Comparing the effect of laparoscopic supracervical and total hysterectomy for uterine fibroids on ovarian reserve by assessing serum anti-mullerian hormone levels: a prospective cohort study.

STUDY OBJECTIVE

To compare prospectively the impact on ovarian reserve of total laparoscopic hysterectomy (TLH) and laparoscopic supracervical hysterectomy (LSH) for treating uterine fibroids as measured by serum anti-Mullerian hormone (AMH) levels.

DESIGN

In this prospective study, 83 patients (aged 38-47 years) with symptomatic uterine fibroids underwent either TLH (n = 40) or LSH (n = 43) with conservation of both ovaries. Of these, 33 patients from the TLH group and 34 patients from the LSH group completed follow-up (Canadian Task Force Classification II-2).

SETTING

Hospital.

PATIENTS

Eighty-three patients aged 38-47 years.

INTERVENTIONS

Patients with symptomatic uterine fibroids underwent either TLH (n = 40) or LSH (n = 43).

MEASUREMENTS AND MAIN RESULTS

Changes in ovarian reserve were investigated by measuring serum levels of AMH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) before surgery and at 1 month and 4 months after surgery. In both the TLH and LSH groups, serum AMH levels were significantly decreased at 1 month and 4 months postsurgery compared with baseline levels (p < .001). The decrease in serum AMH levels was greater in the TLH group than in the LSH group at 1 month postsurgery, but the difference was not statistically significant. The decrease in serum AMH levels was significantly greater in the LSH group at 4 months postsurgery (p < .001). In both groups, no significant changes in serum FSH, LH, or E2 levels were seen at 1 month or 4 months (p > .05).

CONCLUSION

Serum AMH levels were decreased significantly at 4 months after hysterectomy, with a greater decrease in the TLH group compared with the LSH group, indicating the prognostic importance of serum AMH level in reflecting ovarian reserve in patients undergoing hysterectomy.