Decreased Concentrations of AMH in Follicular Fluid of Women with Endometriosis: A Hypothetical New Marker of Oocyte Quality

Abstract

Introduction Anti-müllerian hormone (AMH) has been recently introduced as a new marker of ovarian reserve with a high sensitivity and with the added value of being independent of cycle day. Some authors have claimed that it may also provide information regarding oocyte quality. As endometriosis is a disease that mainly affects the ovary and thus, egg quality, we decided to evaluate AMH follicular fluid concentrations in three clinical groups: a) women with endometriosis and a visible endometrioma at ultrasound in one of the ovaries, b) same women with endometrioma-free contralateral ovary, and c) women without endometriosis. Material and Methods From August to December 2007, 28 women undergoing an IVF/ICSI cycle in whom an endometrioma > 2cm was clearly visible at ultrasound in one of the ovaries and not in the other, and 28 fertile egg donors as controls entered the study. Follicular fluid from the largest follicle of each ovary (with endometrioma and without endometrioma) was individually collected prior to the rest of the follicular aspiration at the time of egg retrieval, and similarly in the control group. After cumulus identification and short centrifugation to remove cells, fluids were stored at -80°C until assayed. AMH was evaluated by a commercially available ELISA. Kolmorov-Smirnov test was performed to test for normality, as well as a one-way ANOVA with Tukey test to evaluate differences among groups. Significance was set at 0.05. Results AMH follicular fluid concentrations were significantly lower in women with endometriosis versus control (4.5 ± 2.6 vs 6.2 ± 3.0 ng/mL, p=0.02). Interestingly, when the three groups were evaluated individually, the concentration of AMH in follicular fluid obtained from the ovaries where a large endometrioma was present was significantly lower than in the other two groups – a) 4.1 ± 2.7 ng/mL in the ovaries with the endometrioma, b) 4.9 ± 2.6 ng/mL in the contralateral ovary in the same patients, and c) 6.2 ± 3.0 ng/mL in control patients; (p=0.039). Conclusions AMH concentration in follicular fluid is diminished in women with endometriosis. The presence of the endometrioma itself may reduce even further AMH concentration in the surrounding follicles. These results may reflect oocyte quality and could be useful when counselling patients regarding their reproductive outcome.