Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya 15208, Israel; Azrieili Faculty of Medicine in Galilee, Safed, Bar-Ilan University, Israel.
School of Medicine, Glasgow Royal Infirmary, New Lister Building, University of Glasgow, Glasgow G31 2ER, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK; The Fertility Partnership, Oxford OX4 2HW, UK.
Reprod Biomed Online. 2021 Apr;42(4):691-693. doi: 10.1016/j.rbmo.2021.01.016. Epub 2021 Jan 30.
Women with endometriosis, especially those with endometrioma, present a considerable challenge for ovarian reserve appraisal. This diagnostic difficulty arises from several fundamental questions inherently linked to patient management: the potential influence of endometrioma on ovarian reserve; the adverse effect of ovarian surgery on ovarian reserve; and the adequacy of the established ovarian reserve biomarkers, anti-Müllerian hormone and antral follicle count, to appraise ovarian reserve accurately in these women. Until recently, a key argument was that the development and growth of endometriomas is associated with a progressive damage to normal ovarian tissue, resulting in a concomitant reduction in serum AMH levels. Contrary to this widely accepted position; recent studies have reported that, in women with no previous history of ovarian surgery, AMH levels were increased in women with large endometriomas. These findings are surprising and, if replicated, would have substantial clinical implications. In this commentary, we would, however, urge caution before these reports lead to systematic changes in clinical practice, and recommend urgent replication as the finding linking large endometrioma to high serum AMH levels seems to be biologically implausible, and contradicts the existing extensive body of research.
对于子宫内膜异位症患者，尤其是内异囊肿患者，卵巢储备评估存在相当大的挑战。这种诊断困难源于与患者管理密切相关的几个基本问题：内异囊肿对卵巢储备的潜在影响；卵巢手术对卵巢储备的不利影响；以及抗苗勒管激素和窦卵泡计数等已建立的卵巢储备生物标志物在这些女性中准确评估卵巢储备的充分性。直到最近，一个关键论点是，内异囊肿的发展和生长与正常卵巢组织的逐渐损伤有关，导致血清 AMH 水平相应降低。与这一广泛接受的观点相反；最近的研究报告称，在没有卵巢手术史的妇女中，大的内异囊肿患者的 AMH 水平升高。这些发现令人惊讶，如果得到证实，将具有重要的临床意义。然而，在这些报告导致临床实践的系统改变之前，我们敦促谨慎行事，并建议紧急复制，因为将大的内异囊肿与高血清 AMH 水平联系起来的发现似乎在生物学上是不合理的，并且与现有的大量研究相矛盾。
