Abstract
BackgroundEndometriosis is a well-known cause of infertility, and the anti-Mullerian hormone (AMH) is an accepted biomarker of ovarian reserve and response to artificial reproductive technology procedures. The present study was a prospective analysis of age-dependent AMH serum concentration in women with bilateral and unilateral ovarian endometriomas before therapy onset compared with healthy controls.MethodsThis prospective cross-sectional study included 384 women aged 18–48 years. AMH serum concentration was assessed between days 3 and 6 of the menstrual cycle in 78 patients with bilateral and 157 patients with unilateral ovarian endometriomas and compared with 149 healthy controls. Ovarian endometriosis was confirmed histopathologically, and data were presented as medians with interquartile range (IQR).ResultsStage III endometriosis was diagnosed in 53.2 %, stage IV in 18.3 %, stage V in 23.4 % and stage VI in 5.4 % of the patients. Patients with bilateral ovarian endometriomas showed the lowest median AMH levels compared with patients suffering from unilateral ovarian endometriosis (0.55; IQR: 0.59 vs. 2.00; IQR: 2.80; p < 0.001) and the control group (0.55; IQR: 0.59 vs. 2.84; IQR: 3.2; p < 0.001). Median AMH concentration values were not significantly different between patients with unilateral ovarian endometriosis and the healthy controls (2.00; IQR: 2.80 vs. 2.84; IQR: 3.2; p = 0.182). A strongly negative correlation between AMH levels and age was confirmed in healthy individuals (R = −0.834; p < 0.001) and women with unilateral ovarian endometriomas (R = −0.774; p < 0.001). Patients with bilateral ovarian endometriosis showed a significantly negative but only moderate correlation between AMH levels and age (R = −0.633; p < 0.001), which was significantly lower than in the healthy controls (R = −0.633 vs. R = −0.834; p = 0.006) but not in the patients with unilateral ovarian endometriosis (R = −0.663 vs. R-0.774; p = 0.093). Based on a multivariate regression analysis, only bilateral localization of ovarian endometrial cysts (p = 0.003) and patient age (p < 0.001), but not left/right localization of unilateral cyst or cyst volume, were negatively associated with AMH serum concentration.ConclusionAccording to our data, unilateral ovarian endometriosis had a moderately negative and nonsignificant effect on AMH-based ovarian reserve evaluated prior to surgery, irrespective of age. In contrast, the ovarian reserve was significantly reduced in women with bilateral ovarian endometriomas.
Highlights
Endometriosis is a well-known cause of infertility, and the anti-Mullerian hormone (AMH) is an accepted biomarker of ovarian reserve and response to artificial reproductive technology procedures
We excluded the following subjects: (1) pregnant women; (2) patients with previous excision of ovarian cysts; (3) patients diagnosed with infertility; (4) patients who had received hormonal treatment during the prior 36 months; (5) patients diagnosed with endocrine disorders; (6) patients suffering from chronic disease; and (7) patients with a history of malignancy
- pregnancy (n=9) - history of ovarian surgery (n=45) - infertility (n=23) - treated with hormones during the past 36 months (n=31) - with endocrine disorders (n=66) - with chronic diseases (n=51) - with history of malignancy (n=5) - lack of AMH evaluation (n=19) - age over 48 years (n=14)
Summary
Endometriosis is a well-known cause of infertility, and the anti-Mullerian hormone (AMH) is an accepted biomarker of ovarian reserve and response to artificial reproductive technology procedures. Infertility is an increasing medical and socioeconomic problem affecting up to 15 % of couples [1] Many of these patients have an opportunity for parenting, due to rapidly developing diagnostics and artificial reproduction techniques (ARTs). The fibrosis together with the ROS-triggered decrease in angiogenesis and capillary loss in the ovarian cortex impair follicle nutrition and may be responsible for lower follicular density and functional follicle loss in the ovaries with endometriosis [10]. These findings support the theory that endometriomas cause ovarian damage before surgical treatment
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