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Preoperative serum anti-mullerian hormone levels in women with ovarian endometriosis compared to women with peritoneal endometriosis

      Objective

      Anti-Mullerian hormone (AMH) is an important serum marker to gauge ovarian reserve and predicted response to number of oocytes retrieved after ovarian stimulation. Patients who have ovarian involvement of endometriosis have clinically demonstrated lower baseline AMH levels. Whether or not patients with peritoneal endometriosis only have lower baseline AMH levels has not been established. Our aim is to investigate preoperative baseline AMH levels in women who have ovarian endometriosis versus women who have peritoneal endometriosis without ovarian involvement.

      Design

      Retrospective cross-sectional analysis.

      Materials and Methods

      Pre-operative AMH levels were evaluated for 111 women aged 19-42 who underwent laparoscopic surgery from January 2017 and July 2018 for suspected endometriosis. Patients were identified by those who desired future fertility and had preoperative AMH levels drawn. Patients with a diagnosis of polycystic ovaries or history of prior endometriosis excision surgery and/or oophorectomy were excluded. AMH levels were analyzed according to where endometriosis was anatomically located and confirmed by pathology, comparing women who had peritoneal endometriosis (n=71) without any ovarian involvement versus women with ovarian involvement (n=40). Subanalysis of AMH values was also performed within three different age groups.

      Results

      Preoperative serum AMH level was not significantly different in the ovarian endometriosis group compared to the peritoneal endometriosis group (3.22 ± 3.07 ng/mL vs 3.94 ± 2.90 ng/mL, P=0.113). Subgroup analysis by age demonstrated significantly lower AMH levels for women with ovarian endometriosis aged 27-35 (2.62 ± 2.28 ng/mL vs 3.85 ± 2.98 ng/dL, P=0.045). Patients with ovarian endometriosis were significantly more likely to have more endometriotic lesions confirmed on pathology (16.95 ± 8.75 lesions vs 8.97 ± 6.85 lesions, P <0.0001).

      Conclusions

      Patients with ovarian endometriosis demonstrate lower serum AMH levels than baseline age-matched populations [1], thus reflecting ovarian function and potential success with oocyte retrieval. These findings indicate that some women with peritoneal endometriosis may be at a similar disadvantage in regards to ovarian reserve compared to women with endometriomas and could benefit from earlier intervention regarding active management of fertility preservation.
      Tabled 1AMH Levels by Age Group Subanalysis (Mean ± 1 Standard Deviation)
      Age Group (years)AMH level (ng/dl) in Ovarian EndometriosisAMH level (ng/dl) in Peritoneal EndometriosisP value
      18-265.45 ± 4.2 (n = 10)4.62 ± 2.81 (n = 28)0.294
      27-352.62 ± 2.28 (n = 23)3.85 ± 2.98 (n = 31)0.045
      36-421.99 ± 2.12 (n = 7)2.78 ± 2.64 (n = 11)0.249
      All years3.22 ± 3.07 (n = 40)3.94 ± 2.90 (n = 71)0.113

      Reference

      Muzii L, Di Tucci C, Di Feliciantonio M, Galati G, Di Donato V, Musella A, Palaia I, Panici PB. Antimüllerian hormone is reduced in the presence of ovarian endometriomas: a systematic review and meta-analysis. Fertil Steril. 2018 Oct;110(5):932-940.e1. https://doi.org/10.1016/j.fertnstert.2018.06.025.