Serum Anti-Müllerian Hormone Levels and Endometriosis Surgery: Unraveling the Evidence

Assessment of ovarian reserve is important in patients with fertility intention. Anti-Müllerian Hormone (AMH) serum levels are a useful ovarian reserve marker. Endometriosis is a benign disease with three phenotypes: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA) and Deep Endometriosis (DE). Endometriosis is linked with infertility, however, the exact impact of endometriosis per se and endometriosis surgery on AMH levels is less clear. Evidence suggests that OMA per se is linked to reduced AMH values and higher AMH decline rate over time. OMA cystectomy causes further reduction in AMH which, however, tends to recover post-operatively. Non-excisional surgery for OMA spares the ovarian parenchyma, however, an, at least temporary, decline in AMH has been observed. The effect is likely smaller than cystectomy. Non-thermal methods of hemostasis following cystectomy are likely superior in terms of AMH. AMH levels before OMA surgery appear positively correlated with the post-operative probability of pregnancy, particularly spontaneous conception, but not livebirth rates. Pre-operative AMH levels are, also, predictive of the risk of diminished ovarian reserve (DOR). Similarly, post-operative AMH levels and the rate of AMH decline at 1 year after OMA surgery appear predictive of fertility outcomes. SUP likely has little, if any, impact on AMH levels. DE per se reduces AMH levels and a further reduction following surgery is anticipated. However, a reduction in AMH values should not be interpreted as a decline in the patient’s reproductive potential. Further research should focus on extra-ovarian locations of endometriosis and their impact on AMH values.