ADVANCING ENDOMETRIOSIS STAGE IS ASSOCIATED WITH A DECLINE IN ANTI-MULLERIAN HORMONE INDEPENDENT OF

OBJECTIVE: Endometriosis is a common infertility diagnosis with diverse treatment approaches, mostly focused on histology and endocrine physiology. Therapeutic options for fertility are plagued by uncertain mechanisms of impaired fecundity and variable efficacy. As evidence continues to accumulate, excision ofendometriomata appears detrimental to postoperative ovarian reserve. Limited evidence assesses general ovarian reserve in endometriosis-related infertile populations. This study explores whether endometriosis in an infertile population is a risk for decreased ovarian reserve, measured by Anti-Mullerian Hormone (AMH). DESIGN: A retrospective analysis in an infertile population. MATERIALS AND METHODS: From an academically-affiliated practice, 1025 consecutive women seeking fertility over a 4 years (1/1/09 to 12/31/12) were identified. Patients were excluded if prior to testing, they were on oral contraceptives, GnRH agonists, received chemotherapy or had excisional ovarian surgery. Thus, 1019 women were further segregated by tobacco exposure, and surgical evaluation for the presence/stage of endometriosis (rASRM Staging). AMH was measured with Beckman Coulter ELISA.Statisticalanalysesusednonparametric,two-factor ANOVA(p value % 0.05 significant). RESULTS: Surgery in 312 women confirmed endometrisosi in 202. There is a negative and significant correlation of AMH level with maternal age (p<0.0001, r¼0.36). Adjusted for age and tobacco, AMH levels are significantly lower in the presence of endometriosis (p¼0.01) and a significant progressive decline with advancing stage of disease. A relationship between tobacco exposure (past, current, or never use) and AMH level was not seen. CONCLUSION: In an infertile, pretreatment population, the presence and stage of endometriosis are associated with declining ovarian reserve as measured by AMH. These findings suggest a detriment of endometriosis on ovarian reserve, and demonstrate a potential mechanism for the decreased fecundity associated with the condition.