Age-related trends in anti-Mullerian hormone serum level in women with unilateral and bilateral ovarian endometriomas prior to surgeryReport as inadecuate

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Reproductive Biology and Endocrinology

, 13:128

First Online: 24 November 2015Received: 16 September 2015Accepted: 17 November 2015


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.

KeywordsAnti-Mullerian hormone AMH Ovarian endometrioma Endometriosis AbbreviationsANOVAanalysis of variance

AMHanti-mullerian hormone

ARTartificial reproductive technology

ELISAenzyme-linked immunosorbent assay

FSHfollicle-stimulating hormone

IQRinterquartile range

NSstatistically not significant

NAdata not available

TNFtumor necrosis factor

NKnatural killer cells

Rcorrelation index

SDstandard deviation

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Author: Dorota Nieweglowska - Iwona Hajdyla-Banas - Kazimierz Pitynski - Tomasz Banas - Oliwia Grabowska - Grzegorz Juszczyk - Artur



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