Abstract

Introduction: Laparoscopic cystectomy for ovarian endometriomas (LCE) can reduce ovarian reserve (DOR), potentially affecting ovarian response in assisted reproductive technology. This study aimed to identify predictors of DOR after LCE based on the Bologna criteria.

Methods: A prospective longitudinal study was conducted on 100 patients with normal preoperative ovarian reserve (AMH ≥1.1 ng/mL). Of these, 75 had unilateral and 25 had bilateral endometriomas. Serum AMH levels were measured before surgery and at 1, 3, and 6 months postoperatively. DOR was defined as AMH <1.1 ng/mL post-surgery. Factors analyzed included age, BMI, infertility status, pain score, number of involved ovaries, mean cyst diameter, CA125, rASRM stage, and operative time.

Results: DOR rates were 34%, 33%, and 30% at 1, 3, and 6 months, respectively. Logistic regression revealed two independent predictors of postoperative DOR: bilateral involvement (positive correlation) and higher preoperative AMH (negative correlation). In unilateral endometriomas, preoperative AMH cutoffs of 3.11 ng/mL (for 1-month DOR) and 2.62 ng/mL (for 3- or 6-month DOR) were identified. However, in bilateral endometriomas, while DOR rates ranged from 64% to 68%, no definitive cutoff was determined.
Conclusions: Bilateral involvement and lower preoperative AMH strongly predict postoperative DOR according to the Bologna criteria. These findings emphasize the importance of carefully assessing ovarian reserve prior to LCE, particularly in women with infertility.