The impact of excision of benign nonendometriotic ovarian cysts on ovarian reserve: a systematic review

Mohamed, Ahmed A.; Al-Hussaini, Tarek K.; Fathalla, Mohamed M.; El Shamy, Tarek T.; Abdelaal, Ibrahim I.; Amer, Saad A.

Abstract

Background

Benign nonendometriotic ovarian cysts are very common and often require surgical excision. However, there has been a growing concern over the possible damaging effect of this surgery on ovarian reserve.

Objective

The aim of this metaanalysis was to investigate the impact of excision of benign nonendometriotic ovarian cysts on ovarian reserve as determined by serum anti-Müllerian hormone level.

Data Sources

MEDLINE, Scopus, ScienceDirect, and Embase were searched electronically.

Study Design

All prospective and retrospective cohort studies as well as randomized trials that analyzed changes of serum anti-Müllerian hormone concentrations after excision of benign nonendometriotic cysts were eligible. Twenty-five studies were identified, of which 10 were included in this analysis.

Data Extraction

Two reviewers performed the data extraction independently.

Results

A pooled analysis of 367 patients showed a statistically significant decline in serum anti-Müllerian hormone concentration after ovarian cystectomy (weighted mean difference, –1.14 ng/mL; 95% confidence interval, –1.36 to –0.92; I2 = 43%). Subgroup analysis including studies with a 3-month follow-up, studies using Gen II anti-Müllerian hormone assay and studies using IOT anti-Müllerian hormone assay improved heterogeneity and still showed significant postoperative decline of circulating anti-Müllerian hormone (weighted mean difference, –1.44 [95% confidence interval, –1.71 to –1.1; I2 = 0%], –0.88 [95% confidence interval, –1.71 to –0.04; I2 = 0%], and –1.56 [95% confidence interval, –2.44 to –0.69; I2 = 22%], respectively). Sensitivity analysis including studies with low risk of bias and excluding studies with possible confounding factors still showed a significant decline in circulating anti-Müllerian hormone.

Conclusion

Excision of benign nonendometriotic ovarian cyst(s) seems to result in a marked reduction of circulating anti-Müllerian hormone. It remains to be established whether this reflects a real compromise to ovarian reserve.

Citation

Mohamed, A. A., Al-Hussaini, T. K., Fathalla, M. M., El Shamy, T. T., Abdelaal, I. I., & Amer, S. A. (2016). The impact of excision of benign nonendometriotic ovarian cysts on ovarian reserve: a systematic review. American Journal of Obstetrics and Gynecology, 215(2), https://doi.org/10.1016/j.ajog.2016.03.045

• Journal Article Type: Article
• Acceptance Date: Mar 28, 2016
• Online Publication Date: Apr 5, 2016
• Publication Date: Aug 31, 2016
• Deposit Date: Jul 17, 2017
• Publicly Available Date: Jul 17, 2017
• Journal: American Journal of Obstetrics and Gynecology
• Print ISSN: 0002-9378
• Electronic ISSN: 1097-6868
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 215
• Issue: 2
• DOI: https://doi.org/10.1016/j.ajog.2016.03.045
• Keywords: Anti-Müllerian hormone, Benign ovarian cysts, Ovarian cystectomy, Ovarian reserve
• Public URL: https://nottingham-repository.worktribe.com/output/803777
• Publisher URL: https://doi.org/10.1016/j.ajog.2016.03.045
• Contract Date: Jul 17, 2017