• Postoperative AMH reduction is not associated with reduced fecundity two years following ovarian cyst surgery

Postoperative AMH reduction is not associated with reduced fecundity two years following ovarian cyst surgery

HEALTH OF WOMAN. 2016.7(113):152–155 

Postoperative AMH reduction is not associated with reduced fecundity two years following ovarian cyst surgery

Tekla Lind, Claudia Lampic, Jan I. Olofsson, Kenny A. Rodriguez-Wallberg

Department of Oncology-Pathology, KarolinskaInstitutet, Stockholm, Sweden

Department of Obstetrics and Gynecology, So ?dersjukhuset, Stockholm, Sweden

Department of Neurobiology, Care Sciences and Society, KarolinskaInstitutet, Stockholm, Sweden

Division of Obstetrics/ Gynecology, Department of Clinical Science, Intervention and Technology, KarolinskaInstitutet, Stockholm, Sweden

Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Karolinska University,

Stockholm, Sweden

Gynecol Endocrinol, Early Online: 1–4

In a prospective study, we investigated the impact of anti-Mullerian hormone (AMH) changes following ovarian cyst surgery on the probability to achieve pregnancy and live birth. Women of reproductive age (n=60) were included before surgery for benign ovarian cysts. Serum AMH concentrations were determined pre- and postoperative at 6 and 24 months. Information regarding pregnancy wish and attempts to conceive were obtained by a questionnaire. At the time of inclusion, 45/60 women reported desire of children. At six months, the levels of AMH decreased significantly in the whole group and further reduction was observed at two years (from 2.7 mg/L to 2,0 mg/L to 1,1 mg/L, respectively, p<0.008), with a percentage reduction of 42.9%. At two-year follow-up, 36 women reported to have attempted to conceive and 18 achieved pregnancy (50%), with a live birth rate of 33%. The percentage change in AMH at two years did not differ significantly between the women who conceived versus those who did not (p=0.117). Data reported herein demonstrate that the AMH reduction following ovarian cyst surgery is maintained two years after surgery; however, the postoperative AMH decrease that follows ovarian cyst surgery might not reduce the chances to achieve pregnancy.

Key words: AMH, cyst enucleation, live birth rate, ovarian reserve, ovarian cyst surgery, pregnancy outcome.


1. Kwon SK, Kim SH, Yun SC et al. 2014. Decline of serum antimullerian hormone levels after laparoscopic ovarian cystectomy in endome- trioma and other benign cysts: a prospective cohort study. FertilSteril. 101:435–41. http://dx.doi.org/10.1016/j.fertnstert.2013.10.043; PMid:24290000

2. Uncu G, Kasapoglu I, Ozerkan K et al. 2013. Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve. Hum Reprod. 28:2140–5. http://dx.doi.org/10.1093/humrep/det123; PMid:23624580

3. Somigliana E, Berlanda N, Benaglia L et al. 2012. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimu ̈llerian hormone level modifications. FertilSteril. 98:1531–8. http://dx.doi.org/10.1016/j.fertnstert.2012.08.009

4. Raffi F, Metwally M, Amer S. 2012. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta- analysis. J ClinEndocrinolMetab. 97:3146–54. http://dx.doi.org/10.1210/jc.2012-1558; PMid:22723324

5. Iwase A, Hirokawa W, Goto M et al. 2011. The post-operative decline in serum anti-Mullerian hormone correlates with the bilaterality and severity of endometriosis. Hum Reprod. 26:904–10. http://dx.doi.org/10.1093/humrep/der006; PMid:21292639

6. Lind T, Hammarstrom M, Lampic C, Rodriguez-Wallberg K. 2015. AMH reduction after ovarian cyst surgery is dependent on the histological cyst type and pre-operative AMH levels. ActaObstetGynecolScand. 94:183–90. http://dx.doi.org/10.1111/aogs.12526; PMid:25287421

7. Kalampokas T, Kamath MS, Kalampokas E. 2013. AMH after laparo- scopic surgery of the ovaries: a review. GynecolEndocrinol. 29:408–11. http://dx.doi.org/10.3109/09513590.2012.754877; PMid:23452339

8. Moscarini M, Milazzo GN, Assorgi C et al. 2014. Ovarian stripping versus cystectomy: recurrence of endometriosis and pregnancy rate. Arch GynecolObstet. 290:163–7. http://dx.doi.org/10.1007/s00404-014-3158-z

9. Carmona F, Martinez-Zamora MA, Rabanal A et al. 2011. Ovarian cystectomy versus laser vaporization in the treatment of ovarian endometriomas: a randomized clinical trial with a five-year follow- up. FertilSteril. 96:251–4. http://dx.doi.org/10.1016/j.fertnstert.2011.04.068

10. Lind T, Lampic C, Hammarstrom M, Rodriguez-Wallberg K. 2013. Young women’s perceptions of fertility-related information and fertility distress before surgery for ovarian cysts. ActaObstetGynecolScand. 92:1290–6. http://dx.doi.org/10.1111/aogs.12228

11. Armuand GM, Rodriguez-Wallberg KA, Wettergren L et al. 2012. Sex differences in fertility-related information received by young adult cancer survivors. J ClinOncol. 30:2147–53. http://dx.doi.org/10.1200/JCO.2011.40.6470; PMid:22585695

12. Asante A, Whiteman MK, Kulkarni A et al. 2010. Elective oophorectomy in the United States: trends and in-hospital complications, 1998-2006. ObstetGynecol. 116:1088–95. http://dx.doi.org/10.1097/aog.0b013e3181f5ec9d

13. Statistical database, Operationerislutenva ?rd. Operations in inpatient care. Internet. 2015. Available from: http://www.socialstyrelsen.se/ statistik/statistikdatabas/operationerislutenvard. last accessed 30 Dec 2015.

14. Lee MM, Donahoe PK, Hasegawa T et al. 1996. Mullerian inhibiting substance in humans: normal levels from infancy to adulthood. J ClinEndocrinolMetab. 81:571–6. http://dx.doi.org/10.1210/jcem.81.2.8636269http://dx.doi.org/10.1210/jc.81.2.571

15. Bentzen JG, Forman JL, Johannsen TH et al. 2013. Ovarian antral follicle subclasses and anti-mullerian hormone during normal reproductive aging. J ClinEndocrinolMetab. 98:1602–11. http://dx.doi.org/10.1210/jc.2012-1829; PMid:23463653

16. La Marca A, Spada E, Grisendi V et al. 2012. Normal serum anti- Mullerian hormone levels in the general female population and the relationship with reproductive history. Eur J ObstetGynecolReprodBiol. 163:180–4. http://dx.doi.org/10.1016/j.ejogrb.2012.04.013

17. Shao MJ, Hu M, He YQ, Xu XJ. 2015. AMH trend after laparoscopic cystectomy and ovarian suturing in patients with endometriomas. Arch GynecolObstet. [Epub ahead of print]. doi: 10.1007/ s00404-015-3926-4.

18. Lee HJ, Lee JE, Ku SY et al. 2013. Natural conception rate following laparoscopic surgery in infertile women with endometriosis. ClinExpReprod Med. 40:29–32. http://dx.doi.org/10.5653/cerm.2013.40.1.29

19. Rizk B, Turki R, Lotfy H et al. 2015. Surgery for endometriosis- associated infertility: do we exaggerate the magnitude of effect? Facts Views Vis Obgyn. 7:109–18. PMid:26177374 PMCid:PMC4498168

20. Vercellini P, Somigliana E, Vigano P et al. 2009. Surgery for endomet- riosis-associated infertility: a pragmatic approach. Hum Reprod. 24:254–69. http://dx.doi.org/10.1093/humrep/den379; PMid:18948311

21. Pados G, Venetis CA, Almaloglou K, Tarlatzis BC. 2010. Prevention of intra-peritoneal adhesions in gynaecological surgery: theory and evidence. Reprod Biomed Online. 21:290–303. http://dx.doi.org/10.1016/j.rbmo.2010.04.021; PMid:20688570

22. Lower AM, Hawthorn RJ, Clark D et al. 2004. Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24 046 patients. Hum Reprod. 19:1877–85. http://dx.doi.org/10.1093/humrep/deh321; PMid:15178659