Ovarian Reserve
We found increased day 3 FSH and AMH level and decreased AFC level in CC group. All these factors are related with ovarian reserve. Also AFC was found as the only independent factor related with cycle cancellation. These findings clearly indicated that decreased ovarian reserve, especially decreased AFC is related with high possibility of cycle cancellation independent of endometriosis subtypes.
There is a study analyzing the poor response and cycle cancellations according to AMH levels during different days of menstrual cycle. The results indicated that day3 AMH level below 0.3 ng/ml predicts high risk of CC with 70% sensitivity and 90% specificity. In our study we found AMH level 0.5 (0.01 – 10) ng/ml in CC group. (It was 1.9 (0.01 – 10) ng/ml in ETC group) All these findings indicated that poor ovarian reserve is related with increased risk of CC in ERI.
It is clearly known that AFC is a good predictor of ovarian response even in ovary with endometrioma.. In our study AFC was found the only independent prognostic factor related with CC. (OR:0.81, CI:0.70:0.93) This result shows the importance of AFC for assessing ovarian reserve and to predict cycle cancellation.
Previously in our prospective ERROR (Endometrioma Related Reduction in Ovarian Reserve) study, we evaluated that endometrioma is associated with progressive decline in ovarian reserve than normal healthy women.(17) In another study done in our department related to oocyte quality in endometriosis showed that endometriosis negatively affects the oocyte morphology but not pregnancy rates. In this study, patients were divided in two groups, as male factor and endometriosis. Of the abnormal oocytes determined in all cycles, 59.1% of oocytes were in endometriosis group and 40.9% of oocytes in male factor group. The difference was statically significance. (7)
In our study, we formed a new classification for cycle cancellation. Type A ; inefficient ovarian response, Type B; fertilization failure, Type C; maturation arrest. As our results, we found CCR 9.1% as Type A, 54,6% as Type B, 36,3% as Type C. We may say that the main reason of cancellation is the fertilization problem with 54%. The results show that presence of endometriosis negatively effects ovarian quality while decreasing ovarian reserve. And if a patient with endometriosis has a poor ovarian reserve, the risk of cycle cancellation is higher than the ones with normal ovarian reserve independently of the subtypes of endometriosis