The Impact of Laparoscopic Cystectomy on Ovarian Reserve in Patients with Chocolate Cysts

Abstract

Background: Endometriomas, commonly referred to as chocolate cysts, are a form of endometriosis that can impair fertility and ovarian function. Laparoscopic cystectomy is a standard treatment for symptom relief and fertility improvement. However, concerns remain about its potential impact on ovarian reserve. Objective: T To assess the effect of laparoscopic cystectomy on ovarian reserve in women with chocolate cysts using serum Anti-Müllerian Hormone (AMH) levels and Antral Follicle Count (AFC). Methods: This prospective observational study was conducted at Anwer Khan Modern Medical College, Dhaka, Bangladesh, from January to December 2024. 46 women aged 20–40 years with unilateral or bilateral endometriomas undergoing laparoscopic cystectomy were enrolled. Serum AMH and AFC were measured before surgery and at 3 months postoperatively. Paired t-tests were used to assess changes in ovarian reserve. Subgroup analysis was performed based on cyst laterality. Results: Mean AMH significantly decreased from 3.25 ± 1.10 ng/mL preoperatively to 2.01 ± 0.85 ng/mL postoperatively (p < 0.001). Similarly, mean AFC declined from 11.3 ± 3.7 to 7.5 ± 2.9 (p < 0.001). Patients with bilateral endometriomas experienced a greater decline in AMH (-1.65 ± 0.7 vs. -0.95 ± 0.6; p = 0.003) and AFC (-4.6 ± 1.8 vs. -2.8 ± 1.3; p = 0.001) compared to those with unilateral cysts. Conclusion: Laparoscopic cystectomy significantly reduces ovarian reserve, particularly in women with bilateral endometriomas. These findings highlight the importance of fertility-preserving surgical approaches and comprehensive preoperative counseling for reproductive-age women undergoing surgery for endometriomas.