Endometrioma-related reduction in ovarian reserve (ERROR): a prospective longitudinal study

Women with endometriomas not only had lower serum antimullerian hormone (AMH) levels than age-matched healthy controls at recruitment, their AMH levels also declined significantly faster over 6 months.

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Volume 110, Issue 1, Pages 122–127


Isil Kasapoglu, M.D., Baris Ata, M.D., M.C.T., Ozlem Uyaniklar, M.D., Ayse Seyhan, M.D., Adnan Orhan, M.D., Sule Yildiz Oguz, M.D., Gurkan Uncu, M.D.



To evaluate whether endometrioma is associated with a progressive decline in ovarian reserve, and to compare the rate of decline with natural decline in ovarian reserve.


Prospective, observational study.


Tertiary university hospital, endometriosis clinic.


Forty women with endometrioma and 40 age-matched healthy controls.


Women with endometriomas who did not need hormonal/surgical treatment at the time of recruitment and were expectantly managed. Controls were age-matched, healthy women. All participants underwent serum antimüllerian hormone (AMH) testing twice, 6 months apart. Sexually active patients with endometrioma also underwent antral follicle count.

Main Outcome Measure(s)

Change in serum AMH levels.


Median (25th–75th percentile) serum AMH level at recruitment was 2.83 (0.70–4.96) ng/mL in the endometrioma group and 4.42 (2.26–5.57) ng/mL in the control group. The median percent decline in serum AMH level was 26.4% (11.36%–55.41%) in the endometrioma group and 7.4% (−11.98%, 29.33%) in the control groups. Twenty-two women with endometrioma who had antral follicle count (AFC) had median AFC of 10 (8–12) at recruitment and 8 (6.3–10) at 6 months.


Women with endometrioma experience a progressive decline in serum AMH levels, which is faster than that in healthy women.

Clinical Trial Registration Number


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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.