Preserving Fertility in Young Women: Triple-Step Strategy for Managing Giant Endometriomas With Minimal AMH Decline-A...

Endometriomas are a frequent cause of infertility in reproductive-aged women, often requiring surgery. However, cystectomy for large endometriomas may reduce ovarian reserve, as indicated by decreased anti-Müllerian hormone (AMH) levels. This case report presents a triple-step approach to managing a 20-year-old woman with bilateral endometriomas and infertility, focusing on preserving ovarian function. The patient, with primary infertility for 2 years and large bilateral endometriomas (10 cm on the right ovary and 5 cm on the left), underwent a staged treatment. Step 1 involved laparoscopic drainage of the cysts, followed by 3 months of GnRH agonist therapy to shrink the cysts and suppress endometriosis. Step 2 was a laparoscopic cystectomy performed carefully to minimize ovarian tissue loss. Step 3 included 3 more months of postoperative GnRH agonist therapy to suppress residual disease and aid ovarian recovery. Predrainage AMH was 3.27 ng/mL, decreased slightly to 3.17 ng/mL at 6 months after surgery, and was 2.54 ng/mL at 12 months of follow-up, indicating minimal ovarian reserve depletion. The patient resumed regular menstrual cycles 3 months postoperatively and conceived within 1 year, with no evidence of endometrioma recurrence observed. This case highlights the effectiveness of the triple-step approach in managing giant endometriomas while preserving fertility. Combining medical and surgical methods reduced AMH depletion and improved reproductive outcomes. This strategy may be a valuable option for young women with endometriomas, though further research is needed to confirm its long-term benefits.