The effect of unilateral and bilateral laparoscopic surgery for endometriosis on Anti-Mullerian Hormone (AMH) level after 3 and 6 months: a systematic review and meta-analysis

Abstract

Background Endometriosis is one of the most common causes of infertility. The causes of the disease and its definitive treatments are still unclear. Moreover, Anti-Mullerian Hormone (AMH) is a glycoprotein dimer that is a member of the transient growth factors family. This research work aimed to identify the effect of unilateral and bilateral laparoscopic surgery for endometriosis on AMH levels after 3 months, and 6 months, using meta-analysis. Methods In this study, the articles published in national and international databases of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, Science Direct, Scopus, PubMed, and Web of Science (ISI) were searched to find electronically published studies between 2010 and 2019. The heterogeneous index between studies was determined using the I2 index. Results In this meta-analysis and systematic review, 19 articles were eligible for inclusion in the study. The standardized mean difference was obtained in examining of unilateral laparoscopic surgery for endometriosis (before intervention 2.8 ± 0.11, and after 3 months 2.05 ± 0.13; and before intervention 3.1 ± 0.46 and after 6 months 2.08 ± 0.31), and in examining bilateral laparoscopic surgery for endometriosis examination (before intervention 2.0 ± 08.08, and after 3 months 1.1 ± 0.1; and before intervention 2.9 ± 0.23 and after 6 months 1.4 ± 0.19). Conclusion The results of this study demonstrate that unilateral and bilateral laparoscopic surgery for endometriosis is effective on AMH levels, and the level decreases in both comparisons.

Endometriosis-associated infertility: From pathophysiology to tailored treatment

“…However, the damage inflicted by surgery may also be due to the related local inflammation or vascular compromise secondary to excessive manipulation of the cortex with subsequent tearing, bleeding, and the need for electrosurgical coagulation ( 159 ). Five meta-analyses showed a significant reduction in serum AMH concentrations after surgical treatment of endometriomas ( 160 – 162 ) and this effect is persistent post-operatively up to 18 months ( 162 ) and more pronounced in case of bilateral adnexal surgery ( 163 – 165 ). In contrast, two meta-analyses showed that ovarian reserve evaluated by AFC is not decreased after surgical treatment of endometriomas ( 162 , 166 ).…”

The treatment of endometriosis-associated infertility

“…The effect of surgery for ovarian endometriosis on markers of ovarian reserve has been previously discussed in this article. The results of those studies [17][18][19][20][21][22]24] reinforce the ESHRE recommendation to avoid surgery for ovarian endometrioma unless required to improve endometriosis-associated pain or accessibility of follicles [2]. A study looking at the surgical treatment of endometrioma >3 cm prior to IVF found a similar CPR and LBR as in women with unexplained infertility, however this was a prospective case-control study despite identifying itself as an RCT [40].…”

Molecular Signatures Correlated With Poor IVF Outcomes: Insights From the mRNA and lncRNA Expression of Endometriotic Granulosa Cells

“…One is the space occupation of OEM cyst, and subsequent ovarian tissue fibrosis reduces the functional ovarian tissue ( 6 , 28 ). The other is that inevitable removal of unaffected ovarian tissue during the surgical excision of endometrioma cyst wall aggravates the reduction in ovarian reserve function ( 3 , 29 ). Therefore, it is the dual factors of OEM itself and laparoscopic surgery that lead to the significant decrease in ovarian reserve.…”