Impact of Laparoscopic Cystectomy on Ovarian Reserve Markers in Women with Endometriosis: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.65406/3.1/55-69/2026Keywords:
ovarian reserve, laparoscopic cystectomy, endometriosis, infertile women, anti-Müllerian hormone, follicle-stimulating hormoneAbstract
Background: Laparoscopic cystectomy is a common treatment for endometriomas, but its its impact on ovarian reserve is still debated. This meta-analysis aimed to evaluate the effects of laparoscopic cystectomy on markers of ovarian reserve in women with endometriosis.
Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Google Scholar, Cochrane Library, and MEDLINE databases were searched for relevant studies published from 2000 to 2024. Randomized controlled trials and observational studies comparing pre- and post-operative levels of anti-Müllerian hormone (AMH), antral follicle count (AFC), and follicle-stimulating hormone (FSH) in women undergoing laparoscopic cystectomy for endometriomas were included. Random-effects meta-analyses were performed.
Results: Seventeen studies (12 cohorts and 5 RCTs) involving 2,415 patients were included. Laparoscopic cystectomy was associated with significant decreases in AMH levels (mean difference: -1.01 ng/mL, 95% CI: -1.30 to -0.73) and AFC (mean difference: -1.01, 95% CI: -1.83 to -0.20) compared to controls. FSH levels increased post-operatively (mean difference: 1.71 mIU/mL, 95% CI: -0.01 to 3.42). Heterogeneity across studies was high (I² = 88-97%).
Conclusion: This meta-analysis found that laparoscopic cystectomy for endometriomas is associated with a significant decline in ovarian reserve markers, particularly AMH and AFC. Clinicians should consider these potential effects when counselling patients on the surgical management of endometriomas, especially in women desiring future fertility. Further research is needed to evaluate the long-term impact on reproductive outcomes.
Keywords: ovarian reserve, laparoscopic cystectomy, endometriosis, infertile women
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