Impact of laparoscopic cystectomy on ovarian reserve: serial changes of serum anti-Mullerian hormone levels

Objective: To evaluate the ovarian reserve changes after laparoscopic cystectomy, we prospectively evaluated pre- and postoperative serum anti-Mullerian hormone (AMH) level, and ovarian volumes. Design: Prospective longitudinal study. Setting: University Hospital. Patient(s): Twenty women with benign ovarian masses participated; endometrioma [13], mature teratoma [6], and mucinous cystadenoma [1]. Seven patients had bilateral ovarian masses. Intervention(s): All patients had undergone laparoscopic ovarian cystectomy. Serum AMH levels were serially measured: preoperative, 1 week, 1 month, and 3 months after operation. Volumes of total ovary and ovarian mass were measured by 3D ultrasonography before operation. Main Outcome Measure(s): Postoperative serum AMH level and ovarian volume. Result(s): Median AMH level was 2.23 ng/mL (95% confidence interval [CI] 1.35-3.41 ng/mL) before operation, but reduced to 0.67 ng/mL (95% CI 0.44-1.70 ng/mL) at the first week postoperatively and then increased to 1.14 ng/mL (95% CI 0.79-2.36 ng/mL) in the first month and 1.50 ng/mL (95% CI 0.58-3.26 ng/mL) in the third month. The serum AMH level after 3 months postoperatively was recovered to about 65% of the preoperative level. The serum AMH level at postoperative 1 week was more decreased in endometrioma compared with nonendometrioma (33.9% vs. 69.2% of preoperative level), and in bilateral group compared with unilateral group (16.9% vs. 62.9%). Conclusion(s): This study suggests that ovarian reserve could be reduced after laparoscopic cystectomy; however, it could be restored thereafter up to 3 months postoperative in reproductive women. (Fertil Steril (R) 2010; 94: 343-9. (C) 2010 by American Society for Reproductive Medicine.)