Ovarian reserve damage less with ablation vs cystectomy for endometrioma

In the treatment of patients with endometrioma, both ablation and cystectomy cause significant damage to ovarian reserve, although the extent of damage appears to be less with ablation, as shown in a study.

Researchers conducted a systematic review and meta-analysis of studies investigating whether cystectomy or ablation for endometrioma had less impact on ovarian reserve as evaluated by antral follicle count (AFC) and antimüllerian hormone (AMH) levels. They searched multiple online databases for relevant studies.

The search led to the identification of four randomized clinical trials and two prospective cohort studies, which involved a total of 294 patients, for inclusion in the meta-analysis. None of these studies used medical treatment as adjuvant therapy for the surgery. Two researchers assessed eligibility and risk of bias independently. The statistical data were evaluated using the Review Manager software.

The main outcome measures included changes in AMH levels and AFC values in the cystectomy group and in the ablation group. Pooled data showed that in the intergroup comparisons, preoperative AFC values were similar (low heterogeneity between studies), but postoperative AFC values were significantly lower following cystectomy than ablation (mean difference [MD], −1.33, 95 percent credible interval [CrI], −2.15 to −0.51; I², 57 percent).

Intragroup comparisons confirmed a significant drop in AFC values after cystectomy (MD, −1.93, 95 percent CrI, −2.40 to −1.45; I², 0 percent) at the 6-month follow-up. On the other hand, there was no decrease noted following ablation.

The intragroup comparisons of AMH levels indicated that ovarian reserve was adversely affected by both cystectomy (MD, −1.26, 95 percent CrI, −1.64 to −0.88; I², 45 percent) and ablation (MD, −0.70, 95 percent CrI, −1.07 to −0.32; I², 0 percent).