Changes in Serum Anti-müllerian Hormone (AMH) as an Indicator of Ovarian Reserve in Patients Undergoing Ovarian Cystectomy: A Prospective Cohort Study

Abstract

Benign ovarian cysts are common in reproductive aged women. They are associated with pain, infertility and poor IVF results. Ovarian cystectomy is the method of choice for treating benign ovarian cyst. They are characterized by having high cure rate and low recurrence when compared with other surgical techniques or medical treatment. However, ovarian cystectomy is associated with ovarian damage and removal of normally functioning follicles leading to a subsequent decline in ovarian reserve. Anti-mullarian hormone is an accurate marker for measuring the ovarian reserve. It is secreted by the primordial follicles and early antral stage independent from the gonadotropin serum levels. It is very important to determine the fertility potential of women in the reproductive age after ovarian cystectomy(Chang et al., 2010). This is a prospective cohort study aimed at determining the AMH changes as an indicator of ovarian reserve after ovarian cystectomy in patients with endometrioma and other benign cysts. Our study included 30 patients undergoing ovarian cystectomy at Ain shams maternity hospital to measure the change in AMH levels before and after ovarian cystectomy. The patients were reproductive aged women diagnosed of having benign ovarian cyst by Transvaginal Ultrasound with no prior hormonal treatment in the last 3 month, no evidence of other endocrinal disorders such as PCO, thyroid dysfunction or hyperprolactinemia. No suspicious findings of ovarian malignancy. Preoperative serum sample was collected before surgery and another sample after one month of surgery. The AMH level was quantified by ELISA assay. Those patients were further subdivided into two groups to Non-endometriomatous and Endometriomatous cysts group to determine the significance of the histological cyst type on the change of AMH. The preoperative AMH had a mean 3.64 ± 1.48, the postoperative AMH was 2.37 ± 1.00. There was a statistically significant difference between preoperative and postoperative AMH levels after one month from ovarian cystectomy with a mean difference of 1.27 (95% confidence interval of difference between 1.08 to 1.46, p <0.0001); showing the deleterious effects of ovarian cystectomy of benign ovarian cysts resulting from the acute traumatic damage to the ovarian cortex and healthy ovarian tissue unintentionally excised. There was a statistically significant difference between the endometrioma group and non-endometrioma group; denoting that the histological type of cyst could affect the postoperative decline of AMH and that the greater damage to the ovarian reserve caused by cystectomy of endometriomas compared with other benign ovarian cysts. Surprisingly, regarding laterality of the cyst; our study showed no significant difference between unilateral and bilateral cysts. Moreover, there was no statistically significant difference between cases done by laparotomy or laparoscopy.