Supplementary Material for: The impact of laparoscopic cystectomy for ovarian endometrioma on anti-Mullerian hormone levels: a systematic review and meta-analysis

Introduction: Endometriosis is a condition that leads to a chronic inflammatory state, which has been associated with pelvic pain and infertility. Ovarian endometriomas are commonly treated via laparoscopic cystectomy, however, there is some debate on the degree of ovarian damage after cystectomy. The aim of this systematic review and meta-analysis was to conduct a thorough assessment of post-operative anti-Müllerian hormone levels, a marker of ovarian reserve, after laparoscopic cystectomy for endometriomas.
Methods: We conducted a search of PubMed, EMBASE, Web of Science, Google Scholar, and Science Direct from inception to March 31, 2024. We included randomized and non-randomized studies that assessed pre- and post-operative anti-Müllerian hormone levels after ovarian cystectomy for endometriomas. Outcomes of interest included the differences in anti-Müllerian hormone levels assessed within one month prior to surgery and up to 18 months post-operatively. These outcomes were categorized as short-term (up to six weeks), medium-term (seven weeks to six months), and long-term (six months to 18 months). Randomized and observational studies were pooled together for analysis, as only the intervention arm from the randomized trials was included in the meta-analysis. Continuous variables were extracted as means and standard deviations to produce a pooled weighted mean difference with 95% confidence intervals were calculated using a random-effects model.
Results: Of the 2,396 articles identified, 30 studies were included. Primary outcomes showed a statistically significant (P < 0.001) decrease in anti-Müllerian hormone in the postoperative short-term period [-1.39 ng/mL, 95% CI, -2.01- (-0.76)], medium term period [-1.13 ng/mL (95% CI, -1.4- (-0.87)], and long term [-2.12 ng/mL (95% CI, -2.61- (-1.63)]. There was no significant difference when comparing anti-Müllerian hormone levels in the short term versus long-term period across all groups. There was no significant difference when comparing long term unilateral and bilateral cystectomies on anti-Müllerian hormone levels post operatively.
Conclusions: This systematic review and meta-analysis highlights that there is a decline in serum AMH levels following laparoscopic cystectomy for endometriomas, suggesting a potential adverse impact on ovarian reserve. This outcome emphasizes the need to incorporate discussions about the implications of surgery on fertility into preoperative counseling.