The impact of laparoscopic ovarian drilling on AMH and ovarian reserve: a meta-analysis

Amer, Saad; Shamy, Tarek El; James, Cathryn; Yosef, Ali; Mohamed, Ahmed A.

doi:10.1530/rep-17-0063

Cited by 45 publications

(35 citation statements)

References 29 publications

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“…Although the effect of ovarian surgery for PCOS is not fully understood, a decrease in the levels of testosterone, androstenedione, estradiol, and LH has been shown, while FSH in some cases increases, possibly due to a reduced negative feedback from estradiol . Follow ups on the effect of LOD on AMH levels have shown a significant decline after 6 months, but whether this is caused by damage to the ovaries or rather from a normalization of the endocrine dysfunction is currently unknown as there are no long‐term follow‐up studies …”

Section: Resultsmentioning

confidence: 99%

Ovulation induction in polycystic ovary syndrome

Tanbo

Mellembakken

Bjercke

et al. 2018

Acta Obstet Gynecol Scand

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The objective of this narrative review was to suggest a rational order of treatment choices in anovulatory women with polycystic ovary syndrome (PCOS), for whom a multitude of treatment options exist. In obese/overweight women with PCOS the importance of weight reduction should be stressed. Inositol, a dietary supplement with a documented effect on ovulation and without adverse effects in the doses recommended, may be suggested. Additional first-line medical alternatives include insulin sensitizers, selective estrogen receptor modulators, and aromatase inhibitors. Of these, the aromatase inhibitor letrozole and the combination of clomiphene citrate and metformin have the highest rates of ovulation and live birth. Second-line treatments are ovarian electrocautery and low-dose follicle-stimulating hormone stimulation. Controlled ovarian stimulation with in vitro fertilization, should be considered the last option as it carries a significant risk of ovarian hyperstimulation syndrome in patients with PCOS.

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Section: Resultsmentioning

confidence: 99%

Ovulation induction in polycystic ovary syndrome

Tanbo

Mellembakken

Bjercke

et al. 2018

Acta Obstet Gynecol Scand

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“…In a meta-analysis conducted by Amer et al (2017) using 7 articles, the level of AMH after laparoscopy was reported as 2.13 ng/ml [ 27 ]. This difference between this and our findings may be due to the fact that in our study the articles related to unilateral and bilateral laparoscopic surgery for endometriosis have been studied separately.…”

Section: Discussionmentioning

confidence: 99%

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

Nankali

Kazeminia

Jamshidi

et al. 2020

Health Qual Life Outcomes

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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.

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“…It is reported that the amount of decrease in AMH seems to be depending on the extent of ovarian damage during surgery [ 13 – 15 ]. Some authors suggest, that any surgical damage to the ovary might be associated with a subsequent loss of ovarian follicles followed by a decrease in AMH serum levels [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Generally, ovarian drilling proved successful as second-line treatment for ovulation induction in clomiphene citrate-resistant women with PCOS [ 20 , 21 ]. In their meta-analysis, Amer et al performed a pooled analysis of 442 studies and reported a statistically significant AMH serum level reduction of 2.13 ng/mL after LOD [ 6 ]. Theoretically, it might be possible that repetitive oocyte retrievals and ovarian drilling have similar effects on the ovarian reserve.…”

Section: Discussionmentioning

confidence: 99%

“…The amount of energy used in LOD is discussed to be a crucial factor for the extent of the fall in serum AMH concentration. Whether this decrease reflects a real damage to ovarian reserve is still a matter of discussion, but some authors suggest that any surgical intervention, that leads to loss of ovarian follicles, might be associated with subsequent reduction in AMH [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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The impact of repetitive oocyte retrieval on the ovarian reserve: a retrospective cohort study

Marschalek

Ott

Aitzetmueller

et al. 2019

Arch Gynecol Obstet

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Purpose To investigate a possible influence of repetitive micro-traumata on the ovaries in the course of oocyte retrieval during IVF/ICSI treatment on serum anti-Müllerian hormone (AMH) levels. Methods The study included retrospectively collected data from women who underwent three or more consecutive IVF/ICSI treatments between 2007 and 2017. The primary endpoint of the study was to evaluate changes in serum AMH levels on cycle days 1–3 during the course of repetitive IVF/ICSI treatments. Results A total of 125 patients were included in this study. Median AMH levels before the first, second and third IVF/ICSI cycles were 3.8 ng/mL (IQR 1.8–7.1), 3.3 ng/mL (IQR 1.8–6.1) and 3.0 ng/mL (IQR 1.6–5.3), respectively ( p = n.s.). In patients who underwent IVF/ICSI due to polycystic ovary syndrome (PCOS), we found a significant decrease in AMH serum levels between the first [AMH 9.7 ng/mL (IQR 7.4–14.4)] and the third [AMH 5.3 ng/mL (IQR 3.3–10.4)] IVF/ICSI cycles ( p = 0.026). When performing a generalized linear model, we found PCOS to be an independent predictor for serum AMH decrease during the course of three oocyte retrievals ( p < 0.001). Conclusions When comparing the indications for IVF/ICSI, we observed a significant decrease in AMH serum levels after repetitive oocyte retrievals only in women with PCOS, while the decrease in AMH was not significant in patients with tubal factor, endometriosis, male factor and unexplained infertility. This finding leads us to hypothesize that repetitive micro-traumata on the ovarian cortex might diminish/normalize functional ovarian reserve in women with PCOS. Further prospective studies are highly warranted to allow firm conclusions.

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The impact of laparoscopic ovarian drilling on AMH and ovarian reserve: a meta-analysis

Cited by 45 publications

References 29 publications

Ovulation induction in polycystic ovary syndrome

Ovulation induction in polycystic ovary syndrome

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

The impact of repetitive oocyte retrieval on the ovarian reserve: a retrospective cohort study

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