Serum anti-mullerian hormone in reproductive aged women with benign ovarian cysts

Objective: There is consistent evidence demonstrating that laparoscopic removal of benign ovarian cysts significantly damages the ovarian reserve. In contrast, the pre-operative impact of these cysts on the ovarian reserve is yet controversial. To elucidate this aspect, we set up a cross-sectional study in reproductive age women with and without benign ovarian cysts. Study design: Inclusion criteria were as follow: (1) Age 18-40 years, (2) regular menstrual cycles, (3) Indication to laparoscopic surgery. Eligible women donated a blood sample for anti-Mullerian hormone (AMH) testing. Women who were diagnosed at surgery with concomitant endometriotic and non-endometriotic ovarian cysts, deep infiltrating peritoneal endometriosis or malignancies were subsequently excluded. Results: Diagnoses of the included women were as follows: ovarian endometriomas (n = 122), non-endometriotic ovarian cysts (n = 50) and non-ovarian diagnoses (n = 113). Serum AMH in the three groups did not significantly differ. The median (Interquartile range-IQR) was 1.8 (0.8-3.1), 2.0 (0.8-3.9) and 1.9 (0.9-3.3) ng/ml, respectively (p = 0.60). The analyses were repeated grouping women into those with bilateral cysts (n = 54), unilateral cysts (n = 118) and intact gonads (n = 113). Women with bilateral lesions were found to have significantly lower levels of serum AMH. The median (IQR) serum AMH in the three groups was 1.3 (0.5-2.5), 2.0 (1.1-3.6) and 1.9 (0.9-3.3) ng/ml, respectively (p = 0.019). We failed to demonstrate any correlation between serum AMH and the dimension of the ovarian cysts. Conclusions: Serum AMH is lower in women with bilateral ovarian cysts and this does not appear to be related to the histology or dimension of the lesions.