Rezerva ovariană după chirurgia endometrioamelor

Objective. This study was designed to analyze the dele­te­rious effect of endometriosis on ovarian reserve after sur­ge­ry by studying anti-Müllerian hormone (AMH) levels. Mate­rials and method. This is a systematic review that included observational studies and randomized clinical trials published in English between 2015 and 2019. We in­clu­ded 17 studies that reported AMH levels in patients un­der­going laparoscopic surgery for endometrioma, mea­sured preoperatively and postoperatively. Results. Seventeen stu­dies met the inclusion criteria. A significant decrease in AMH levels was observed in the short-, medium- and long-term postoperative periods compared to baseline AMH levels. However, there were no differences between post­ope­ra­tively immediately and one year after surgery. Post­ope­ra­tive AMH levels were significantly reduced in bi­la­te­ral endometriomas compared to unilateral cases. Also, patients with endometriomas, compared to patients with other benign ovarian conditions, had a more important de­cline in AMH levels. The same was observed in cases of bi­la­te­ral cystectomy compared to vaporization with bipolar ener­gy or laser. A greater decrease in postsurgical AMH was also observed with bipolar energy hemostasis compared to su­ture and hemostatic agents. Conclusions. Endometrioma sur­gery has a negative effect on postoperative AMH levels. Bila­te­ral endometriomas and those greater than 7 cm are associated with a significant decrease in AMH. The mecha­ni­cal removal of healthy tissue and the destruction of the ova­rian cortex may explain the reduction in ovarian reserve.