Factors influencing preoperative AMH levels in women with ovarian endometrioma

Background Ovarian endometrioma is a common ovarian cyst in women with endometriosis, often causing pelvic pain and infertility and potentially impairing ovarian reserve. Anti-Mullerian Hormone (AMH) is a reliable serum marker of ovarian reserve, yet its relationship with baseline clinical characteristics remains inadequately explored.

This retrospective study included 576 patients who underwent laparoscopic surgery for ovarian endometrioma between January 2021 and March 2025. We analyzed clinical age, parity, BMI, cyst features, postoperative rASRM stage, and preoperative AMH using SPSS 27.0.

Among the 576 enrolled patients, the median preoperative AMH level was 2.45 ng/mL. Age was strongly negatively correlated with AMH (P < 0.001), with median AMH declining from 3.23 ng/mL in patients < 25 years to 0.66 ng/mL in those ≥ 40 years. Nulliparous patients had a higher median AMH (2.79 ng/mL) than parous ones (1.41 ng/mL) (P < 0.001). BMI was also negatively associated with AMH (P < 0.001), with underweight patients having the highest median AMH (2.88 ng/mL). Regarding cyst-related features, bilateral cysts were linked to lower AMH (2.12 ng/mL) compared to unilateral cysts (2.50 ng/mL) (P = 0.038); postoperative rASRM stage was strongly correlated with AMH (P < 0.001), with stage IV patients having the lowest median AMH (1.98 ng/mL). Notably, no significant associations were found between AMH and dysmenorrhea (P = 0.134) or cyst size (P = 0.579). In the multivariable logistic regression model (AUC = 0.841), only age remained independently associated with low AMH (OR = 1.265, 95% CI 1.190–1.344, P < 0.001), whereas parity, BMI, cyst laterality, postoperative rASRM stage, and dysmenorrhea were no longer significant after adjustment, indicating that their univariate associations were largely confounded by age. Continuous lnAMH analysis confirmed age as the strongest factor, with a possible nonlinear component, and bootstrap validation supported the robustness of the age association.

In this retrospective cohort, age was the factor most strongly associated with low preoperative AMH. After adjustment, parity, BMI, cyst laterality, and postoperative rASRM stage were no longer independently associated. Given the observational design, these findings are exploratory and should only inform hypothesis-generating discussions regarding preoperative counseling and fertility preservation. Similar content being viewed by others Acknowledgments Not applicable. Funding There was no external funding for this study. Author information Authors and Affiliations Corresponding authors Ethics declarations Ethics approval and consent to participate This study adheres to the ethical principles outlined in the Declaration of Helsinki by the World Medical Association, as well as comply with applicable norms and regulations governing clinical research. Written informed consent for the use of clinical data in research was obtained from all patients prior to their inclusion in this retrospective study. Approval for this study has been granted by the Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University (No.II2025-179-01). Consent for publication Not applicable. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Yang, X., He, H., Li, Y. et al. Factors influencing preoperative AMH levels in women with ovarian endometrioma. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-05005-w Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-05005-w