Reproductive
Endometriosis diagnosis, severity, and location and serum anti-müllerian Hormone levels Michelle Valenti* Michelle Valenti Karen V. Schliep Madeline Paulson Rachael B. Hemmert Matthew Peterson Melissa A. Furlong Zelieann Craig Anna Pollack Leslie V. Farland
Introduction: Endometriosis, a chronic, inflammatory condition, is often associated with pelvic pain and infertility. Anti-müllerian hormone (AMH), a marker of ovarian reserve, is associated with time to menopause and has been shown to be lower in those with endometriosis. The purpose of this study was to evaluate the association between incident endometriosis diagnosis, severity, and location with AMH levels measured prior to gynecologic surgery.
Methods: Data was acquired from the Endometriosis: Natural History, Diagnosis, and Outcomes Study, which recruited an operative cohort of women undergoing laparoscopy/laparotomy for any indication. Serum AMH levels (ng/mL) were log transformed and multivariable linear regression models were utilized adjusting for age (continuous and squared), body mass index (BMI), age at menarche, exogenous hormonal contraceptive use, and cigarette smoke exposure. Percent difference and 95% confidence intervals (CI) were calculated.
Results: In our sample (n=348), those with endometriosis (n=156) were slightly younger (32 years SD 6.8) than those without endometriosis (n=192) (33 years SD 7.3). Those with endometriosis had a lower BMI (26.7 kg/m2 SD 7.3 vs. 29.6 kg/m2 SD 9.0) and reported a higher proportion of infertility (41.0% vs. 18.8%) compared to those without endometriosis. Endometriosis diagnosis was associated with lower AMH levels (-20.6%, 95% CI -37.6, 1.0). Compared to those without endometriosis, stage I-II and stage II-IV endometriosis were associated with a 11.1% reduction (95% CI -62.25, -19.93) and 44.7% reduction (95% CI -62.3, -19.9), respectively. Ovarian endometriosis was associated with a 57.8% reduction (95% CI -71.9, -36.5) in AMH levels compared to those without endometriosis.
Conclusion: At surgical diagnosis, moderate to severe (Stage III-IV) and ovarian endometriosis were associated with lower AMH levels. This provides insight into the potential mechanism by which endometriosis may affect infertility.