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Background/Objective <p>Ovarian cystectomy, while preserving fertility, may compromise ovarian reserve as reflected by declining Anti-Müllerian hormone (AMH) levels. Evidence regarding the comparative impact of laparoscopic versus laparotomic approaches remains conflicting. This study aimed to compare serum AMH levels before and three months after ovarian cystectomy performed by laparoscopy versus laparotomy in reproductive-aged women and to identify factors influencing postoperative AMH decline.</p> Methods <p>This quasi-experimental study enrolled 66 women with benign ovarian cysts undergoing cystectomy at Hajar Hospital, Shahrekord, Iran (March 2024–March 2025). Participants were assigned to laparoscopy (<i>n</i> = 33) or laparotomy (<i>n</i> = 33) based on clinical indications. Serum AMH was measured preoperatively and three months postoperatively using ELISA. Primary outcomes were absolute and percentage changes in AMH. Subgroup analyses examined age, marital status, cyst type, and electrocautery use.</p> Results <p>Baseline characteristics were comparable between groups except for larger cyst diameter in the laparotomy group (96.88 ± 18.45 vs. 82.30 ± 17.88&#xa0;mm; <i>p</i> = 0.002). No significant between-group differences in AMH were observed preoperatively (2.18 ± 1.20 vs. 2.26 ± 1.25 ng/mL; <i>p</i> = 0.802) or postoperatively (1.98 ± 1.15 vs. 1.97 ± 1.12 ng/mL; <i>p</i> = 0.974). Both groups demonstrated significant within-group declines (laparoscopy: -0.20 ng/mL [-9.2%], <i>p</i> &lt; 0.001; laparotomy: -0.29 ng/mL [-12.8%], <i>p</i> &lt; 0.001). In patients aged 15–34 years, significant decline occurred only in the laparotomy group, while both approaches reduced AMH in those aged 35–45 years. Endometrioma excision caused significant AMH decline regardless of approach, whereas follicular cyst decline was significant only in laparotomy. Electrocautery use during laparoscopy was associated with significant AMH reduction (<i>p</i> = 0.012), while its avoidance yielded non-significant decline (<i>p</i> = 0.066). No significant AMH change followed dermoid cyst excision in either group.</p> Conclusions <p>Both laparoscopic and laparotomic cystectomy significantly reduce ovarian reserve without inter-technique differences. However, laparoscopy may better preserve ovarian function in younger patients and when electrocautery is minimized. Cyst type significantly influences outcomes, with endometriomas conferring greatest risk and dermoid cysts minimal impact. These findings support individualized surgical planning prioritizing minimally invasive techniques and suture-based hemostasis in fertility-concerned patients.</p>

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Comparative Effect of Laparoscopic and Laparotomic Cystectomy on Ovarian Reserve: A Quasi-Experimental Study of Anti-Müllerian Hormone Changes

  • 期刊论文

  • 发表日期：

    2026年5月11日

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  • Zahra Saedi Dezzaki,
  • Zahra Dayani,
  • Fatemeh Deris,
  • Alireza Dehghan,
  • Maryam Ayar,
  • Mojdeh Khaledi

摘要

Background/Objective

Ovarian cystectomy, while preserving fertility, may compromise ovarian reserve as reflected by declining Anti-Müllerian hormone (AMH) levels. Evidence regarding the comparative impact of laparoscopic versus laparotomic approaches remains conflicting. This study aimed to compare serum AMH levels before and three months after ovarian cystectomy performed by laparoscopy versus laparotomy in reproductive-aged women and to identify factors influencing postoperative AMH decline.

Methods

This quasi-experimental study enrolled 66 women with benign ovarian cysts undergoing cystectomy at Hajar Hospital, Shahrekord, Iran (March 2024–March 2025). Participants were assigned to laparoscopy (n = 33) or laparotomy (n = 33) based on clinical indications. Serum AMH was measured preoperatively and three months postoperatively using ELISA. Primary outcomes were absolute and percentage changes in AMH. Subgroup analyses examined age, marital status, cyst type, and electrocautery use.

Results

Baseline characteristics were comparable between groups except for larger cyst diameter in the laparotomy group (96.88 ± 18.45 vs. 82.30 ± 17.88 mm; p = 0.002). No significant between-group differences in AMH were observed preoperatively (2.18 ± 1.20 vs. 2.26 ± 1.25 ng/mL; p = 0.802) or postoperatively (1.98 ± 1.15 vs. 1.97 ± 1.12 ng/mL; p = 0.974). Both groups demonstrated significant within-group declines (laparoscopy: -0.20 ng/mL [-9.2%], p < 0.001; laparotomy: -0.29 ng/mL [-12.8%], p < 0.001). In patients aged 15–34 years, significant decline occurred only in the laparotomy group, while both approaches reduced AMH in those aged 35–45 years. Endometrioma excision caused significant AMH decline regardless of approach, whereas follicular cyst decline was significant only in laparotomy. Electrocautery use during laparoscopy was associated with significant AMH reduction (p = 0.012), while its avoidance yielded non-significant decline (p = 0.066). No significant AMH change followed dermoid cyst excision in either group.

Conclusions

Both laparoscopic and laparotomic cystectomy significantly reduce ovarian reserve without inter-technique differences. However, laparoscopy may better preserve ovarian function in younger patients and when electrocautery is minimized. Cyst type significantly influences outcomes, with endometriomas conferring greatest risk and dermoid cysts minimal impact. These findings support individualized surgical planning prioritizing minimally invasive techniques and suture-based hemostasis in fertility-concerned patients.