Variability of AMH
Several studies have reported that serum AMH levels are mildly decreased in endometriomas than other ovarian tumors and severely declined as the endometriosis is severe and bilateral19. Iwase et al reported that decreased AMH levels were found after laparoscopic excision of endometriomas and non-endometriotic cysts but the decrease was more profound in endometriomas than in non-endometriomas26. Hirokawa et al also reported that the rate of decline of the serum AMH level was significantly higher in the bilateral group than the unilateral group and was correlated with the revised American Society for Reproductive Medicine( rASRM) score22. Laparoscopic cystectomy further exerted a significant negative impact on ovarian reserve measured by serum AMH levels in both short and long term observations27. Tsolakidis et al reported that the mean serum AMH level was significantly reduced 6 months after surgery28. Chang et al also observed a significant decrease in serum AMH levels 3 months after laparoscopic cystectomy6.