Effect of laparoscopic excision of the endometriotic cyst capsule on the ovarian reserve (a retrospective analysis)

Endometriotic cyst is one of manifestations of the endometriotic process and its incidence among all women with endometriosis varies from 17 to 44%. This chronic process in the ovary is accompanied by persistent inflammation, which leads to fibrosis of the ovarian cortex and loss of follicles. Laparoscopic excision of the endometriotic cyst capsule is by far the mainstay of treatment for cysts of 3 cm or more in diameter. This standard surgical procedure can reduce an ovarian reserve marker such as anti-Müllerian hormone (AMH), raising concerns about reduced fertility after surgery. The aim of the study was to analyze the effect of operative, in particular, laparoscopic cystectomy, on the ovarian reserve in women of fertile age with endometriotic cysts. A retrospective analysis of the data of 202 women with endometriotic cysts who underwent examination, surgery and outpatient observation from 2011 to 2020 was carried out. The analysis was carried out in comparison before and after surgical treatment of all cases. The state of the ovarian reserve was assessed by the level of serum AMH. At baseline, the mean AMH in women with bilateral cysts 1,78 (95% CI 1,62; 1,91) ng/ml was lower than in women with monolateral cysts 2,44 (95% CI 2,18; 2,54) ng/m (p<0.001). When comparing AMH values 6 months after surgery, it was found that in all women the median AMH level significantly decreased by an average of 0,34 (95% CI 0,2-0,48) ng/ml (p<0,001). Laparoscopic excision of the cyst capsule is the main method of treatment of endometriotic cysts, and its minimally invasiveness and acceptability of use in women of fertile age makes it the standard surgical approach. However, the analysis showed that, nevertheless, laparoscopic excision of the endometriotic cyst capsule does not guarantee the safety of the negative effect of this method on the ovarian reserve, both during and after its application, on the contrary, significantly reducing the AMH values in comparison with its levels before surgery.