Design: This was a systematic review and meta-analysis that assessed pre and post-operative anti-mullerian hormone levels after ovarian cystectomy for endometriomas. Anti-Mullerian hormone levels were reported up to 18 months after surgery categorized as short term (up to six weeks), medium term (seven weeks to six months) and long term (six months to 18 months).

Setting: The setting included all countries where a laparoscopic cystectomy was performed in a hospital operating room.

Patients or Participants: A total of 30 studies and 1,315 participants were included. Inclusion criteria included reproductive aged patients with known endometriomas, anti-mullerian hormone levels assessed within one month prior to surgery, and levels reported up to 18 months after surgery.

Interventions: Interventions included laparoscopic cystectomy, unilateral or bilateral, for endometriomas.

Measurements and Main Results: Serum Anti-mullerian hormone levels were assessed at various time points post operatively as described above using an enzyme linked immunosorbent assay. Primary outcomes showed a statistically significant (P < 0.001) decrease in anti-mullerian 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 period [-2.12 ng/mL (95% CI, -2.61- (-1.63)]. There was no significant difference when comparing anti-mullerian 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-mullerian hormone levels post operatively.

Conclusion: This systematic review and meta-analysis highlight the decline in serum anti-mullerian hormone 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.