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