***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective The aim of this study was to evaluate the surgical impact of benign ovarian mass on ovarian reserve as measured by serum follicle stimulating hormone ( FSH ) , estradiol ( E2 ) and anti-Müllerian hormone ( AMH ) levels , antral follicle count ( AFC ) and ovarian volumes . In addition , the differences in ovarian reserve impairment between endometrioma cystectomy and non-endometrioma cystectomy were investigated . Methods In this prospect i ve study , 22 patients of reproductive age ( range , 18.35 years ) with benign ovarian masses were enrolled to undergo laparoscopic cystectomy . Of whom 12 had endometriomas and 10 had non-endometriomas . On early follicular phase ( day 3 ) of the cycle preceding the operation and three months after the laparoscopic cystectomy , serum levels of FSH , E2 and AMH , AFC and ovarian volumes were measured in all patients . Data were analyzed with Mann-Whitney U-test and Wilcoxon rank test using SPSS ver . 12.0 for statistic analysis . Results Median level of serum AMH was significantly decreased from 5.48 ng/mL ( interquartile range [ IQR ] , 2.80 - 7.47 ) before cystectomy to 2.56 ng/mL ( IQR , 1.74 - 4.32 ) 3 months postoperation ( P<0.05 ) . On the other h and , no significant differences in FSH , E2 , AFC and ovarian volumes were found between the preoperative and three months postoperative levels . In a subgroup analysis of the pathologic type of the ovarian cyst , postoperative serum AMH levels were significantly decreased in the endometrioma group , but not in the non-endometrioma group . Conclusion Serum AMH levels were significantly decreased after laparoscopic cystectomy without any changes of other ovarian reserve tests OBJECTIVE To compare the effects of laparoscopic bipolar electrocoagulation with laparotomic hemostatic suturing during unilateral ovarian cystectomy on the ovarian reserve . METHODS A prospect i ve r and omized trial was conducted on 59 women with unilateral benign ovarian cysts who underwent laparoscopic ovarian cystectomy by a stripping technique ( n = 30 ) or open laparotomy with hemostatic suturing ( n = 29 ) .  Serum anti-Müllerian hormone ( AMH ) , antral follicle count ( AFC ) , and ovarian stromal peak systolic velocity ( PSV ) at the 1st , 3rd , and 6th postoperative cycle were used to assess the ovarian reserve . RESULTS Preoperative AMH levels did not differ significantly ( P = 0.18 ) between the laparoscopy and laparotomy groups . In the laparoscopy group , there was a significant decrease in AMH levels , AFC , and PSV at the 3rd and 6th postoperative cycles compared with the 1st postoperative cycle , with an insignificant decrease between the 3rd and 6th cycles . In the laparotomy group , nonsignificant decreases in AMH levels , AFC , and PSV were detected at the 1st , 3rd , and 6th postoperative cycle and between the 3rd and 6th cycles . CONCLUSION Laparoscopic ovarian cystectomy is associated with a significant reduction in ovarian reserve . This is a consequence of damage to the ovarian vascularity and the removal of an increased amount of ovarian tissue STUDY OBJECTIVE To evaluate damage to ovarian reserve following laparoscopic cystectomy of benign ovarian cysts . DESIGN Prospect i ve study ( Canadian Task Force classification II-3 ) . SETTING Tertiary gynecologic endoscopic unit at a university-affiliated hospital . PATIENTS Thirty-one patients who underwent excision of monolateral ( n=25 ) or bilateral ( n=6 ) benign ovarian cysts . INTERVENTIONS Serial transvaginal ultrasound examinations during the first and third postsurgical menstrual cycles . The following ovarian echographic variables were evaluated : antral follicle count , ovarian volume , stromal blood flow , and side of ovulation . Two types of statistical analysis were performed : a paired analysis comparing operated and intact ovaries of the same patient and a prospect i ve analysis comparing ecographic characteristics of the operated gonad at first and second evaluation . MEASUREMENTS AND MAIN RESULTS Antral follicle count and stromal blood flow were not significantly affected by surgery . While ovarian volume was similar in the operated and in the contralateral intact gonad at the first ultrasound evaluation , the volume of the operated ovary was significantly reduced at the second assessment . The median ( interquartile range ) of the percentage of this reduction was 33 % ( 18%-81 % ) . This progressive reduction was confirmed by prospect ively analyzing the operated ovaries . An increased probability of ovulation in the intact gonad was observed at both assessment s. CONCLUSION Laparoscopic excision of ovarian cysts is associated with damage to ovarian reserve , at least immediately after surgery . This effect does not appear to be consequent to an injury to ovarian vascularization OBJECTIVE To evaluate safety and efficacy , in terms of spillage risk and ovarian tissue preservation , of mesial incision for laparoscopic dermoid cystectomy .  DESIGN R and omized controlled trial . SETTING University . PATIENT(S ) Sixty-seven women with dermoid cysts . INTERVENTION(S ) Laparoscopic dermoid cystectomy performed by mesial incision ( 33 patients , study group ) or antimesial incision ( 34 patients , control group ) . MAIN OUTCOME MEASURE(S ) Spillage of intracystic content rate , operative times , chemical peritonitis rate , and intraoperative blood loss ( ΔHb ) as primary outcomes . Postoperative ovarian reserve ( ΔFSH levels , basal antral follicle number , mean ovarian diameter , and peak systolic velocity at 3 and 12 months after surgery ) as secondary outcome . RESULT ( S ) Spillage of intracystic content rate and operative time were significantly lower in the study than in the control group . None developed chemical peritonitis . ΔHb was higher in the study group but not significantly . During the follow-up , median FSH values were significantly lower in the study group , with no differences in the E(2 ) levels . Moreover , median basal antral follicle number , median ovarian diameter , and median peak systolic velocity were significantly higher in the study group . CONCLUSION ( S ) Ovarian mesial-side incision appears to be a safe as well as tissue-sparing technique . CLINICAL TRIAL REGISTRATION NUMBER Background To evaluate the impact of the presence of endometrioma and laparoscopic cystectomy on ovarian reserve as assessed by serum anti-Müllerian hormone ( AMH ) level . In addition , factors related to the decline in ovarian reserve were analyzed . Methods From June 2013 to January 2014 , we prospect ively included 40 women with endometriomas as the study group ( group A ) , 36 women with tubal factor infertilities as control group 1 ( group B ) and 22 women with the other benign ovarian cysts as control group 2 ( group C ) . The women with ovarian cysts underwent laparoscopic cystectomy .  Serum AMH levels were determined preoperatively and at 1 month after surgery . Results The endometrioma group had lower AMH levels ( 1.53 ± 1.37 ng/ml ) compared with the other benign ovarian cyst group ( 2.20 ± 1.23 ng/ml ) and the tubal factor infertility group ( 2.82 ± 1.74 ng/ml ) . The rate of serum AMH decline 1 month after surgery in the endometrioma group ( 0.62 ± 0.35 ) was larger than the decline in the other benign ovarian cyst group ( 0.32 ± 0.30 ) . The preoperative AMH level showed a significant correlation with patient age ( group A , r = −0.32 ; group B , r = −0.54 ; group C , r = −0.71 ) ; there was a statistically significant correlation between the rate of serum AMH decline and endometrioma diameter as well as with the preoperative serum AMH level . In addition , the rate of serum AMH decline was larger for bilateral endometriomas than for unilateral endometriomas , but there was no similar correlation in the other benign ovarian cyst group . The rate of AMH decline after surgery in the subgroup of > 7 cm was significantly higher than in the subgroup of ≤7 cm . Conclusions Ovarian endometriomas per se may damage ovarian reserve , and cystectomy of endometriomas may cause greater damage to ovarian reserve compared with other benign ovarian cysts . The operation-related damage to the ovarian reserve was positively related to whether the endometriomas were bilateral , as well as cyst size ( especially for cysts > 7 cm ) , but was negatively related to the preoperative serum AMH level . Age was a negative factor that affected the ovarian reserve OBJECTIVE To determine whether the stripping technique by laparoscopy is a tissue-sparing procedure . DESIGN Prospect i ve study . SETTING University hospital . PATIENT(S ) Forty-two women , 21 to 35 years of age , who had a unilateral ovarian cyst ( 26 endometriomas , 7 serous , 6 dermoid , and 3 mucinous cysts ) . INTERVENTION(S ) Laparoscopic excision of ovarian cysts by using the stripping technique . MAIN OUTCOME MEASURE(S ) Histologic analysis of the excised specimens was done to evaluate the presence and nature of ovarian tissue adjacent to the cyst wall . RESULT ( S ) Recognizable ovarian tissue adjacent to the cyst wall was present in 15 of 42 excised specimens ( 36 % ) . A significant difference was present for endometriomas versus non-endometriosis cysts ( ovarian tissue was present in 14 of 26 specimens [ 54 % ] vs. 1 of 16 specimens [ 6 % ] ; P<.005 ) . No specimen showed the normal follicular pattern observed in healthy ovaries . CONCLUSION ( S ) The stripping technique appears to be a tissue-sparing procedure . In 36 % of the cysts , ovarian tissue is excised together with the cyst wall , but this tissue does not show the morphologic characteristics observed in normal ovarian tissue CONTEXT The interindividual variation in the age-related decline of ovarian follicles is wide . Hence , it is important to identify reliable , sensitive , and specific markers to assess the ovarian reserve of the individual woman . OBJECTIVE The aim of this study was to characterize the relation between age and ovarian reserve parameters in a population of healthy women with regular menstrual cycle . DESIGN AND SETTING We conducted a prospect i ve , population -based , cross-sectional study . PARTICIPANTS A total of 366 health care workers aged 21 - 41 years employed at a University Hospital were included . INTERVENTIONS There were no interventions . MAIN OUTCOME MEASURES  Serum anti-Müllerian hormone ( AMH ) concentration , antral follicle count ( AFC ) , antral follicle size categories ( small : 2 - 4 mm ; intermediate : 5 - 7 mm ; and large : 8 - 10 mm ) , and ovarian volume were measured . RESULTS Serum AMH level declined by 5.6 % per year ( 95 % confidence interval 3.7 - 7.4 % , P < .001 ) , AFC ( 2 - 10 mm ) declined by 4.4 % per year ( 3.2 - 5.7 % , P < .001 ) , and ovarian volume declined by 1.1 % per year ( 0.2 - 2.0 , P = .002 ) , respectively . The mean proportion of small follicles decreased with age ( P = .04 ) , the proportion of intermediate follicles displayed no significant change with age ( P = .58 ) , and the mean proportion of large follicles increased with age ( P < .001 ) . The prevalence of large follicles increased with decreasing serum AMH concentration [ odds ratio 1.04 per 1 pmol/L ( 1.02 - 1.06 ) , P < .001 , area under the curve 0.66 ] , and with decreasing total AFC [ odds ratio 1.04 per follicle ( 1.02 - 1.05 ) , P < .001 , area under the curve 0.62 ] . CONCLUSION Chronological age was inversely related to serum AMH concentration , total AFC , and ovarian volume . Subclasses of AFC sized 2 - 4 and 5 - 7 mm decreased with increasing age , whereas AFC sized 8 - 10 mm increased with increasing age . Within AFC , a shift toward larger follicles with increasing age was observed . The occurrence of large follicles was more strongly related to biological age in terms of AMH and AFC than chronological age OBJECTIVE To determine whether different methods of hemostasis and pathologic subtypes would lead to significant differences regarding ovarian reserve after laparoscopic ovarian cystectomy . STUDY DESIGN Data were prospect ively collected from 129 patients who underwent laparos 
    Output:
    
CONCLUSION Excision of benign nonendometriotic ovarian cyst(s ) seems to result in a marked reduction of circulating anti-Müllerian hormone .
It remains to be established whether this reflects a real compromise to ovarian reserve