Relation of Endometrioma and Deep Infiltrating Endometriosis Surgery on Ovarian Reserve: A Large Single-Centre, Cross-Sectional Study.

Background: There is a lack of reliable data or evidence-based protocol for the management of deep infiltrating endometriosis (DIE) lesions in reproductive age women. This study examines ovarian reserves in women who underwent endometriosis surgeries in an attempt to assist clinicians with decision-making for surgery and fertility preservation. Materials and Methods: This single-centre cross-sectional study included 508 women who underwent laparoscopic endometriosis surgery from June 2018 to December 2022. The women were divided into three groups: endometrioma (OMA; n=156), OMA+DIE (n=235), and DIE (n=117). Their anti-Müllerian hormone (AMH) levels were compared to 50 healthy controls before surgery and at four and eight months post-surgery. Results: The DIE group had lower baseline AMH levels compared to the other groups (P<0.0001) following surgery, AMH levels decreased notably across all groups (P<0.001). Reductions in AMH levels after surgery were as follows: OMA group (49.84%), OMA+DIE group (62.20%), and the DIE group (43.46%). The most substantial decline was observed in the OMA+DIE group. There was no significant difference in AMH levels between four and eight months post-surgery. Conclusion: Although the OMA+DIE group experienced the greatest drop in ovarian reserve after surgery, DIE is as effective as OMA in reducing ovarian reserve pre- and post-surgery. Hence, overlooked DIE lesions during an ultrasound examination can greatly impact ovarian reserve in these women.