Chung Yun Soo, Choi Euna, Baek Jin Kyung, Kim Heeyon, Yun Bo Hyon
Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
J Clin Med. 2025 Jun 25;14(13):4495. doi: 10.3390/jcm14134495.
: As the population of women with endometriosis increases, approximately 10% of those of reproductive age experience symptoms such as pelvic pain, painful menstruation, and infertility. Individuals with endometriosis usually undergo multiple surgeries due to the high recurrence rate of the condition. However, ovarian surgery tends to reduce the ovarian reserve, presenting a dilemma when deciding whether to recommend surgery or medical treatment for women of reproductive age. The impact of endometriomas on the residual volume of ovarian tissue remains controversial, and it is unclear whether endometriosis itself or endometriomas are the primary problem. In this study, we aimed to investigate whether women with endometriosis have lower levels of anti-Müllerian hormone than women with healthy ovaries before treatment initiation. : A total of 298 participants enrolled in the endometriosis cohort at Severance Hospital, Korea, from 1 October 2020 to 1 July 2024 were included in this study. Of these, 63 participants were from a retrospective study, and 235 were from a prospective study. Due to the use of different assay methods between the reference values and anti-Müllerian hormone measurements from Severance Hospital, a correction was applied using the regression equation. The mean anti-Müllerian hormone levels for individuals with endometriosis were corrected with the regression equation and compared to those of the reference group for each age group using a one-sample -test. : Anti-Müllerian hormone levels decreased with age in the endometriosis group. When comparing mean anti-Müllerian hormone concentrations between the endometriosis group and reference values, among 168 participants aged 20-31 years, the corrected mean anti-Müllerian hormone concentration was 5.96 ± 3.22 ng/mL, higher than the reference value of 4.94 ± 0.17 ng/mL ( < 0.01). Among 31 participants aged 35-37 years, the corrected average anti-Müllerian hormone value was 4.33 ± 3.06 ng/mL, compared to the reference anti-Müllerian hormone level of 3.22 ± 0.15 ng/mL ( = 0.05). There were no significant differences in corrected anti-Müllerian hormone levels between the 32-34-, 38-40-, 41-43-, and ≥44 years age groups. : Patients with endometriosis, especially those aged 20-31 years, tended to have higher anti-Müllerian hormone levels than did individuals with healthy ovaries. In other age groups, there were no differences. Given that these levels do not differ significantly across age groups, it is difficult to conclude that patients with endometriosis have a reduced ovarian reserve.
随着子宫内膜异位症女性患者数量的增加,约10%的育龄女性会出现盆腔疼痛、痛经和不孕等症状。由于该病复发率高,子宫内膜异位症患者通常需要接受多次手术。然而,卵巢手术往往会降低卵巢储备,这给决定对育龄女性推荐手术还是药物治疗带来了两难困境。卵巢子宫内膜异位囊肿对卵巢组织残余量的影响仍存在争议,目前尚不清楚是子宫内膜异位症本身还是卵巢子宫内膜异位囊肿是主要问题。在本研究中,我们旨在调查子宫内膜异位症女性在开始治疗前抗苗勒管激素水平是否低于卵巢健康女性。
本研究纳入了2020年10月1日至2024年7月1日在韩国Severance医院子宫内膜异位症队列中登记的298名参与者。其中,63名参与者来自回顾性研究,235名来自前瞻性研究。由于Severance医院参考值与抗苗勒管激素测量采用了不同的检测方法,因此使用回归方程进行了校正。使用单样本t检验,用回归方程校正子宫内膜异位症患者的平均抗苗勒管激素水平,并与各年龄组的参考组进行比较。
子宫内膜异位症组中,抗苗勒管激素水平随年龄下降。在比较子宫内膜异位症组与参考值之间的平均抗苗勒管激素浓度时,在168名年龄在20 - 31岁的参与者中,校正后的平均抗苗勒管激素浓度为5.96±3.22 ng/mL,高于参考值4.94±0.17 ng/mL(P<0.01)。在31名年龄在35 - 37岁的参与者中,校正后的平均抗苗勒管激素值为4.33±3.06 ng/mL,与参考抗苗勒管激素水平3.22±0.15 ng/mL相比(P = 0.05)。在32 - 3�、38 - 40、41 - 43和≥44岁年龄组中,校正后的抗苗勒管激素水平无显著差异。
子宫内膜异位症患者,尤其是20 - 31岁的患者,其抗苗勒管激素水平往往高于卵巢健康的个体。在其他年龄组中,没有差异。鉴于这些水平在各年龄组之间没有显著差异,很难得出子宫内膜异位症患者卵巢储备减少的结论。