Background: Hence, there is scarce and no reliable data or evidence-based protocol for the management of DIE (deep infiltrating endometriosis) lesions in reproductive age women, in this study we examined ovarian reserve in endometriosis surgeries to aid in decision-making for surgery and fertility preservation.

Material and methods: This single-center cross-sectional study included 508 women who underwent laparoscopic endometriosis surgery in three groups: endometrioma (OMA) (n=156), OMA+ DIE (n=235), and DIE (n=117)), from June 2018 to December 2022. Their AMH levels were compared to 50 healthy controls before surgery and at 4, 8 months post-surgery.

Results: The DIE group had lower baseline anti mullerian hormone (AMH) levels compared to other groups. (P < 0.0001 ) Following surgery, AMH levels decreased notably across all groups. (P < 0.001) Reductions in AMH levels after surgery were as follows: OMA group 49.84%, DIE+OMA group 62.20%, DIE group 43.46%, with the most substantial decline observed in the DIE+OMA group. There was no significant difference in AMH levels between 4 and 8 months post-surgery.

Conclusion: While the OMA+DIE group experienced the greatest drop in ovarian reserve after surgery. Yet, DIE is as effective as OMA in reducing ovarian reserve pre- and post-surgery, highlighting that overlooked DIE lesions in ultrasound examination, greatly impact ovarian reserve in affected women.