Antimullerian hormone level and endometrioma ablation using plasma energy

Horace Roman, Michael Bubenheim, Mathieu Auber, Loïc Marpeau, Lucian Puscasiu, Horace Roman, Michael Bubenheim, Mathieu Auber, Loïc Marpeau, Lucian Puscasiu

Abstract

Objective: To investigate the impact of ovarian endometrioma vaporization using plasma energy on antimullerian hormone (AMH) level.

Method: We report a prospective, noncomparative series (NCT01596985). Twenty-two patients with unilateral ovarian endometriomas≥30 mm, with no surgical antecedent and no ongoing pregnancy, underwent vaporization of ovarian endometriomas using plasma energy during the period of November 29, 2010 to November 28, 2012. We assessed AMH levels before surgery, 3 months postoperatively, and at the end of follow-up.

Results: The mean length of postoperative follow-up was 18.2±8 months. AMH level significantly varied through the 3 assessments performed in the study, as the mean values±SD were 3.9±2.6 ng/mL before the surgery, 2.3±1.1 ng/mL at 3 months, and 3.1±2.2 ng/mL at the end of the follow-up (P=.001). There was a significant increase from 3 months postoperatively to the end of follow-up (median change 0.7 ng/mL, P=.01). Seventy-one percent of patients had an AMH level>2 ng/mL at the end of the follow-up versus 76% before the surgery (P=1). During the postoperative follow-up, 11 patients tried to conceive, of whom 8 (73%) became pregnant.

Conclusions: The ablation of unilateral endometriomas is followed in a majority of cases by a significant decrease in AMH level 3 months after surgery. In subsequent months, this level progressively increases, raising questions about the real factors that impact postoperative ovarian AMH production.

Keywords: Ablation; Antimullerian hormone; Endometrioma; Plasma energy; PlasmaJet; Vaporization.

Figures

Figure 1.
Figure 1.
Ovarian endometrioma ablation using PlasmaJet.
Figure 2.
Figure 2.
Intraoperative findings in 22 patients included in analysis.

References

    1. Somigliana E, Berlanda N, Benaglia L, Viganò P, Vercellini P, Fedele L. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimullerian hormone level modifications. Fertil Steril. 2012;98(6):1531–1538
    1. Celik HG, Dogan E, Okyay E, et al. . Effect of laparoscopic excision of endometriomas on ovarian reserve: serial changes in the serum antimullerian hormone levels. Fertil Steril. 2012;97(6):1472–1478
    1. Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrin Metab. 2012;97(9):3146–3154
    1. Tsolakidis D, Pados G, Vavilis D, et al. . The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study. Fertil Steril. 2010;94(1):71–77
    1. Kitajima M, Khan KN, Hiraki K, Inoue T, Fujishita A, Masuzaki H. Changes in serum anti-Mullerian hormone levels may predict damage to residual normal ovarian tissue after laparoscopic surgery for women with ovarian endometrioma. Fertil Steril. 2011;95(8):2589–2591.e1
    1. Ercan CM, Duru NK, Karasahin KE, Coksuer H, Dede M, Baser I. Ultrasonographic evaluation and anti-mullerian hormone levels after laparoscopic stripping of unilateral endometriomas. Eur J Obstet Gynecol Reprod Biol. 2011;158(2):280–284
    1. Biacchiardi CP, Piane LD, Camanni M, et al. . Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons. Reprod Biomed Online. 2011;23(6):740–746
    1. Hwu YM, Wu FS, Li SH, Sun FJ, Lin MH, Lee RK. The impact of endometrioma and laparoscopic cystectomy on serum anti-Mullerian hormone levels. Reprod Biol Endocrinol. 2011;9:80.
    1. Ercan CM, Sakinci M, Duru NK, Alanbay I, Karasahin KE, Baser I. Antimullerian hormone levels after laparoscopic endometrioma stripping surgery. Gynecol Endocrinol. 2010;26:468–472
    1. Hirokawa W, Iwase A, Goto M, et al. . The post-operative decline in serum anti-Mullerian hormone correlates with the bilaterality and severity of endometriosis. Hum Reprod. 2011;26(4):904–910
    1. Lee DY, Young Kim N, Jae Kim M, Yoon BK, Choi D. Effects of laparoscopic surgery on serum anti-Mullerian hormone levels in reproductive-aged women with endometrioma. Gynecol Endocrinol. 2011;27(10):733–736
    1. Donnez J, Nisolle M, Gillet N, Smets M, Bassil S, Casanas-Roux F. Large ovarian endometriomas. Hum Reprod. 1996;11(3):641–646
    1. Roman H, Pura I, Tarta O, et al. . Vaporization of ovarian endometrioma using plasma energy: histological findings of a pilot study. Fertil Steril. 2011;95(5):1853–1856.e1–4
    1. Auber M, Bourdel N, Mokdad C, et al. . Ultrasound ovarian assessments after endometrioma ablation using plasma energy. Fertil Steril. 2011;95(8):2621–2624.e1
    1. Roman H, Auber M, Mokdad C, et al. . Ovarian endometrioma ablation using plasma energy versus cystectomy: a step toward better preservation of the ovarian parenchyma in women wishing to conceive. Fertil Steril. 2011;96(6):1396–1400
    1. Roman H, Auber M, Bourdel N, Martin C, Marpeau L, Puscasiu L. Postoperative recurrence and fertility after endometrioma ablation using plasma energy: retrospective assessment of a 3-year experience. J Minim Invasive Gynecol. 2013;20(5):573–582
    1. Sugita A, Iwase A, Goto M, et al. . One-year follow-up of serum antimüllerian hormone levels in patients with cystectomy: are different sequential changes due to different mechanisms causing damage to the ovarian reserve? Fertil Steril. 2013;100(2):516–522.e3
    1. Roman H. Rectal shaving using PlasmaJet in deep endometriosis of the rectum. Fertil Steril. 2013;100(5):e33.
    1. Lehmann EL. Nonparametrics: Statistical Methods Based on Ranks. Upper Saddle River, NJ: Prentice Hall Inc; 1998
    1. Köninger A, Kauth A, Schmidt B, et al. . Anti-Mullerian-hormone levels during pregnancy and postpartum. Reprod Biol Endocrinol. 2013;11:60.
    1. Roman H, Tuech JJ, Slim K, Canis M. Functional Outcomes of Surgical Management of Deep Endometriosis Infiltrating the Rectum (ENDORE). NCT01291576, 2011. Clinical Trials database. Available at: . Accessed October 10, 2013
    1. Elmashad AI. Impact of laparoscopic ovarian drilling on anti-Mullerian hormone levels and ovarian stromal blood flow using three-dimensional power Doppler in women with anovulatory polycystic ovary syndrome. Fertil Steril. 2011;95(7):2342–2346, 2346.e1
    1. Rosen MP, Johnstone E, McCulloch CE, et al. . A characterization of the relationship of ovarian reserve markers with age. Fertil Steril. 2012;97(1):238–243
    1. Practice Committee of the American Society of Reproductive Medicine. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril. 2012;98(6):1407–1415
    1. Su HI, Maas K, Sluss P, Chang RJ, Hall JE, Joffe H. The impact of depot GnRH agonist on AMH levels in healthy reproductive-aged women. J Clin Endocrinol Metab. 2013;98(12):E1961–1966
    1. Şenateş E, Çolak Y, Erdem ED, et al. . Serum anti-Müllerian hormone levels are lower in reproductive-age women with Crohn's disease compared to healthy control women. J Crohns Colitis. 2013;7(2):e29–34
    1. Fréour T, Miossec C, Bach-Ngohou K, et al. . Ovarian reserve in young women of reproductive age with Crohn's disease. Inflamm Bowel Dis. 2012;18(8):1515–1522
    1. Morel N, Bachelot A, Chakhtoura Z, et al. ., for the PLUS Group. Study of anti-Mullerian hormone and its relation to the subsequent probability of pregnancy in 112 patients with systemic lupus erythematosus, exposed or not to cyclophosphamide. J Clin Endocrinol Metab. 2013;98(9):3785–3792
    1. Falconer H, Sundqvist J, Gemzell-Danielsson K, von Schoultz B, D'Hooghe TM, Fried G. IVF outcome in women with endometriosis in relation to tumour necrosis factor and anti-Müllerian hormone. Reprod Biomed Online. 2009;18(4):582–588
    1. Seracchioli R, Mabrouk M, Frascà C, et al. . Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial. Fertil Steril. 2010;93(1):52–56
    1. Somigliana E, Ragni G, Benedetti F, Borroni R, Vegetti W, Crosignani PG. Does laparoscopic excision of endometriotic ovarian cysts significantly affect ovarian reserve? Insights from IVF cycles. Hum Reprod. 2003;18(11):2450–2453

Source: PubMed

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