Research question

Does the presence of ovarian endometriomas affect ovarian response to ovarian stimulation after adjusting for age and ovarian reserve markers?

Design

This retrospective cross-sectional study compared the ovarian response between patients with ovarian endometriomas and women with other infertility factors undergoing their first ovarian stimulation for IVF/intracytoplasmic sperm injection (ICSI). An age-specific nomogram model for the number of oocytes retrieved was built for both groups, and ovarian response was compared after adjusting for age, gonadotrophin dose, anti-Mullerian hormone (AMH) concentration and antral follicle count (AFC).

Results

A total of 923 patients were included: 101 women with at least one ovarian endometrioma, and 822 patients with other infertility factors. Comparisons of the nomograms for the number of oocytes retrieved demonstrated that response was significantly lower for women with endometrioma when the results were adjusted for age the z-score for the number of oocytes retrieved (–0.49 ± 0.71 versus –0.20 ± 0.86; 95% confidence interval [CI] –0.47 to –0.12) and also after adjustment for the total dose of gonadotrophins and AMH values (z-score mean difference –0.338; 95% CI –0.54, –0.14). When the z-score was adjusted for gonadotrophin dose and AFC, the number of oocytes retrieved was comparable between the two groups (z-score mean difference –0.038; 95% CI –0.34 to 0.27).

Conclusions

Ovarian response after ovarian stimulation for IVF/ICSI in women with endometriomas is significantly lower than in controls after adjusting for age, gonadotrophin dose and AMH. Dose and protocol selection for ovarian stimulation in patients with endometrioma should be based on AFC rather than AMH, as the latter may be overestimated.

中文翻译：

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卵巢子宫内膜瘤会影响卵巢对IVF / ICSI刺激卵巢的反应吗？

研究问题

调整年龄和卵巢储备标记后，卵巢子宫内膜瘤的存在会影响卵巢对卵巢刺激的反应吗？

设计

这项回顾性横断面研究比较了卵巢子宫内膜瘤患者与接受其他首次IVF /胞浆内精子注射（ICSI）卵巢刺激的其他不育因素的女性之间的卵巢反应。建立两组年龄特定的卵母细胞数目的诺模图模型，并在调整年龄，促性腺激素剂量，抗Mullerian激素（AMH）浓度和肛门卵泡计数（AFC）之后，比较卵巢反应。

结果

总共包括923名患者：101名患有至少一种卵巢子宫内膜瘤的妇女和822名患有其他不育因素的患者。列线图对卵母细胞的数目的比较取出了证明，响应显著降低的妇女子宫内膜异位时的结果进行了调整年龄ž为获卵的数目（-0.49±0.71 -0.20对比±0.86 -score; 95％置信区间[CI] –0.47至–0.12）以及调整后的促性腺激素总剂量和AMH值（z得分平均差异–0.338； 95％CI –0.54，–0.14）。当调整了z分数的促性腺激素剂量和AFC后，两组中回收的卵母细胞数量相当（z-得分平均差–0.038；95％CI –0.34至0.27）。

结论

调整年龄，促性腺激素剂量和AMH后，子宫内膜异位症患者的IVF / ICSI卵巢刺激后的卵巢反应明显低于对照组。子宫内膜瘤患者卵巢刺激的剂量和方案选择应基于AFC而非AMH，因为后者可能被高估了。