子宮內膜異位腫瘤切除後AMH數值會下降

子宮內膜異位瘤之病患接受子宮內膜異位腫瘤切除後AMH數值會下降
腫瘤切除手術對於卵巢殘餘功能之不良影響可能需謹慎評估

http://humrep.oxfordjournals.org/content/26/4/904.full

The post-operative decline in serum anti-Müllerian hormone correlates with the bilaterality and severity of endometriosis

1. Wakana Hirokawa1,2, 
2. Akira Iwase1,2,*, 
3. Maki Goto1,2, 
4. Sachiko Takikawa1,
5. Yoshinari Nagatomo1, 
6. Tatsuo Nakahara1, 
7. Bayasula Bayasula1,
8. Tomoko Nakamura1, 
9. Shuichi Manabe1 and 
10. Fumitaka Kikkawa1

+Author Affiliations

1. ¹Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
2. ²Department of Maternal and Perinatal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan

1. *Correspondence address. Tel: +81-52-744-2261; Fax: +81-52-744-2268; E-mail:akiwase@med.nagoya-u.ac.jp

• Received October 31, 2010.
• Revision received December 22, 2010.
• Accepted January 7, 2011.

 

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Abstract

BACKGROUND To assess the impact of ovarian cystectomy for endometriomas on the ovarian reserve, we evaluated the pre- and post-operative levels of serum anti-Müllerian hormone (AMH). We also analyzed the correlations between factors related to endometriosis and surgery for endometriomas and the serum AMH levels to investigate which factors affect ovarian reserve.

METHODS Thirty-eight patients who were undergoing ovarian cystectomy for unilateral endometrioma (n = 20) and bilateral endometriomas (n = 18) participated. Preoperative and post-operative serum samples were collected and assayed for AMH levels, and changes between the two samples were analyzed in association with parameters of endometriosis and surgery for endometriomas.

RESULTS The mean AMH level was 3.9 ng/ml prior to surgery, and was reduced to 2.1 ng/ml at 1 month post-surgery. The rate of decline of the serum AMH level was significantly higher in the bilateral group than the unilateral group (62.8 ± 29.6 versus 24.7 ± 32.5%, P < 0.001). The rate of decline in the serum AMH levels showed a significant correlation to the revised American Society for Reproductive Medicine (rASRM) score (P = 0.003), but not age, cyst diameter, blood loss during the operation or the number of follicles removed in the specimens.

CONCLUSIONS Our results suggest that the decrease in ovarian reserve should be taken into account in patients indicated for cystectomy for bilateral endometriomas or unilateral endometrioma with high rASRM scores.

Figure 1

The rate of decline in serum AMH is defined as 100 × [preoperative AMH level – post-operative AMH level]/preoperative AMH level. Data are represented by box-and-whisker plots. The lines inside boxes indicate the median value, and the upper and lower limits of the boxes and whiskers indicate the interquartile and total ranges. The P-value is denoted with italicized numbers.