Does preoperative antimüllerian hormone level influence postoperative pregnancy rate in women undergoing surgery for severe endometriosis?

Pregnancy rates after surgery for stage 3 and 4 endometriosis were comparable between women with low and normal preoperative antim€ullerian hormone level.

Like Comment

Volume 107, Issue 3, Pages 707–713

Authors:

Emanuela Stochino-Loi, M.D., Basma Darwish, M.D., Oana Mircea, M.D., Salma Touleimat, M.D., Jenny-Claude Millochau, M.D., Carole Abo, M.D., Stefano Angioni, M.D., Ph.D., Horace Roman, M.D., Ph.D.

Abstract:

Objective

To compare postoperative pregnancy rates as they relate to presurgery antimüllerian hormone (AMH) level in patients with stage 3 and 4 endometriosis.

Design

Retrospective comparative study using data prospectively recorded in the North-West Inter-Regional Female Cohort for Patients with Endometriosis (CIRENDO) database.

Setting

University tertiary referral center.

Patient(s)

One hundred eighty patients with stage 3 and 4 endometriosis and pregnancy intention, managed from June 2010 to March 2015, were divided into two groups according to their preoperative AMH levels: group A (AMH ≥2 ng/mL) and group B (AMH <2 ng/mL).

Intervention(s)

Surgical procedure involved ovarian endometrioma ablation by plasma energy along with resection of various localizations of the disease. Postoperative conception was either spontaneous or used assisted reproductive technology, depending on patient characteristics.

Main Outcome Measure(s)

Patient characteristics, preoperative symptoms, infertility history, intraoperative findings, and probability of pregnancy were recorded and compared between the two groups.

Result(s)

Among 180 women enrolled in the study, 134 (74.4%) were assigned to group A and 46 (25.6%) to group B. The women's ages were, respectively, 30 ± 3.8 and 32 ± 4.6 years. Pregnancy was achieved by 134 (74.4%) patients, and conception was spontaneous in 74 of them (55.2%). Pregnancy rates in groups A and B were, respectively, 74.6% (100 women) and 73.9% (34 women), while spontaneous conception represented 54% (54 women) and 58.8% (20 women). The probability of pregnancy at 12, 24, and 36 months after surgery in groups A and B was comparable, respectively, 65% (95% confidence interval [CI], 55%–75%), 77% (95% CI, 86%–68%), and 83% (95% CI, 90%–75%) versus 50% (95% CI, 69%–34%), 77% (95% CI, 90%–61%), and 83% (95% CI, 94%–68%). Supplementary analysis in women with normal (≥2 ng/mL), low (1–1.99 ng/mL), and very low (<1 ng/mL) AMH level showed an inverse relationship between AMH level, age, and antecedents of miscarriage; however, postoperative pregnancy rates were comparable among the three groups at 12 and 24 months, respectively, 59.5% (95% CI, 49.3%–70%) and 77.4% (95% CI, 68%–85.4%); 57.1% (95% CI, 34%–83%) and 78.6% (95% CI, 55.2%–94.8%); and 46.7% (95% CI, 25.6%–73.7%) and 73.3% (95% CI, 50.4%–91.7%).

Conclusion(s)

The probability of postoperative pregnancy was comparable between women with low and normal AMH level who were managed for stage 3 and 4 endometriosis and who were a mean age of 30 years. However, the small sample size might have been unable to detect differences in pregnancy and live-birth rates between the two groups. As the majority of pregnancies were spontaneous, our results suggest that surgical management may be offered to young patients with severe endometriosis and reduced ovarian reserve with good fertility outcomes.

Read the full text here.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

No comments yet.