The effects of laparoscopic surgery on anti-Müllerian Hormone (AMH) levels for ovarian endometriomas: A systematic review and meta-analysis

Abstract

Background: The anti-Müllerian Hormone (AMH) is an important sign that gives clues about the ovarian reserve; it is mostly made by the granulosa cells of ovarian follicles. AMH plays a crucial role in the complicated process of folliculogenesis, controlling the "recruitment" of primordial follicles, regulating growth and atresia in primary and secondary follicles, and suppressing the excessive growth of ovarian follicles.
Purpose: To ascertain the effect of laparoscopic surgery on AMH levels in patients with ovarian endometrioma.
Materials and methods: A systematic review and meta-analysis were performed. Searches of the PubMed, Medline, Scopus, and Embase databases were conducted by two independent reviewers. The search strategy identified relevant randomized controlled trials (RCTs) and quasi-experimental studies from 2000 to 2023. The quality of the studies was assessed using the Cochrane Risk of Bias tool. The study's primary outcome was the change in AMH levels from baseline to 12 months after laparoscopic surgery for endometrioma. We used a random effects model to estimate pooled means. Findings: The results from the six included RCTs studies involving a total of 681 patients were pooled. The meta-analysis revealed that patients who underwent laparoscopic surgery experienced an overall decline in AMH levels in the 12-month time frame post-surgery, with a mean difference of - 1.41ng/mL (95% CI = - 2.04 to - 0.78, P < 0.0001, I² = 93%). Conclusion: Laparoscopic surgery on ovarian endometriomas may adversely affect ovarian reserve. Notably, a decline in AMH levels has been observed 12 months post-surgery, indicating potential long-term effects on ovarian function. Therefore, a cautious approach is recommended when considering laparoscopic surgery, emphasizing the importance of monitoring ovarian reserve in the postoperative period to mitigate any adverse outcomes.