title: Assessment of ovarian reserve by antral follicle count in ovaries with endometrioma.
abstract: OBJECTIVE
  To evaluate whether the antral follicle count (AFC) is underestimated in the presence of an endometrioma.
  
  
  METHODS
  This was a retrospective cohort study assessing all women undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) at our clinic between January 2011 and December 2012 who had both ovaries and unilateral endometrioma. The primary outcome of the study was the difference between AFC and the number of oocytes retrieved per ovary.
  
  
  RESULTS
  Within the study period 787 women underwent IVF/ICSI at our clinic. Sixty of these women had at least one endometrioma, but 23 were excluded from the analysis as six had only one ovary and 17 had bilateral endometriomas. Therefore a total of 37 women were included in this study and analysis. Compared with the contralateral ovaries, ovaries with an endometrioma were significantly larger in volume (median, 10.3 (interquartile range (IQR), 4.7-18.9)  cm(3) vs median, 3.6 (IQR, 2.7-6.5)  cm(3); P < 0.001) and presented a significantly lower AFC (median, 3.0 (IQR, 1.0-6.0) vs median, 5.0 (IQR, 2.0-6.5); P = 0.001). However, the median number of oocytes retrieved was similar (P = 0.60) between ovaries with an endometrioma (2.0 (IQR, 0.5-5.0)) and the contralateral ovaries (2.0 (IQR, 0.0-4.0)). Accordingly, the median difference between AFC and number of oocytes retrieved was significantly smaller (P = 0.005) for ovaries with an endometrioma (0.0 (IQR, -1.0 to 1.5) than for those without (2.0 (IQR, 0.0-4.0)).
  
  
  CONCLUSIONS
  Although the AFC is reduced in ovaries with an endometrioma, the number of oocytes retrieved is similar, suggesting that the AFC is underestimated in such ovaries. We believe that this is a consequence of an impaired ability to detect small follicles in the presence of an endometrioma.
authors.affiliation: Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.
authors.forename: M L
authors.initials: ML
authors.lastname: Lima
authors.affiliation: Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.
authors.forename: W P
authors.identifier: http://orcid.org/0000-0002-7593-5607
authors.initials: WP
authors.lastname: Martins
authors.affiliation: Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.
authors.forename: M A
authors.initials: MA
authors.lastname: Coelho Neto
authors.affiliation: Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.|School of Health Technology - Ultrasonography School of Ribeirao Preto, Ribeirao Preto, Brazil.
authors.forename: C O
authors.initials: CO
authors.lastname: Nastri
authors.affiliation: Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.
authors.forename: R A
authors.initials: RA
authors.lastname: Ferriani
authors.affiliation: Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.
authors.forename: P A
authors.initials: PA
authors.lastname: Navarro
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D015331:Cohort Studies; D004715:Endometriosis / Q000097:blood / Q000473:pathology*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D006801:Humans; D054315:Oocyte Retrieval / Q000379:methods; D009865:Oocytes / Q000187:drug effects / Q000473:pathology; D006080:Ovarian Follicle / Q000187:drug effects / Q000473:pathology*; D065851:Ovarian Reserve / Q000187:drug effects / Q000502:physiology*; D010053:Ovary / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D010062:Ovulation Induction; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods; D014463:Ultrasonography
chemical_list: D006063:Chorionic Gonadotropin; D054304:Anti-Mullerian Hormone
keywords: antral follicle count; assisted reproduction; endometriomas; endometriosis; ovarian follicle; reproductive techniques