title: Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls.
abstract: BACKGROUND
  Many women who experience endometriosis and endometriomas also encounter problems with fertility.
  
  
  OBJECTIVE
  The purpose of this study was to determine the impact of surgical excision of endometriosis and endometriomas compared with control subjects on ovarian reserve.
  
  
  METHODS
  This was a prospective cohort study of 116 women aged 18-43 years with pelvic pain and/or infertility who underwent surgical treatment of 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). Ovarian reserve was measured by anti-Müllerian hormone and compared before surgery and at 1 month and 6 months after surgery.
  
  
  RESULTS
  Baseline anti-Müllerian hormone values were significantly lower in the endometrioma vs negative laparoscopy group (1.8 ng/mL [95% confidence interval, 1.2-2.4 ng/mL] vs 3.2 ng/mL [95% confidence interval, 2.0-4.4 ng/mL]; P<.02), but the peritoneal endometriosis group was not significantly different than either of these groups. Only patients with endometriomas had a significant decline in ovarian reserve at 1 month (-48%; 95% confidence interval, -54 to -18%; P<.01; mean anti-Müllerian hormone baseline value, 1.77-1.12 ng/mL at 1 month). Six months after surgery, anti-Müllerian hormone values continued to be depressed from baseline but were no longer significantly different. The rate of anti-Müllerian hormone decline was correlated positively with baseline preoperative anti-Müllerian hormone values and the size of endometrioma that was removed. Those with bilateral endometriomas (n=19) had a significantly greater rate of decline (53.0% [95% confidence interval, 35.4-70.5%] vs 17.5% [95% confidence interval, 3.2-31.8%]; P=.002).
  
  
  CONCLUSIONS
  At baseline, patients with endometriomas had significantly lower anti-Müllerian hormone values compared with women without endometriosis. Surgical excision of endometriomas appears to have temporary detrimental effects on ovarian reserve.
authors.affiliation: Cleveland Clinic, Section of Reproductive Endocrinology and Infertility, Obstetrics, Gynecology and Women's Health Institute, Beachwood, OH. Electronic address: Linnea.Goodman@gmail.com.
authors.forename: Linnea R
authors.initials: LR
authors.lastname: Goodman
authors.affiliation: Cleveland Clinic, Section of Reproductive Endocrinology and Infertility, Obstetrics, Gynecology and Women's Health Institute, Beachwood, OH.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Goldberg
authors.affiliation: Cleveland Clinic, Section of Reproductive Endocrinology and Infertility, Obstetrics, Gynecology and Women's Health Institute, Beachwood, OH.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Flyckt
authors.affiliation: Cleveland Clinic, Section of Reproductive Endocrinology and Infertility, Obstetrics, Gynecology and Women's Health Institute, Beachwood, OH; Department of Endocrinology Laboratory, Obstetrics, Gynecology and Women's Health Institute, Cleveland, OH.
authors.forename: Manjula
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Department of Endocrinology Laboratory, Obstetrics, Gynecology and Women's Health Institute, Cleveland, OH.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Harwalker
authors.affiliation: Cleveland Clinic, Section of Reproductive Endocrinology and Infertility, Obstetrics, Gynecology and Women's Health Institute, Beachwood, OH.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Falcone
mesh_terms: D000293:Adolescent; D000328:Adult; D054304:Anti-Mullerian Hormone / Q000378:metabolism*; D016022:Case-Control Studies; D015331:Cohort Studies; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery; D010049:Ovarian Diseases / Q000150:complications / Q000601:surgery*; D065851:Ovarian Reserve; D010053:Ovary / Q000601:surgery; D017699:Pelvic Pain / Q000209:etiology / Q000601:surgery; D010532:Peritoneal Diseases / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D054304:Anti-Mullerian Hormone
keywords: endometrioma; endometriosis; infertility; ovarian reserve