Critical Care Obstetrics and Gynecology

Using Anti-Mullerian Hormone Level in Infertile Women with Ovarian Endometrioma for Selection of the Laparoscopic Management Modality

Background: Ovarian function is affected by the presence of endometrioma and by its management. Treatment of endometrioma should be tailored according to the ovarian reserve.
Aim of the study: To evaluate the role of AMH in guiding the method of surgical management of endometrioma.
Design: Prospective comparative clinical study.
Setting: Gynecology Department-Tanta University and private clinic.
Patients and Methods: 330 women with ovarian endometrioma, complaining of infertility were classified according to AMH level and laterality of endometrioma into 4 groups: group I (120 women) with unilateral endometrioma and AMH above 3ng/ml, group II (80 women) with unilateral endometrioma and AMH below 3 ng/ml, group III (50 women) with bilateral endometrioma and AMH above 2.7 ng/ml and group IV (80 women) with bilateral endometrioma and AMH below 2.7 ng/ml. In groups I and III, laparoscopic ovarian endometrioma resection was done while in groups II and IV, laparoscopic endometrioma drainage with bipolar coagulation was done.
Results: AMH did not decrease significantly in all groups after 3 months, while it decreased significantly after 6 months in groups 2 and 4 and highly significant decrease was found in groups 1 and 3. Endometrioma recurrence occurred in groups (II&IV), while no recurrence occurred in groups (I&III). Conclusion: Laparoscopic management of endometrioma should be guided by serum AMH level and cystectomy should be avoided if lower levels of AMH were found.

Author(s):

Ayman A. El-Dorf and Tarek M. Elhawary

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