Full length article Surgery for endometriomas within the context of infertility treatment Ekaterina D. Dubinskaya*, Alexandr S. Gasparov, Victor E. Radzinsky, Oxana E. Barabanova, Alexandr A. Dutov Department of Obstetrics and Gynecology with the Course of Perinatology, Peoples Friendship University of Russia (RUDN University), 117198, 8 Miklukho- Maklay Str., Moscow, Russian Federation A R T I C L E I N F O Article history: Received 20 April 2019 Received in revised form 16 August 2019 Accepted 17 August 2019 Available online xxx Keywords: Laparoscopy Endometrioma Infertility Pregnancy rate Cystectomy Cyst type A B S T R A C T Background: The presence of an endometrioma can often be accompanied by a clinical dilemma during the course of fertility treatment. The aim of this study was to evaluate anti-Müllerian hormone (AMH) levels and spontaneous pregnancy rate in infertility patients with endometriomas depending of initial AMH levels and cyst type. Methods: This prospective cohort study included infertility patients with unilateral endometrioma (3– 5 s m in diameter) aged 25–35. A total of them underwent laparoscopic cystectomy. All patients were divided into two groups due to AMH levels and cyst type during surgery. We investigated AMH levels and spontaneous pregnancy rate in 1,3 and 12 months after surgery. Results: The majority of patients with normal AMH level had type II endometriomas (70%) compared with low AMH level group (30%). There were no significant differences between AMH levels in all the patients with type II endometriomas after surgery. AMH level decreased significantly at 1 month in patients with normal AMH level and type I endometriomas (P = 0.018). But at 3 months the AMH level was compared with initial parameters. Women with low AMH levels before surgery and type I cysts had a significant decrease of AMH level at 1 and at 3 months after surgery. All patients with a time interval of 6 months after surgery had the best outcomes with significantly higher pregnancy rate (PR) in patients with normal AMH level and type II cysts (P = 0.036) and with AMH less than 2 ng/ml and type I cysts (P = 0.021). The group with normal AMH level and type II endometriomas had a significantly higher ongoing cumulative PR than others (59.4%). Conclusions: Our data suggest that laparoscopic surgery could affect ovarian reserve in case of initial low AMH levels and type I of endometriomas. We believe that the good surgical technique helps to increase pregnancy rate in infertility patients with endometriomas. Good prognosis group are the infertility patients with normal AMH level and type II endometriomas. © 2019 Elsevier B.V. All rights reserved. Introduction Ovarian endometrioma(s) can be found in up to 17–44% of women with endometriosis and are often associated with the severe form of the disease [1]. Endometriotic ovarian cysts (known as ‘endometriomas’) are mostly thought to occur through invagination of endometriotic tissue/cells through the ovarian serosa, for example, during remodelling of the ovarian cortex after ovulation [2]. The previous study showed that ovarian endometrioma increases SRA, ERs, and TSP-1 but decreases VEGF levels in the surrounding ovarian tissues, which may affect biological behaviors of ovarian endometrioma [3]. Clinical data suggest that the presence of an ovarian endometrioma may cause per se damage to the surrounding otherwise healthy ovarian tissue. An endome- trioma contains free iron, reactive oxygen species (ROS), proteo- lytic enzymes and inflammatory molecules in concentrations from tens to hundreds of times higher than those present in peripheral blood or in other types of benign cysts. The cyst fluid causes substantial changes in the endometriotic cells that it baths from gene expression modifications to genetic mutations [4]. The distinguishing cellular and molecular features of Serum anti- Müllerian hormone (AMH), day 3 levels have been proposed as markers of ovarian reserve [5]. The presence of an endometrioma can often present a clinical dilemma during the course of fertility treatment. For example, there can be uncertainty regarding the decision to operate or to manage conservatively, balancing the potential detrimental effect of surgery on the ovarian reserve against the potential benefit that may be gained [6,7]. * Corresponding author. E-mail address: eka-dubinskaya@yandex.ru (E.D. Dubinskaya). https://doi.org/10.1016/j.ejogrb.2019.08.009 0301-2115/© 2019 Elsevier B.V. All rights reserved. European Journal of Obstetrics & Gynecology and Reproductive Biology 241 (2019) 77–81 Contents lists available at ScienceDirect European Journal of Obstetrics & Gynecology and Reproductive Biology journal homepage: www.elsevier.com/locate/ejogrb