85 ng/mL, P = 0.006), and those with pouch of Douglas occlusion (1.16 +/- 0.90 versus 2.93 +/- 1.60 ng/mL, P= 0.002). Conclusions: Abdominal wall lifting yielded the same AMH level changes as insufflation, suggesting that their effects on recurrence and preservation of the ovarian reserve following ovarian cystectomy are comparable. Abdominal wall lifting should be proactively considered when performing laparoscopic surgery for patients with endometriosis. If the ovarian reserve is preserved in the long term despite transient postoperative reduction in the ovarian reserve, physicians should consider surgery with consideration of postoperative artificial reproductive therapy for these patients who desire to have children.