Antimüllerian hormone is reduced in the presence of ovarian endometriomas: a systematic review and meta-analysis

Objective: To evaluate if the presence of endometriomas impacts on the ovarian reserve as evaluated with antimüllerian hormone (AMH). Design: Systematic review and meta-analysis. Setting: Not applicable. Patient(s): Patients with unoperated endometriomas versus controls without endometriomas. Intervention(s): Electronic databases searched up to June 2017 to identify articles evaluating AMH levels in patients with unoperated endometriomas versus controls without endometriomas. Main Outcome Measure(s): The primary analysis was aimed at evaluation of AMH levels (mean and SD) in patients with and without endometriomas. Secondary analyses were aimed at evaluating AMH levels in patients with ovarian endometriomas compared to patients with either non-endometriosis benign ovarian cysts or healthy ovaries. Result(s): Of the 39 studies evaluated in detail, 17 were included, for a total of 968 patients with endometriomas and 1874 without endometriomas. AMH was significantly lower in patients with unoperated endometriomas compared to patients with no endometriomas (mean difference −0.84, with 95% confidence interval [CI] −1.16 to −0.52). At secondary analyses, AMH in patients with endometriomas was significantly lower both versus non-endometriosis benign ovarian cysts (mean difference −0.85, 95% CI −1.37 to −0.32, and versus women with healthy ovaries (mean difference −0.61, 95% CI −0.99 to −0.24). Conclusion(s): Ovarian reserve evaluated with AMH is reduced in patients with ovarian endometriomas compared both to patients with other benign ovarian cysts, and to patients with healthy ovaries.