Analysis of factors influencing ovarian reserve in patients with endometriosis

To discover the related factors of ovarian reserve function and explore the relationship between AFC and AMH.

In this study, a retrospective analysis of endometriosis cases from January 2022 to December 2023 was performed with DIE ultrasound or surgical procedures. The association of AFC and AMH with age, single or bilateral cysts, healthy or affected side, cyst size, BMI, pregnancy history, recurrence, standard medication, comorbidities, four ultrasound sliding signs, presence or absence of deep nodules, and size of deep nodules were analyzed, and then multivariate analysis was performed.

Correlation analysis results show significant factors influencing: Total AFC with age (R = -0.242, P < 0.001), Unilateral/bilateral (Z = -4.095, P < 0.001), the largest cyst diameter on the left side (R = -0.181, P = 0.004), the largest cyst diameter on the right side (R = -0.286, P < 0.001), AMH (R = 0.543, P < 0.001), recurrence (R = -2.007, P = 0.038), associated adenomyosis (R = -2.667, P = 0.007), posterior uterine wall sliding sign (R = -4.324, P < 0.001), rectouterine pouch sliding sign (R = -2.098,P = 0.036), largest diameter of deep nodules (Z = -0.175, P = 0.023). AMH shared associations with age (R = -0.432, P < 0.001), BMI (Z = -0.203, P < 0.001), left AFC, right AFC, total AFC, gravidity (R = -0.795, P < 0.001), recurrence (R = -2.203, P = 0.028), associated adenomyosis (R = -4.518, P < 0.001), associated uterine fibroids (R = -3.504, P < 0.001), posterior uterine wall sliding sign (R = -2.927, P = 0.003), and rectouterine pouch sliding sign (R = -1.995, P = 0.046). AFC on the healthy side was significantly higher than that on the affected side (Z = -9.786, P < 0.001). The results of the multivariate analyses showed the following: Larger cyst diameters on the left side were associated with lower left AFC (OR = -0.547, P < 0.001). Larger cyst diameters on the right side were associated with lower right AFC (OR = -0.601, P < 0.001). Higher AMH levels were associated with higher left AFC (OR = 0.775, P < 0.001), right AFC (OR = 0.778, P < 0.001), and total AFC (OR = 0.667, P < 0.001). AMH levels were influenced only by a history of recurrence (OR = 1.436, P = 0.047).

In OEM, compared to AMH, AFC may serve as a more suitable marker for assessing ovarian reserve.