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Endometriosis, endometrioma and AMH levels

Endometriosis affects about ten per cent of women in the reproductive age group and between 20 to 25 per cent of women who have painful periods seem to have endometriosis.

A significant proportion of women who come to a fertility clinic also have endometriosis and have ovarian cysts in the form of endometriomas. In these cases, laparoscopy is the best treatment for this, and laparoscopy where we open the cyst (endometrioma), strip the cyst wall, gives better pregnancy rates, lowers the chance of recurrence and pain.

The question “does it also reduce ovarian reserve?” is often asked.   AMH is a test that is done to check ovarian reserve. In a study which was done in Serbia, 54 patients in early follicular phase had an AMH test done and then had surgery. Of the cysts removed, they were opened, the cysts were stripped away and endometriosis treated. 37 of these had endometriomas at one side and 17 had bilateral endometriosis. The AMH test was done six months and 12 months later. There was almost a significant drop of AMH from 3.3 to 1.4 nano ml/l in six months and then 1.72.  There were also bilateral endometriomas which were treated, there was a continual dramatic decline to very low levels from 2.55 to 0.98 (plus or minus the variables).

This evidence clearly indicates that endometriomas, the surgical stripping of endometriomas and coagulation leads to unwanted and inevitable damage to the ovarian reserve, more so with bilateral endometriomas.

If you are concerned about endometriosis and fertility, contact your GP or fertility specialist.

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