<![CDATA[ABSTRACT Elevated Anti-Müllerian Hormone (AMH) levels, caused by the buildup of immature antral follicles, define Polycystic Ovary Syndrome (PCOS), the leading cause of anovulatory infertility in reproductive-aged women. When other treatments for polycystic ovary syndrome (PCOS) fail to induce ovulation, laparoscopic ovarian drilling (LOD) is considered a second line of defense. The question of whether the decrease in AMH following LOD represents diminished ovarian reserve or normalization of previously dysregulated follicular function arises because, interestingly, ovulation and pregnancy rates rise and AMH levels fall significantly, according to multiple studies. The quantitative relationship between changes in AMH and reproductive outcomes after LOD remains inconsistent and warrants further investigation. This meta-analysis aimed to evaluate changes in AMH levels following LOD and their association with ovulation and pregnancy outcomes in patients with PCOS. Results from cohort, prospective, and meta-analytic studies reporting AMH levels, ovulation, and pregnancy outcomes both before and after Laparoscopic Ovarian Drilling were included in a comprehensive literature search that was carried out using PubMed and Google Scholar. A total of nine studies involving 366 patients were included. Meta-analysis demonstrated that LOD was consistently associated with a significant reduction in AMH levels (mean decrease: 2.28 ng/mL; 95% CI 1.62–2.95; p 0.001). Substantial heterogeneity was observed (I² = 76.4%), and therefore a random-effects model was applied. The prediction interval suggested that AMH reduction is likely to persist across different populations. Additionally, seven studies comprising 279 patients were analyzed to assess spontaneous ovulation following LOD. The pooled ovulation rate was approximately 70% (random-effects model: 69.5%; 95% CI 60.9–77.0), with moderate heterogeneity (I² = 32%). Meta-regression analysis revealed a significant inverse relationship between baseline AMH levels and the likelihood of ovulation after LOD (β = −0.207; p = 0.018), indicating that each 1 ng/mL increase in baseline AMH was associated with an 18.7% reduction in the odds of ovulation. Overall, LOD effectively reduced AMH levels and improved ovulation rates in PCOS patients, particularly in those with lower baseline AMH. Further studies with more homogeneous designs and long-term follow-up are required to strengthen these findings. Patients with Polycystic Ovary Syndrome may have improved ovulation rates and a significant decrease in Anti-Müllerian Hormone levels with Laparoscopic Ovarian Drilling, according to this meta-analysis. It seems that the decrease in AMH after LOD is due to restored ovulation and increased follicular function, rather than decreased ovarian reserve. Baseline AMH levels were identified as an important predictor of ovulatory response, with higher AMH levels associated with a reduced likelihood of ovulation following LOD. These findings support the role of LOD as an effective therapeutic option for PCOS patients who are resistant to ovulation induction, particularly among those with lower baseline AMH levels. Nevertheless, the substantial heterogeneity across studies highlights the need for further research with more homogeneous study designs and long-term follow-up to confirm the effects of LOD on ovarian function and reproductive outcomes. Keywords: Polycystic Ovary Syndrome, Laparoscopic Ovarian Drilling, Anti-Müllerian Hormone, Ovulation, Pregnancy. ABSTRAK Kadar Anti-Müllerian Hormone (AMH) yang tinggi, yang disebabkan oleh penumpukan folikel antral yang belum matang, mendefinisikan Sindrom Ovarium Polikistik (PCOS), penyebab utama infertilitas anovulasi pada wanita usia reproduksi. Ketika pengobatan lain untuk sindrom ovarium polikistik (PCOS) gagal menginduksi ovulasi, Laparoscopic Ovarian Drilling (LOD) dianggap sebagai lini pertahanan kedua. Pertanyaan apakah penurunan AMH setelah LOD menunjukkan penurunan cadangan ovarium atau normalisasi fungsi folikel yang sebelumnya terganggu muncul karena, menariknya, tingkat ovulasi dan kehamilan meningkat dan kadar AMH menurun secara signifikan, menurut beberapa penelitian. Hubungan kuantitatif antara perubahan AMH dan keberhasilan reproduksi pasca-LOD belum konsisten, sehingga perlu dikaji lebih lanjut. Meta-analisis ini bertujuan mengevaluasi perubahan AMH setelah LOD dan hubungannya dengan keberhasilan ovulasi serta kehamilan pada pasien PCOS.: Hasil dari studi kohort, prospektif, dan meta-analitik yang melaporkan kadar AMH, ovulasi, dan hasil kehamilan baik sebelum maupun setelah Laparoscopic Ovarian Drilling dimasukkan dalam pencarian literatur komprehensif yang dilakukan menggunakan PubMed dan Google Scholar. Sebanyak sembilan studi dengan total 366 pasien dianalisis. Meta-analisis menunjukkan bahwa LOD secara konsisten menurunkan kadar AMH secara signifikan (penurunan rata-rata 2,28 ng/mL; 95% CI 1,62–2,95; p 0,001), meskipun terdapat heterogenitas tinggi (I² = 76,4%), sehingga digunakan model random-effects. Prediction interval mengindikasikan penurunan AMH tetap mungkin terjadi pada populasi berbeda. Selain itu, tujuh studi dengan 279 pasien menunjukkan bahwa proporsi ovulasi spontan pasca-LOD mencapai sekitar 70% (random-effects 69,5%; 95% CI 60,9–77,0) dengan heterogenitas moderat (I² = 32%). Meta-regression menunjukkan hubungan negatif yang bermakna antara kadar AMH baseline dan peluang ovulasi setelah LOD (β = –0,207; p = 0,018), di mana setiap peningkatan 1 ng/mL AMH menurunkan peluang ovulasi sebesar 18,7%. Secara keseluruhan, LOD efektif menurunkan kadar AMH dan meningkatkan ovulasi pada pasien PCOS, terutama pada mereka dengan AMH awal yang lebih rendah. Studi lanjutan dengan desain lebih homogen dan follow-up jangka panjang masih diperlukan. Menurut meta-analisis ini, pasien dengan Sindrom Ovarium Polikistik mungkin mengalami peningkatan tingkat ovulasi dan penurunan kadar Hormon Anti-Müllerian (AMH) yang signifikan dengan Laparoskopi Ovarian Drilling (LOD). Tampaknya penurunan AMH setelah LOD disebabkan oleh pemulihan ovulasi dan peningkatan fungsi folikel, bukan karena penurunan cadangan ovarium. Penurunan AMH pasca-LOD tidak mengindikasikan penurunan cadangan ovarium, melainkan berhubungan dengan perbaikan fungsi folikular dan pemulihan ovulasi sehingga dapat meningkatkan keberhasilan kehamilan. Kadar AMH baseline terbukti menjadi prediktor penting keberhasilan ovulasi, di mana kadar yang lebih tinggi berkaitan dengan respons ovulasi yang lebih rendah setelah LOD. Temuan ini mendukung peran LOD sebagai terapi efektif pada pasien PCOS yang resisten terhadap induksi ovulasi, khususnya pada kelompok dengan kadar AMH awal yang lebih rendah. Namun, tingginya heterogenitas antar studi menegaskan perlunya penelitian lanjutan dengan desain yang lebih homogen dan tindak lanjut jangka panjang untuk mengonfirmasi dampak LOD terhadap fungsi ovarium dan luaran reproduksi. Kata Kunci: Polycystic Ovary Syndrome, Laparoscopic Ovarian Drilling, Anti-Müllerian Hormone, Ovulasi, Kehamilan.]]>
