Impacts of endometrioma type and two-different techniques of laparoscopic cystectomyon ovarian reserve by measuring anti-mullerian hormone concentration

Abstract

 Purpose: This study aims to understand the impact of the type of endometrioma and two different laparoscopic cystectomy excision techniques (“stripping” or complete excision vs partial excision) on the ovarian reserve by measuring the anti-mullerian hormone (AMH) levels in patients with endometrioma.Method: This is an experimental study in the form of “pre test – post test group design”. The subjects were patients with >3 cm endometrioma detected via transvaginal USG which were classified into two different groups, i.e. the “stripping” laparoscopic cystectomy group as control and partial excision laparoscopic cystectomy as a intervention group. Cystectomy techniques were chosen based on “formuted block sampling”. The AMH levels measurements were performed before the operation (pre-test) and post-operation levels were measured at one and three months after the procedures on both groups. The study was conducted in Bali Royal Hospital (BROS), Denpasar, Indonesia, between January 2012 and January 2018. T-independent test was used to analyse the collected data.Results: No significant difference in the age and length of marriage between the two groups (p>0.05). Unilateral endometrioma had higher concentration of AMH compared to bilateral endometrioma before the laparoscopy (2.09±1.33 vs 1.99±1.25 ng/ml; p=0.768), 1 month after the laparoscopy (1.20±0.59 vs 1.12±0.72 ng/ml; p=0.647), as well as 3 months after the laparoscopy (1.79±0.97 vs 1.44±0.87 ng/ml; p=0.148), but they were not statistically significant (p>0.05). Based on the laparoscopy techniques, AMH concentration in partial excision laparoscopic cystectomy was significantly greater (p<0.05) than in the stripping laparoscopic cystectomy, whether before laparoscopy (1.87±1.23 vs 2.36±1.13; p= 0.119), 1 month after (1.33±0.62 vs 0.98±0.67 ng/ml; p=0.038), as well as 3 months (1.88±0.97 vs 1.29±0.77; p=0.011) after the surgery.Conclusion: Unilateral and bilateral endometriomas have no significant difference in AMH levels. The partial excision laparoscopic cystectomy had significantly less effect on the AMH level compared with stripping laparoscopic cystectomy. Â