The Impact of Gynecological Surgery on Ovarian Function in Women of Reproductive Age: Postoperative Changes of Serum Anti-Müllerian Hormone
Premenopausal women were enrolled and were allocated into two groups; operation and control
group. Operations were performed for benign ovarian tumors, leiomyoma or adenomyosis. All
eligible women were identified from the Samsung Medical Center. Written informed consent was
obtained from all subjects and the study was approved by the Institutional Review Board of
Samsung Medical Center.
A complete medical history was taken, and physical and gynecological examinations were
performed at baseline. Data included information on age, menstrual cycle, parity, weight,
height, and BMI. The follow-up length was 3 months. Blood sample was taken before and in 1
week, 1 month and 3 months after surgery for operation group or at the time of screening for
control group, and transvaginal ultrasonography was performed with AMH sampling.
After collection of blood, serum was stored at -70ºC until the measurement of AMH level.
Serum levels of AMH were determined by an enzyme-linked immunosorbent assay using commercial
kit (Beckman Coulter Inc., Paris, France). The detection limit of the assay was 0.14 ng/mL,
and the intra- and inter-assay coefficients of variation were 12.3% and 14.2%, respectively.
Ultrasonographic examination was performed using the ALOKA prosound SSD-3500 (ALOKA,
Wallingford, CT, USA) with a 7.5-MHz vaginal probe for color Doppler ultrasonography to
assess the ovarian artery flow at the ovarian hilum. The pulsatile index (PI) and resistance
index (RI) values were calculated according to the formula PI=[S-D]/mean and RI=[S-D]/S,
where S was the peak systolic flow velocity; D was diastolic velocity; and the mean was the
mean flow velocity. All examinations were conducted by the same investigator to minimize
interobserver bias, and parameters were measured at least 3 times and the mean value was
Operations were performed by gynecologists in our center using the technique of
laparoscopy-assisted vaginal or trans-abdominal approaches for hysterectomy and using
oophorectomy or cystectomy method for ovarian disease.
Statistical analyses were performed using Statistical Analysis System (SAS Institute Inc.,
version 9.1, Enterprise Guide 3.0, Cary, NC, USA) and R (version 2.7.2) by a statistician in
our hospital. The Fisher's exact test was used for frequency data. The variables presenting
normal distribution were compared by t test or analysis of variance. For the variables which
did not show normal distribution, the Kruskal-Wallis test or Wilcoxon test were used. A
P-value <0.05 was considered statistically significant.
Observational Model: Case Control, Time Perspective: Prospective
DooSeok Choi, MD, PhD
Samsung Medical Center
South Korea: Institutional Review Board