title: Does preoperative antimüllerian hormone level influence postoperative pregnancy rate in women undergoing surgery for severe endometriosis?
abstract: OBJECTIVE
  To compare postoperative pregnancy rates as they relate to presurgery antimüllerian hormone (AMH) level in patients with stage 3 and 4 endometriosis.
  
  
  METHODS
  Retrospective comparative study using data prospectively recorded in the North-West Inter-Regional Female Cohort for Patients with Endometriosis (CIRENDO) database.
  
  
  METHODS
  University tertiary referral center.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  METHODS
  Patient characteristics, preoperative symptoms, infertility history, intraoperative findings, and probability of pregnancy were recorded and compared between the two groups.
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Stochino-Loi
authors.affiliation: Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
authors.forename: Basma
authors.initials: B
authors.lastname: Darwish
authors.affiliation: Department of Gynecology and Obstetrics, University of Medicine and Pharmacy, Targu Mures, Romania.
authors.forename: Oana
authors.initials: O
authors.lastname: Mircea
authors.affiliation: Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
authors.forename: Salma
authors.initials: S
authors.lastname: Touleimat
authors.affiliation: Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
authors.forename: Jenny-Claude
authors.initials: JC
authors.lastname: Millochau
authors.affiliation: Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Abo
authors.affiliation: Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Angioni
authors.affiliation: Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; Research Group EA 4308 "Spermatogenesis and Male Gamete Quality," Institut Hospitalier Universitaire Rouen Normandy, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France. Electronic address: horace.roman@gmail.com.
authors.forename: Horace
authors.initials: H
authors.lastname: Roman
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects; D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D016208:Databases, Factual; D004715:Endometriosis / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005298:Fertility; D005602:France; D006785:Hospitals, University; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects; D050498:Live Birth; D011247:Pregnancy; D018873:Pregnancy Rate; D016016:Proportional Hazards Models; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D012720:Severity of Illness Index; D061685:Time-to-Pregnancy; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D054304:Anti-Mullerian Hormone
keywords: AMH; antimüllerian hormone; deep endometriosis; endometrioma; endometriosis; fertility; plasma energy