The effect of endometriosis on the antimüllerian hormone level in the infertile population

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Infertile women with endometriosis, with or without prior ovarian surgery, exhibited lower AMH and higher FSH levels compared to women with male factor infertility.

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This retrospective cohort study examined whether endometriosis in infertile women affects ovarian reserve markers, comparing 671 IVF-referred patients in three groups: endometriosis with prior ovarian surgery, endometriosis without prior ovarian surgery, and male factor infertility as a reference group. Compared with the male factor group, both endometriosis groups had lower mean AMH levels and higher proportions of patients with AMH < 1, and they also had higher baseline FSH levels. The authors note a key limitation that the study is retrospective and analyzes existing IVF presentation groups, which may involve confounding and cannot establish causality. This paper is centrally about endometriosis — it specifically tests how endometriosis presence (with or without prior ovarian surgery) influences AMH and FSH markers of ovarian reserve in infertile women.

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Abstract

PurposeTo determine whether the presence of endometriosis in infertile women without prior ovarian surgery influences markers of ovarian reserve, AMH and FSH.MethodsA retrospective cohort study included three groups of women who presented for IVF treatment at our tertiary care center from 04/27/2015 to 05/31/2017: women with endometriosis and prior ovarian surgery (EnSx), women with endometriosis without prior ovarian surgery (En), and women with a primary diagnosis of male factor infertility (MF; reference group).ResultsThere were 671 patients that met inclusion criteria (78 EnSx, 60 En, and 533 MF). Compared to the MF group (3.6 ± 3.0), a lower mean AMH level (ng/mL) was observed in the EnSx group (2.5 ± 2.5; aβ - 1.21; 95% CI [- 1.79, -0.62]) and in the En group (2.5 ± 2.2; aβ - 1.11; 95% CI [- 1.68, - 0.54]). Both endometriosis groups had a statistically significantly higher proportion of patients with an AMH < 1 (EnSx, 24.4%; OR, 2.39 [95% CI, 1.31, 4.36]; En, 28.3%; OR, 2.67 [95% CI, 1.41, 5.08]) compared to the MF group (13.9%). The mean baseline FSH level (lU/L) was statistically significantly higher in both endometriosis groups (EnSx, 8.6 ± 4.3; β, 1.37 [95% CI, 0.39, 2.34]; En, 8.4 ± 3.7; β, 0.96 [95% CI, 0.04, 1.87]) compared to the MF group (7.3 ± 2.2).ConclusionsAmong infertility patients with endometriosis, with and without a history of ovarian surgery, ovarian reserve markers were worse (lower AMH and higher FSH) and a higher proportion had decreased ovarian reserve as measured by AMH compared to women with MF.
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Abstract

Purpose To determine whether the presence of endometriosis in infertile women without prior ovarian surgery influences markers of ovarian reserve, AMH and FSH.

Methods

A retrospective cohort study included three groups of women who presented for IVF treatment at our tertiary care center from 04/27/2015 to 05/31/2017: women with endometriosis and prior ovarian surgery (EnSx), women with endometriosis without prior ovarian surgery (En), and women with a primary diagnosis of male factor infertility (MF; reference group).

Results

There were 671 patients that met inclusion criteria (78 EnSx, 60 En, and 533 MF). Compared to the MF group (3.6 ± 3.0), a lower mean AMH level (ng/mL) was observed in the EnSx group (2.5 ± 2.5; aβ − 1.21; 95% CI [− 1.79, −0.62]) and in the En group (2.5 ± 2.2; aβ − 1.11; 95% CI [− 1.68, − 0.54]). Both endometriosis groups had a statistically significantly higher proportion of patients with an AMH < 1 (EnSx, 24.4%; OR, 2.39 [95% CI, 1.31, 4.36]; En, 28.3%; OR, 2.67 [95% CI, 1.41, 5.08]) compared to the MF group (13.9%). The mean baseline FSH level (lU/L) was statistically significantly higher in both endometriosis groups (EnSx, 8.6 ± 4.3; β, 1.37 [95% CI, 0.39, 2.34]; En, 8.4 ± 3.7; β, 0.96 [95% CI, 0.04, 1.87]) compared to the MF group (7.3 ± 2.2).

Conclusions

Among infertility patients with endometriosis, with and without a history of ovarian surgery, ovarian reserve markers were worse (lower AMH and higher FSH) and a higher proportion had decreased ovarian reserve as measured by AMH compared to women with MF. Similar content being viewed by others

References

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Rights and permissions About this article Cite this article Romanski, P.A., Brady, P.C., Farland, L.V. et al. The effect of endometriosis on the antimüllerian hormone level in the infertile population. J Assist Reprod Genet 36, 1179–1184 (2019). https://doi.org/10.1007/s10815-019-01450-9 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s10815-019-01450-9

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endometriosis

MeSH descriptors

Anti-Mullerian Hormone Endometriosis Infertility, Female Reproductive Techniques, Assisted Adult Anti-Mullerian Hormone Endometriosis Endometriosis Estradiol Estradiol Female Follicle Stimulating Hormone Follicle Stimulating Hormone Humans Infertility, Female Infertility, Female Ovarian Reserve Ovarian Reserve Ovary Ovary

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