Serum antimüllerian hormone concentration increases with ovarian endometrioma size

In the absence of a prior history of surgery for endometriosis, the serum antimullerian hormone concentration increases with endometrioma size but not with other types of benign ovarian cysts.

Volume 111, Issue 5, Pages 944–952.e1


Louis Marcellin, M.D., Ph.D., Pietro Santulli, M.D., Ph.D., Mathilde Bourdon, M.D., Clémence Comte, M.D., Chloé Maignien, M.D., Pierre Alexandre Just, M.D., Ph.D., Isabelle Streuli, M.D., Ph.D., Bruno Borghese, M.D., Ph.D., Charles Chapron, M.D.



To examine whether serum antimüllerian hormone (AMH) levels correlate with the size of ovarian endometrioma (OMA).


An observational cross-sectional study.


A university hospital.


Two hundred and sixty-seven nonpregnant women, aged 18–42 years, with no prior history of surgery for endometriosis and a histologically documented ovarian cyst.


Surgical management for a benign ovarian cyst.

Main Outcome Measure(s)

Correlation between serum AMH concentration and cyst size according to OMA and non-OMA benign cyst.


Women with OMA were compared with a control group of women who had non-OMA benign ovarian cysts. The AMH assay samples were collected less than a month before the surgery. Between January 2004 and September 2016, 148 women were allocated to the OMA group and 119 to the non-OMA benign cyst group. The AMH concentrations were not statistically significantly different between the two groups (3.7 ± 2.8 ng/mL vs. 4.1 ± 3.3 ng/mL). A multiple linear regression model accounting for potential confounders revealed that the log10 of the serum AMH concentration positively correlated with the log10 of the OMA cyst volume (R2 = 0.23; coefficient = 0.05; 95% CI, 0.007–0.10).


In women no prior history of surgery for endometriosis, serum AMH levels increased with cyst size in cases of OMA.

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Go to the profile of Alexander Quaas
almost 4 years ago

This article examines the interesting question how endometriomas are related to AMH concentrations.

After log transformation of AMH levels, there appeared to be a weak correlation between cyst size and log AMH level. This result is interesting and surprising, given that many clinicians intuitively would have guessed an inverse correlation. The authors speculate on the reasons for this observation, and state how these findings may influence clinical care- most notably in the interpretation of pre-operative AMH levels, and in the choice of gonadotropin dosage for ovarian stimulation in patients with large "OMAs".

However, it is important to ask: is this a case of statistical significance that does not translate into clinical significance? The only group that appears to be notably different from the others is the one with OMA cyst sizes > 70, the standard error bars are large, and the "n" in the largest OMA group is relatively low (26). In addition, as the authors mention, these patients were pre-surgical patients who were not necessarily infertile. 

Therefore, should these findings be viewed with caution and would a larger prospective confirmatory study be useful? At the very least, it is reassuring to note that AMH levels in patients with any size endometriomas are not significantly different from patients with benign cysts of other etiologies.