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BACKGROUND: Benign nonendometriotic ovarian cysts are very common and often require surgical excision. However, there has been a growing concern over the possible damaging effect of this surgery on ovarian reserve. OBJECTIVE: The aim of this metaanalysis was to investigate the impact of excision of benign nonendometriotic ovarian cysts on ovarian reserve as determined by serum anti- Mu¨ llerian hormone level. DATA SOURCES: MEDLINE, Scopus, ScienceDirect, and Embase were searched electronically. STUDY DESIGN: All prospective and retrospective cohort studies as well as randomized trials that analyzed changes of serum anti-Mu¨ llerian hormone concentrations after excision of benign nonendometriotic cysts were eligible. Twenty-five studies were identified, of which 10 were included in this analysis. DATA EXTRACTION: Two reviewers performed the data extraction independently. RESULTS: A pooled analysis of 367 patients showed a statistically significant decline in serum anti-Mu¨ llerian hormone concentration after ovarian cystectomy (weighted mean difference, e1.14 ng/mL; 95% confidence interval, e1.36 to e0.92; I2 ¼ 43%). Subgroup analysis including studies with a 3-month follow-up, studies using Gen II anti- Mu¨ llerian hormone assay and studies using IOT anti-Mu¨ llerian hormone assay improved heterogeneity and still showed significant postoperative decline of circulating anti- Mu¨ llerian hormone (weighted mean difference, e1.44 [95% confidence interval, e1.71 to e1.1; I2 ¼ 0%], e0.88 [95% confidence interval, e1.71 to e0.04; I2 ¼ 0%], and e1.56 [95% confidence interval, e2.44 to e0.69; I2 ¼ 22%], respectively). Sensitivity analysis including studies with low risk of bias and excluding studies with possible confounding factors still showed a significant decline in circulating anti-Mu¨ llerian hormone. CONCLUSION: Excision of benign nonendometriotic ovarian cyst(s) seems to result in a marked reduction of circulating anti-Mu¨ llerian hormone. It remains to be established whether this reflects a real compromise to ovarian reserve.

BACKGROUND: Benign nonendometriotic ovarian cysts are very common and often require surgical excision. However, there has been a growing concern over the possible damaging effect of this surgery on ovarian reserve. OBJECTIVE: The aim of this metaanalysis was to investigate the impact of excision of benign nonendometriotic ovarian cysts on ovarian reserve as determined by serum anti- Mu¨ llerian hormone level. DATA SOURCES: MEDLINE, Scopus, ScienceDirect, and Embase were searched electronically. STUDY DESIGN: All prospective and retrospective cohort studies as well as randomized trials that analyzed changes of serum anti-Mu¨ llerian hormone concentrations after excision of benign nonendometriotic cysts were eligible. Twenty-five studies were identified, of which 10 were included in this analysis. DATA EXTRACTION: Two reviewers performed the data extraction independently. RESULTS: A pooled analysis of 367 patients showed a statistically significant decline in serum anti-Mu¨ llerian hormone concentration after ovarian cystectomy (weighted mean difference, e1.14 ng/mL; 95% confidence interval, e1.36 to e0.92; I2 ¼ 43%). Subgroup analysis including studies with a 3-month follow-up, studies using Gen II anti- Mu¨ llerian hormone assay and studies using IOT anti-Mu¨ llerian hormone assay improved heterogeneity and still showed significant postoperative decline of circulating anti- Mu¨ llerian hormone (weighted mean difference, e1.44 [95% confidence interval, e1.71 to e1.1; I2 ¼ 0%], e0.88 [95% confidence interval, e1.71 to e0.04; I2 ¼ 0%], and e1.56 [95% confidence interval, e2.44 to e0.69; I2 ¼ 22%], respectively). Sensitivity analysis including studies with low risk of bias and excluding studies with possible confounding factors still showed a significant decline in circulating anti-Mu¨ llerian hormone. CONCLUSION: Excision of benign nonendometriotic ovarian cyst(s) seems to result in a marked reduction of circulating anti-Mu¨ llerian hormone. It remains to be established whether this reflects a real compromise to ovarian reserve.

BACKGROUND: Benign nonendometriotic ovarian cysts are very common and often require surgical excision. However, there has been a growing concern over the possible damaging effect of this surgery on ovarian reserve. OBJECTIVE: The aim of this metaanalysis was to investigate the impact of excision of benign nonendometriotic ovarian cysts on ovarian reserve as determined by serum anti- Mu¨ llerian hormone level. DATA SOURCES: MEDLINE, Scopus, ScienceDirect, and Embase were searched electronically. STUDY DESIGN: All prospective and retrospective cohort studies as well as randomized trials that analyzed changes of serum anti-Mu¨ llerian hormone concentrations after excision of benign nonendometriotic cysts were eligible. Twenty-five studies were identified, of which 10 were included in this analysis. DATA EXTRACTION: Two reviewers performed the data extraction independently. RESULTS: A pooled analysis of 367 patients showed a statistically significant decline in serum anti-Mu¨ llerian hormone concentration after ovarian cystectomy (weighted mean difference, e1.14 ng/mL; 95% confidence interval, e1.36 to e0.92; I2 ¼ 43%). Subgroup analysis including studies with a 3-month follow-up, studies using Gen II anti- Mu¨ llerian hormone assay and studies using IOT anti-Mu¨ llerian hormone assay improved heterogeneity and still showed significant postoperative decline of circulating anti- Mu¨ llerian hormone (weighted mean difference, e1.44 [95% confidence interval, e1.71 to e1.1; I2 ¼ 0%], e0.88 [95% confidence interval, e1.71 to e0.04; I2 ¼ 0%], and e1.56 [95% confidence interval, e2.44 to e0.69; I2 ¼ 22%], respectively). Sensitivity analysis including studies with low risk of bias and excluding studies with possible confounding factors still showed a significant decline in circulating anti-Mu¨ llerian hormone. CONCLUSION: Excision of benign nonendometriotic ovarian cyst(s) seems to result in a marked reduction of circulating anti-Mu¨ llerian hormone. It remains to be established whether this reflects a real compromise to ovarian reserve.

BACKGROUND: Benign nonendometriotic ovarian cysts are very common and often require surgical excision. However, there has been a growing concern over the possible damaging effect of this surgery on ovarian reserve. OBJECTIVE: The aim of this metaanalysis was to investigate the impact of excision of benign nonendometriotic ovarian cysts on ovarian reserve as determined by serum anti- Mu¨ llerian hormone level. DATA SOURCES: MEDLINE, Scopus, ScienceDirect, and Embase were searched electronically. STUDY DESIGN: All prospective and retrospective cohort studies as well as randomized trials that analyzed changes of serum anti-Mu¨ llerian hormone concentrations after excision of benign nonendometriotic cysts were eligible. Twenty-five studies were identified, of which 10 were included in this analysis. DATA EXTRACTION: Two reviewers performed the data extraction independently. RESULTS: A pooled analysis of 367 patients showed a statistically significant decline in serum anti-Mu¨ llerian hormone concentration after ovarian cystectomy (weighted mean difference, e1.14 ng/mL; 95% confidence interval, e1.36 to e0.92; I2 ¼ 43%). Subgroup analysis including studies with a 3-month follow-up, studies using Gen II anti- Mu¨ llerian hormone assay and studies using IOT anti-Mu¨ llerian hormone assay improved heterogeneity and still showed significant postoperative decline of circulating anti- Mu¨ llerian hormone (weighted mean difference, e1.44 [95% confidence interval, e1.71 to e1.1; I2 ¼ 0%], e0.88 [95% confidence interval, e1.71 to e0.04; I2 ¼ 0%], and e1.56 [95% confidence interval, e2.44 to e0.69; I2 ¼ 22%], respectively). Sensitivity analysis including studies with low risk of bias and excluding studies with possible confounding factors still showed a significant decline in circulating anti-Mu¨ llerian hormone. CONCLUSION: Excision of benign nonendometriotic ovarian cyst(s) seems to result in a marked reduction of circulating anti-Mu¨ llerian hormone. It remains to be established whether this reflects a real compromise to ovarian reserve.

Chronic pelvic pain (CPP) is a disabling disease that causes distress as the quality of life of CPP patients is vastly diminished. In addition, CPP is a public health crisis and is a burden on healthcare expenditure. In the United States, the annual costs for the diagnosis and treatment of CPP are 2.8 billion US $. Moreover, to the indirect cost resulting from the absence from work and CPP associated family problems add 550 million US $ more making the economic burden more than 3.4 billion US $ (Mathias et al., 1996). Yet, the diagnosis of CPP is usually complicated as there are no gold standard guidelines that clearly define this syndrome. Although we have a limited understanding of its etiology, CPP has been found to be correlated with central sensitization, painful bladder syndrome, irritable bowel syndrome, endometriosis and adhesions. As such, in the evaluation of patients, it is imperative to take a comprehensive patient history. Performing physical examinations and ultrasound imaging is of particular value to elucidate the etiology of pain. As CPP patients are at risk for psychological disorders, psychological assessments are critical to diagnose associated psychological disorders and to take these into account in planning a holistic treatment plan for patients. By such evaluation techniques, we can provide better diagnostic service and patient care to people with CPP

Chronic pelvic pain (CPP) is a disabling disease that causes distress as the quality of life of CPP patients is vastly diminished. In addition, CPP is a public health crisis and is a burden on healthcare expenditure. In the United States, the annual costs for the diagnosis and treatment of CPP are 2.8 billion US $. Moreover, to the indirect cost resulting from the absence from work and CPP associated family problems add 550 million US $ more making the economic burden more than 3.4 billion US $ (Mathias et al., 1996). Yet, the diagnosis of CPP is usually complicated as there are no gold standard guidelines that clearly define this syndrome. Although we have a limited understanding of its etiology, CPP has been found to be correlated with central sensitization, painful bladder syndrome, irritable bowel syndrome, endometriosis and adhesions. As such, in the evaluation of patients, it is imperative to take a comprehensive patient history. Performing physical examinations and ultrasound imaging is of particular value to elucidate the etiology of pain. As CPP patients are at risk for psychological disorders, psychological assessments are critical to diagnose associated psychological disorders and to take these into account in planning a holistic treatment plan for patients. By such evaluation techniques, we can provide better diagnostic service and patient care to people with CPP

Chronic pelvic pain (CPP) is a disabling disease that causes distress as the quality of life of CPP patients is vastly diminished. In addition, CPP is a public health crisis and is a burden on healthcare expenditure. In the United States, the annual costs for the diagnosis and treatment of CPP are 2.8 billion US $. Moreover, to the indirect cost resulting from the absence from work and CPP associated family problems add 550 million US $ more making the economic burden more than 3.4 billion US $ (Mathias et al., 1996). Yet, the diagnosis of CPP is usually complicated as there are no gold standard guidelines that clearly define this syndrome. Although we have a limited understanding of its etiology, CPP has been found to be correlated with central sensitization, painful bladder syndrome, irritable bowel syndrome, endometriosis and adhesions. As such, in the evaluation of patients, it is imperative to take a comprehensive patient history. Performing physical examinations and ultrasound imaging is of particular value to elucidate the etiology of pain. As CPP patients are at risk for psychological disorders, psychological assessments are critical to diagnose associated psychological disorders and to take these into account in planning a holistic treatment plan for patients. By such evaluation techniques, we can provide better diagnostic service and patient care to people with CPP