Early changes of ovarian reserve markers after laparoscopic excision of endometrioma

OBJECTIVE: Antimullerian hormone that designates inactive and growing follicular pool is being used commonly as an ovarian reserve marker at present. Its serum concentration changes minimally during menstruel cycle. In this study, we aimed to show changes of ovarian reserve by using all markers in combination that includes AMH in patients who have undergone laparoscopic cystectomy of endometrioma. At the same time, we aimed to state change in ovarian reserve with histopathologic examination of loss of ovarian tissue during laparoscopic cystectomy.METHODS: 65 patients, 18 to 45 years of age, were enrolled who have undergone laparoscopic operation for endometrioma. Preoperatively on the 3rd day of menstruation FSH, LH, estradiol and AMH were measured and FSH/LH ratio was calculated; also basal antral follicle (BAF) in both ovaries and dimensions of endometrioma were assessed with transvaginal or transabdominal ultrasonography. In these patients, during operation dimensions of endometrioma was assessed again and scoring was done according to revised American Society for Reproductive Medicine Classification of Endometriosis. Postoperatively on the 6th week, patients were called for control; hormone profile that includes FSH, LH, estradiol and AMH were measured and FSH/LH ratio was calculated and BAF were counted by transvaginal or transabdominal ultrasonography on the 3rd day of menstruation. The pathologist evaluated the presence or absence of the ovarian tissue adjacent to the cyst wall and graded the morphological characteristics of this tissue on a semiquantitative scale of 0 to 4 as previously published elsewhere (0= complete absence of follicles; 1= primordial follicles only; 2= primordial and primary follicles; 3= some secondary follicles; 4= pattern of primary and secondary follicles as seen in the normal ovary). Also association between FSH, FSH/LH ratio, AMH and histologic analysis of excised specimens was evaluated.RESULTS: Mean level of postoperative serum FSH was higher than its preoperative level as statistically significant (p<0.001). Mean postoperative value of AMH was lower than its preoperative value as statistically significant (p=0.028). When hormone profile and changes in BAF were evaluated depending on preoperative and postoperative values, increasing of FSH level (p=0.012) and FSH/LH ratio (p=0.006), decreasing of AMH (p=0.017) in score 4 was significant statistically.CONCLUSIONS: As follicular count increases in histopathologic examination, AMH level decreases concomitantly. So damage to ovarian tissue and decreasing of ovarian reserve is unavoidable during excision of endometriomas.