Evidence on Serum Anti-Müllerian Hormone Levels and Endometriosis Surgery

The assessment of the ovarian reserve is important in patients with fertility intent. The anti-Müllerian hormone (AMH) serum level is a useful ovarian reserve marker. Endometriosis is a benign disease with three phenotypes: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), and deep endometriosis (DE). Endometriosis is linked with infertility; however, the exact impact of endometriosis and endometriosis surgery on AMH levels is less clear. This narrative review examines how different endometriosis phenotypes and related surgeries affect AMH levels as well as explores whether pre- and post-surgical AMH can predict the reproductive outcomes in women seeking pregnancy. The evidence suggests that OMA is linked to reduced AMH values and a higher AMH decline rate over time. OMA cystectomy causes further a reduction in AMH, which, however, tends to recover postoperatively. Non-excisional surgery for OMA spares the ovarian parenchyma; however, an at least temporary decline in AMH is observed. The effect is likely smaller than that of cystectomy. Non-thermal methods of hemostasis following cystectomy are likely superior in terms of AMH. The AMH levels before OMA cystectomy appear to be positively correlated with the postoperative probability of pregnancy, particularly spontaneous conception, but not livebirth rates. Preoperative AMH levels are also predictive of the risk of diminished ovarian reserve (DOR). Similarly, postoperative AMH levels and the rate of AMH decline at 1 year after OMA cystectomy appear to be predictive of fertility outcomes. SUP likely has little (if any) impact on AMH levels. DE reduces AMH levels, and a further reduction following surgery is anticipated. However, a reduction in AMH values should not be interpreted as a decline in the patient's reproductive potential. Further research should focus on the extra-ovarian locations of endometriosis and their impact on AMH values.