Does the anti-Mullerian hormone truly reflect ovarian response in women with endometrioma?

In this study, our aim was to determine which factor is more correlated with the number of oocytes retrieved in patients with endometrioma compared with controls undergoing in vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI) cycles: antral follicle count (AFC) or anti-Mullerian hormone (AMH). A total of 60 women with endometrioma and a control population of 60 women without endometrioma in the same period were randomly selected underwent the injection IVF-ICSI treatment. No significant differences were found between the groups in terms of age (28.783.49 vs. 29.522.47, p=.187), body mass index (23.622.05 vs. 23.91 +/- 2.11, p=.449), duration of infertility [(3 (2-4) vs. 3 (2-3), p=.139)], AMH level (1.52 +/- 0.51 vs. 1.32 +/- 0.92, p=.133), duration of stimulation [(9 (9-10) vs. 10 (9-10), p=.135)], total gonadotropin dose [(2750 (2262.5-3337.5) vs. 2770 (2680-3562.5), p=.125)], endometrial thickness [(10 (10-11) vs. 10 (9-11), p=.463)], fertilisation rates (67.20 +/- 18.04 vs. 62.28 +/- 17.13, p=.123), grade I embryo (43.3% vs. 30%, p=.185), clinical pregnancy rates (40% vs. 26.7%, p=.123), and the perinatal outcomes between the groups. The AFC was higher in the controls than in those with endometrioma (9.20 +/- 1.80 vs. 6.32 +/- 2.04, p<.001). The number of oocytes retrieved was also higher in the controls than in those with endometrioma [(7 (6-8) vs. 4 (4-5.75), p<.001)]. We found that women with endometrioma had a significantly lower number of oocytes retrieved than the controls despite the same AMH levels in both groups. AFC is a better marker of ovarian response than AMH in women with endometrioma undergoing IVF-ICSI.Impact statementWhat is already known on this subject? Utilising the ovarian reserve is important in the success of ovarian stimulation and in evaluating the success of assisted reproductive technologies. The anti-Mullerian hormone (AMH) level and the antral follicle count (AFC) are widely used in the prediction of ovarian functional reserve and response. However, no perfect marker exists in the evaluation of ovarian reserve and ovarian response.What do the results of this study add? Our study demonstrated that women with endometrioma have a significantly lower number of oocytes retrieved than the controls, despite the same AMH levels in both groups; which strongly suggests that AFC is a better reflection of ovarian response than AMH in women with endometrioma undergoing an in vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI).What are the implications of these findings for clinical practice and/or further research? This important issue has been reviewed and discussed for years, however, the conclusions are still controversial. Additional research is needed to understand which ovarian reserve test could better predict ovarian response outcome?