8 May, 2022

Endometriosis, Surgery and AMH Levels

AMH (anti Mullerian hormone) test gives us idea regarding ovarian reserve and fertility potential. In endometriosis cases AMH is usually low as it influences the quality and number of eggs.

How AMH is Useful in Fertility Treatment?

• Value of AMH can give idea about how well a woman would respond to IVF treatment.
• It would help the single woman to take decision regarding fertility preservation.
• It alarms towards doing early treatment utilizing helped regenerative strategies like IVF in young patients having premature ovarian failure, endometriosis.
• If AMH is high (in case of pcos) it will help in modification of hormone injections in IVF treatment.

How Endometriosis Affect AMH?

Incidence of endometriosis in infertile women is 50%. Because of changed life systems and irritation of reproductive tract the chance of conceiving naturally decreases. On top of this if someone has chocolate cyst then it affects the structure and function of ovaries and reducing AMH at higher speed than expected.

Does Endometriosis Surgery Affect AMH Levels?

If surgery for endometriosis is involving ovaries, then more or less it affects the ovarian reserve and AMH is reduced after surgery. This is because of removing chocolate cyst wall will remove antral follicles with that, loss of normal ovarian tissue using thermal energy during surgery can damage ovarian blood supply, postoperatively adhesions(band) formation between organs can alter anatomy.

The literature review and scientific studies conducted over past 10 years showed that drop in AMH levels after surgery has been observed. The effect is more obvious if surgery is done on both ovaries. Another finding from the studies showed that endometrioma vaporization using co2 laser results in less decline in AMH compared to cyst removal. However, endometrioma more than 5 cm in size excision surgery is preferred over laser vaporization as it has less impact on AMH levels.

How My Approach Beats the Above Limitations?

We prefer to have fertility preservation options (egg freezing if you are single and embryo freezing if you are married) before choosing the option of ovarian endometrioma surgery by the best gynecologist in Abu Dhabi. However, big endometrioma we advise to remove it by laparoscopic excision surgery and to remove cyst wall fully without compromising ovarian blood supply.

We also prefer cold excision technique to preserve fertility as much as possible because recurrence of endometrioma further reduce AMH. There will be some unavoidable loss of ovarian hold following cystectomy but our procedure ensures that as many healthy eggs as possible continue to grow.