Ovarian cyst removal influences ovarian reserve dependent on histology, size and type of operation

Previous publications suggest a reduction in the ovarian reserve following ovarian surgery. The influence of the underlying disease, histology, size of the ovarian cyst and type of procedure remains unclear. The aim of this study was to investigate the influence of an ovarian operation on the ovarian reserve, based on the anti-Mullerian hormone levels. The anti-Mullerian hormone values were determined by means of a standardized enzyme-linked immunosorbent assay. In total, 52 patients with one or more ovarian cysts of different histologic entities treated at the Department of Women's Health at the Women's University Hospital in Tubingen were included in the study. Anti-Mullerian hormone was determined before and after surgery. The patients were 28 (range=18-40) years old on average. There was a statistically significant decrease in anti-Mullerian hormone from 3.94 +/- 3.18 to 3.14 +/- 2.57 ng/mL (p=0.001). In 80.8%, the cysts were unilateral, and in over 90.4%, a complete cyst extirpation was performed. A statistically significant reduction was seen in follicular cysts (4.72 +/- 3.84 to 3.76 +/- 2.91 ng/mL; p=0.039) and endometriosis cysts (2.55 +/- 1.87 to 1.72 +/- 1.39 ng/mL; p=0.024). Also, the size of the cysts had an influence on the ovarian reserve, only larger ovarian cysts with a diameter of 5cm or more showed a statistically significant reduction in anti-Mullerian hormone. Our data showed a significant decrease in anti-Mullerian hormone levels after surgery on the ovaries. If this results in a long-term reduced ovarian reserve or is merely a short-term reaction to the procedure needs to be clarified. However, concerning young women, the indication of surgery should be given cautiously asat least temporarilya reduction in the ovarian reserve can occur.