Effect Of Ovarian Endometriomas And Their Removel On Ovarian Reserve:Serial Changes In The Serum AMH

Objective:1.To explore the correlation between ovarian endometrioma and ovarian reserve(OR).2.To evaluate the benefit of laparoscopic excision in the aspect of OR.Methods:1.20 Women of reproductive age who had an ultrasonographic diagnosis of ovarian endometrioma were offered participation.Control subjects were recruited from age-matched female medical residents and nurses.Serum AMH levels were determined at 0,3,6 and 9 months.2.50 Women of reproductive age who had an ultrasonographic diagnosis of endometrioma and were to undergo laparoscopic excision due to pain or subfertility were offered participation.On the basis of ASRM,the participators were divided into the mild,moderate and severe groups.Serum AMH levels were determined preoperatively,3d and 1,3,6 months after surgery.Control subjects were recruited from age-matched female medical residents and nurses.Results:In the natural state of endometrioma,serum AMH levels decreased persistently,but gradually.There was no difference between serum AMH levels during 9 months.Serum AMH levels of age-matched healthy controls fluctuated slightly.Patients undergoing laparoscopic excision were devided into the mild group(24 cases),moderate group(16 cases)and severe group(10 cases).Preoperative serum AMH levels of each subgroup were significantly lower than that of age-matched healthy controls.Moreover,the further the condition was soured,the more serum AMH levels declined.In the mild group,serum AMH levels at 3 days after surgery had a significant reduction[3.84±0.99 vs.0.99±1.01](P = 0.02).Serum AMH levels at 1 month after surgery rallied as preoperative.Serum AMH levels kept rising trend at 3 ang 6 months after surgery.In the moderate group,serum AMH levels decreased significantly at 1 month after surgery[3.06±0.82 vs.0.82 ±0.86)](P = 0.03).Serum AMH levels at 3 months after surgery rallied as preoperative.In the severe group,serum AMH levels were on the persistent decline.Serum AMH levels decreased significantly at 6 months after surgery[1.83±0.57 vs.0.57±0.80](P = 0.02).Serum AMH levels of 3 cases in the severe group with lesions near ovarian hilum were lower than the average.Serum AMH levels of the severe group at 6 months after surgery were correlated with the ages.Conclusion:1.Ovarian endometrioma is related to the decrease of OR.As the conditions deteriorate,progressive decline of OR will be accompanied by.2.In different stages of ovarian endometrioma based on ASRM,laparoscopic excision brings different benefit/damage of OR.The OR of mild and moderate lesions after surgery will undergo a short-term decline,and there will be a good compensatory and recovery relatively.The OR of severe lesions will undergo progressive and persistent decline postoperatively,end up with quite low levels,and lesions near ovarian hilum may further increase the risk of postoperative OR lost.