We reviewed the literature to determine whether different
hemostatic methods used following laparoscopic
endometrioma excision have differing effects on ovarian reserve. We performed a systematic literature search using the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and Ovid MEDLINE In-Process & Other Non-Indexed Citations databases to identify studies comparing the rate of change in levels of serum anti-Müllerian
hormone (AMH) at 3 months after laparoscopic
endometrioma excision using bipolar dessication (BD) or suturing/application of a
hemostatic sealant (HS) for hemostasis. Abstracts of the annual meetings of the American Society of Reproductive Medicine, the European Society of Human Reproduction and Embryology, and the American Association of Gynecological Laparoscopists were searched as well. A total of 712 articles were identified, of which 6 were included in the qualitative analysis. Four studies involving 213 women were included in the meta-analysis. Our qualitative analysis suggested that BD is more detrimental to ovarian reserve than alternative
hemostatic methods. There is moderate-quality evidence favoring HS and low-quality evidence favoring
sutures over BD. The meta-analysis also showed that alternative
hemostatic methods are associated with significantly less decline in ovarian reserve compared with BD. The mean decline in serum AMH levels was 6.95% less with alternative
hemostatic methods than with BD (95% CI, -13.0% to -0.9%; p = .02) at 3 months after surgery. According to the best available evidence, the use of BD should be cautiously limited, even avoided when possible, during
endometrioma excision in women who desire to have children.