For a study, researchers sought to determine if changes in postoperative ovarian reserve, as determined by serum anti-müllerian hormone (AMH) levels, were related to either open or minimally invasive myomectomy.

Patients undergoing either an open abdominal myomectomy with a tourniquet or a minimally invasive (robot-assisted or laparoscopic) myomectomy with vasopressin were included in this prospective cohort research. Before the treatment and two weeks, three months, and six months afterward, serum AMH levels were measured. Each postoperative timepoint’s mean change in AMH level was compared to the starting point. Using multivariable linear regression, the impact of the surgical approach on the change in AMH level at each time point was evaluated. A subanalysis examined individual postoperative AMH level changes following open myomectomy and minimally invasive myomectomy.

The research involved 111 individuals with a mean age of 37.9±4.7 years. Of them, 46 received minimally invasive myomectomy, and 65 got open myomectomy. Follow-up data were provided by 87 patients. Two weeks after surgery, there was a substantial decrease in serum AMH levels (mean change -0.30 ng/mL, 95% CI -0.48 to -0.120 ng/mL, P=.002). At three and six months after surgery, there was no difference. Open myomectomy was substantially linked with a drop in AMH level on multiple linear regression at 2 weeks after surgery (open myomectomy versus minimally invasive myomectomy: β=-0.63±0.22 ng/mL, P=.007) but not at 3 months or 6 months. Two weeks after surgery, the open myomectomy group’s mean blood AMH levels significantly decreased (mean change -0.46 ng/mL, 95% CI -0.69 to -0.25 ng/mL, P<.001) but not at three or six months. No discernible variations in mean AMH levels were seen between baseline and any postoperative timepoint in the least invasive myomectomy group.

In the immediate postoperative term; myomectomy was linked to a temporary drop in AMH levels, particularly following open surgery that uses a tourniquet. Even with a tourniquet to reduce blood loss, myomectomy was not linked to a long-term effect on ovarian reserve, as evidenced by the return to baseline of anti-müllerian hormone levels three months following surgery.

Reference: journals.lww.com/greenjournal/Fulltext/2022/12000/Association_of_Myomectomy_With_Anti_M_llerian.15.aspx