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Surgical excision of ovarian endometriomas further exacerbates this impairment by frequently causing unintentional removal of healthy ovarian tissue, leading to a sustained decline in serum AMH levels for at least 69 months and diminished ovarian response to controlled ovarian hyperstimulation (COH), particularly when cyst size exceeds 4 cm ( In terms of oocyte yield and maturity, ovarian endometriosis consistently reduces oocyte yield (mean difference [MD] 1.22) and the number of mature oocytes (MD 2.24)