The impact of laparoscopic ovarian cystectomy on ovarian reserve as assessed by antral follicle count and serum AMH levels

Abstract

OBJECTIVE: Laparoscopic excision of ovarian cysts particularly endometrioma and dermoid cysts are commonly performed in women of reproductive age. We aimed to objectively determine if such a surgical procedure had any negative impact on ovarian reserve. DESIGN: A prospective study. MATERIALS AND METHODS: Of 16 patients (mean age ± [SE] 29.5 ± 1.9) enrolled in the study 12 had unilateral, one had bilateral endometriomas, and 3 had unilateral dermoid cysts. Ovarian reserve was determined with antral follicle count (AFC) and serum antimullerian hormone (AMH) levels measured before and one month postoperatively. Removed cysts were histologically examined for the presence of ovarian cortex and the follicles. RESULTS: The duration of the operation (mean age ± [SE]) was 44.7 ± 3.6 minutes. The mean cyst diameter was 52.5 ± 5.4 mm for endometriomas and 58.1 ± 8.5 mm for dermoid cysts. The cysts were removed completely in all patients. Pre and postoperative AFCs were similar (6.4 ± 0.6 vs. 6.7 ± 0.6 p>0.05, respectively). Serum AMH levels declined postoperatively, however, the difference was not statistically significant (3.7 ± 0.5 vs. 2.7 ± 0.4 p>0.05). Preoperative AMH levels were positively correlated with AFC (r=0.50, p<0.05) but this correlation was lost postoperatively (r=0.46, p>0.05). Both AMH and AFC were negatively correlated with age (r=-0.59 p<0.05, r=-0.61 p<0.05, respectively). On histological examination one antral follicle in one section from a patient and some clusters of primordial follicles in the others did not cause any significant decline in AMH levels postoperatively. CONCLUSIONS: Our results indicate that laparoscopic removal of ovarian cysts using a standard atraumatic technique does not adversely affect the AFC. AMH levels decreased postoperatively but the difference did not reach statistical significance, perhaps due to the small number of patients in the study. The impact of cystectomy on ovarian reserve should be assessed objectively in larger number of patients in order to reach definitive conclusions.