Evaluation of Ovarian Reserve After Cystectomy and Endometrial Ablation.

Abstract

Introduction: Endometriosis surgery can affect ovarian reserve; endometrial ablation is effective for bleeding, but its effect on reserve biomarkers remains unknown. Objective: To determine the impact of ovarian cystectomy and endometrial ablation on ovarian reserve and to identify the clinical–surgical factors associated with its variation. Methodology: Systematic review in PubMed, 2015–2025. Inclusion: studies reporting ovarian reserve measurements after endometrioma cystectomy or endometrial ablation. Results: Cystectomy reduced AMH by 30–55% at 1–6 months with partial recovery by 12 months; the decline was greater with bilaterality, larger cysts, low baseline AMH, and reoperation. Non-thermal hemostasis and CO₂ vaporization preserved reserve better than bipolar coagulation; AFC improved particularly with conservative methods. No pre–post AMH/AFC data were found for endometrial ablation. Discussion: Effects depend on biology and technique; standardizing non-thermal hemostasis and selecting CO₂ in appropriate cases may mitigate damage. The absence of biomarker data for ablation is a priority evidence gap. Conclusion: Indicate surgery with strict criteria, personalize technique to minimize thermal injury, and align decisions with the reproductive plan; investigate the biological impact of endometrial ablation.