Controlled Ovarian Stimulation in Endometriosis Patients Can Be Individualized by Anti-Mullerian Hormone Levels

Abstract

Context. Anti-Mullerian hormone (AMH) assay is becoming the best indicator of successful IVF treatment response to fertility drugs and could be a useful marker of embryo implantation potential. Various protocols are being used for controlled ovarian stimulation (COS), but there is an uncertainty regarding the implementation of the best protocol for endometriosis patients and also little evidence is available concerning the clinical value of AMH levels in endometriosis.Objective. This study aimed to evaluate the prognostic value of serum AMH levels for pregnancy in COS using GnRH-agonist(GnRH-a) and GnRHantagonist(GnRH-ant) protocols in endometriosis patients.Design. This is a cross-sectional study between March 2012 and November 2015.Subjects and Methods. Data were collected from 249 COS cycles of endometriosis patients, including 129 cycles with GnRH-a and 120 cycles with GnRH-ant. Patients in each group were classified into three subgroups based on their serum AMH levels. The outcomes of ICSI program were evaluated.Results. The ROC curve analysis showed that embryo and oocyte counts and AMH were equally predictive for pregnancy, as demonstrated by a similar area under the curve (AUC) of 0.69, 0.66 and 0.64, respectively. The sensitivity and specificity for prediction of positive pregnancy were 70.91% and 67.01% for embryo counts, 70.91% and 67.53% for oocyte counts at the cutoff values of 5 and 7, respectively, and 83.64% and 52.58% for AMH levels at the cutoff values of 1.3ng/mL.Conclusions. This study demonstrates that AMH as a single test has substantial accuracy in the prediction of pregnancy using the GnRH antagonist protocol for patients with endometriosis. In other words, AMH assay prior to ovarian stimulation initiation guides the clinicians to choose the antagonist stimulation protocol for the patients with two extreme AMH levels. AMH levels can be used to individualize control ovarian stimulation in endometriosis patients.

Comparing ART outcomes in women with endometriosis after GnRH agonist versus GnRH antagonist ovarian stimulation: a systematic review

“…[13][14][15][16][17][18][19][20] In these studies, 1721 cycles used the long GnRHagonist protocol and 1040 cycles used the GnRHantagonist protocol. Six retrospective analyses, [13][14][15][16][17]20 one cross-sectional study 18 and one RCT 19 were identified. Each study was undertaken at a single centre, and all inclusion/exclusion criteria were available.…”

“…For the long GnRH-agonist protocol, four studies administered triptorelin, 14,15,18,19 two studies administered leuprorelin 16,17 and one study administered decapeptyl 13 daily starting from day 20 to 21 of the previous menstrual cycle. One study 20 did not specify which GnRH agonist was used and started treatment after day 21 of the preceding cycle.…”

“…Seven studies in the GnRHantagonist arm administered subcutaneous cetrorelix or ganirelix. [13][14][15][16][17][18][19] Five of which followed a flexible multiple dosing protocol 13,[15][16][17]19 and two of which followed a fixed protocol from day 5 or day 6. 14,18 One study also gave patients in the GnRH-antagonist arm an oral contraceptive pill pretreatment taken for 14-24 days in the preceding cycle followed by a 3-to 5-day washout period.…”

Predictive risk factors for occurrence of Tubo-ovarian abscess (TOA) in patients with ovarian endometriosis (OE), a prospective comparative

“…AntiMullerian hormone (AMH) levels have a significant accuracy in pregnancy prediction in patients with ovarian endometriosis [12]. The role of neurotrophins in eutopic endometrium from endometriosis-patients was investigated and no differences were found between patients with and without endometriosis with regards to the neurite outgrowth of sensory ganglia [13]. Pelvic nerve-sparing surgery is effective in improving intestinal symptoms after performing radical surgery for endometriosis which needed segmental intestinal resection [14].…”

Hormonal Therapy in Women of Reproductive Age with Endometriosis: an Update

“…Infertility in endometriosis has multiple mechanisms, including the production of inflammatory mediators with damage to oocytes and sperm, reducing anti-müllerian hormone with an impact on follicular reserve, underlying adhesions, ovarian cysts and changes in tubal anatomy (7). This disorder affects women's health and quality of life, with consequences for personal, romantic, family and workplace relationships (8).…”