Assessment of ovarian reserve by antral follicle count in ovaries with endometrioma

Maria L.S. Lima, M L Lima, Wellington P. Martins, M A Coelho Neto, Mansueto Gomes Neto, C O Nastri, R A Ferriani, Rui Alberto Ferriani, Paula Andrea Navarro, P A Navarro
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2014 · vol. 46(2) , pp. 239–242 · doi:10.1002/uog.14763 · PMID:25504940 · W2043854373
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Ovaries with endometriomas show reduced antral follicle counts but similar oocyte retrieval numbers, indicating the antral follicle count is underestimated in these cases.

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Abstract

OBJECTIVE: To evaluate whether the antral follicle count (AFC) is underestimated in the presence of an endometrioma. METHODS: This was a retrospective cohort study assessing all women undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) at our clinic between January 2011 and December 2012 who had both ovaries and unilateral endometrioma. The primary outcome of the study was the difference between AFC and the number of oocytes retrieved per ovary. RESULTS: Within the study period 787 women underwent IVF/ICSI at our clinic. Sixty of these women had at least one endometrioma, but 23 were excluded from the analysis as six had only one ovary and 17 had bilateral endometriomas. Therefore a total of 37 women were included in this study and analysis. Compared with the contralateral ovaries, ovaries with an endometrioma were significantly larger in volume (median, 10.3 (interquartile range (IQR), 4.7-18.9) cm(3) vs median, 3.6 (IQR, 2.7-6.5) cm(3); P < 0.001) and presented a significantly lower AFC (median, 3.0 (IQR, 1.0-6.0) vs median, 5.0 (IQR, 2.0-6.5); P = 0.001). However, the median number of oocytes retrieved was similar (P = 0.60) between ovaries with an endometrioma (2.0 (IQR, 0.5-5.0)) and the contralateral ovaries (2.0 (IQR, 0.0-4.0)). Accordingly, the median difference between AFC and number of oocytes retrieved was significantly smaller (P = 0.005) for ovaries with an endometrioma (0.0 (IQR, -1.0 to 1.5) than for those without (2.0 (IQR, 0.0-4.0)). CONCLUSIONS: Although the AFC is reduced in ovaries with an endometrioma, the number of oocytes retrieved is similar, suggesting that the AFC is underestimated in such ovaries. We believe that this is a consequence of an impaired ability to detect small follicles in the presence of an endometrioma.

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Condition tags

mesh:D004715endometrioma

MeSH descriptors

Endometriosis Ovarian Follicle Ovarian Reserve Adult Anti-Mullerian Hormone Anti-Mullerian Hormone Chorionic Gonadotropin Chorionic Gonadotropin Cohort Studies Endometriosis Endometriosis Female Fertilization in Vitro Fertilization in Vitro Humans Oocyte Retrieval Oocyte Retrieval Oocytes Oocytes Oocytes

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