Effect of endometrioma size and bilaterality on clinical, surgical, and laboratory parameters in endometriosis: A retrospective study

Endometriosis is a chronic inflammatory disease that can cause many problems such as dipmenorrhea, dyspareunia, pelvic pain, and infertility. The aim of this study was to investigate the clinical, demographic, and laboratory characteristics that are primarily considered in the management of patients with endometrioma, focusing on the effects of cyst size and laterality. This study included 210 patients aged 18 to 50 who underwent endometrioma surgery. Demographic characteristics, infertility histories, surgical procedures, antral follicle counts, and laboratory parameters (CA-125, follicle stimulating hormone, anti-Müllerian hormone [AMH], and estradiol) of the patients were compared by classifying them according to endometrioma size and bilaterality. Endometrioma size was classified as ≤30, >30 to ≤50, >50 to ≤70, and >70 mm. This was a retrospective, observational study. No significant differences in age or reproductive history, including gravida and parity, were observed between groups. However, body mass index was significantly lower in the >70 mm group. Additionally, the rates of pelvic pain and infertility were higher in patients with bilaterality or larger endometriomas (P = .022, P = .029). The >70 mm and with bilaterality group had the lowest preoperative AMH levels and the highest CA-125 levels compared to the ≤30 mm and without bilaterality group (P = .009, P = .008). To improve statistical robustness, an additional literature-based stratification using a 50 mm cutoff and bilaterality was applied, and further comparative and regression analyses were performed. In the logistic regression analysis, Low AMH levels were independently associated with the presence of large (>50 mm) and bilateral endometriomas (odds ratio = 0.12, 95% confidence interval [CI]: 0.04-0.41; P = .002). In conclusion, larger and bilateral endometriomas tend to be associated with lower AMH levels, and further research aimed at better elucidating the underlying mechanisms of this relationship is needed to help resolve existing inconsistencies in the literature.