The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis.
BACKGROUND
Endometriomas are mainly treated surgically. However, there has been concern over the potential damaging effect of this surgery on ovarian reserve.


OBJECTIVE
The aim of this meta-analysis was to investigate the impact of surgery for endometriomas on ovarian reserve as determined by serum anti-müllerian hormone (AMH).


METHODS
MEDLINE, PubMed, and Embase were searched electronically.


METHODS
All prospective cohort studies that analyzed changes of serum AMH concentrations after surgical treatment of endometriomas were eligible. Twenty-one studies were identified, of which eight were selected for meta-analysis.


METHODS
Two reviewers performed the data extraction independently.


RESULTS
Pooled analysis of 237 patients showed a statistically significant decrease in serum AMH concentration after ovarian cystectomy (weighted mean difference -1.13 ng/ml; 95% confidence interval -0.37 to -1.88), although heterogeneity was high. Sensitivity analysis for studies with a preoperative serum AMH level of 3.1 ng/ml or greater improved heterogeneity but also still showed a significant postoperative fall in serum AMH (weighted mean difference -1.52 ng/ml, 95% confidence interval -1.04 to -2).


CONCLUSIONS
The results of this study suggest a negative impact of excision of endometriomas on ovarian reserve as evidenced by a significant postoperative fall in circulating AMH.
University of Nottingham, Medical School, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3DT, United Kingdom. mzxfr1@nottingham.ac.uk
Francesca
F
Raffi
Mostafa
M
Metwally
Saad
S
Amer
D000293:Adolescent; D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D002452:Cell Count; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D016889:Endometrial Neoplasms / Q000503:physiopathology* / Q000601:surgery*; D004715:Endometriosis / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D010048:Ovarian Cysts / Q000150:complications / Q000473:pathology; D006080:Ovarian Follicle / Q000033:anatomy & histology; D010053:Ovary / Q000166:cytology / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D011933:Reagent Kits, Diagnostic; D055815:Young Adult
D012739:Gonadal Steroid Hormones; D011933:Reagent Kits, Diagnostic; D054304:Anti-Mullerian Hormone