Preserving Fertility in Young Women: Triple‐Step Strategy for Managing Giant Endometriomas With Minimal AMH Decline—A Case Report

Endometriomas are a frequent cause of infertility in reproductive‐aged women, often requiring surgery. However, cystectomy for large endometriomas may reduce ovarian reserve, as indicated by decreased anti‐Müllerian hormone (AMH) levels. This case report presents a triple‐step approach to managing a 20‐year‐old woman with bilateral endometriomas and infertility, focusing on preserving ovarian function. The patient, with primary infertility for 2 years and large bilateral endometriomas (10 cm on the right ovary and 5 cm on the left), underwent a staged treatment. Step 1 involved laparoscopic drainage of the cysts, followed by 3 months of GnRH agonist therapy to shrink the cysts and suppress endometriosis. Step 2 was a laparoscopic cystectomy performed carefully to minimize ovarian tissue loss. Step 3 included 3 more months of postoperative GnRH agonist therapy to suppress residual disease and aid ovarian recovery. Predrainage AMH was 3.27 ng/mL, decreased slightly to 3.17 ng/mL at 6 months after surgery, and was 2.54 ng/mL at 12 months of follow‐up, indicating minimal ovarian reserve depletion. The patient resumed regular menstrual cycles 3 months postoperatively and conceived within 1 year, with no evidence of endometrioma recurrence observed. This case highlights the effectiveness of the triple‐step approach in managing giant endometriomas while preserving fertility. Combining medical and surgical methods reduced AMH depletion and improved reproductive outcomes. This strategy may be a valuable option for young women with endometriomas, though further research is needed to confirm its long‐term benefits.