Antral follicle count is reduced in the presence of endometriosis: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational studies
PubMed 33168492 · doi:10.1016/j.rbmo.2020.09.014
What was done
A systematic review and meta-analysis of 15 studies evaluating the relationship between endometriosis and ovarian reserve markers. Nine studies compared antral follicle count (AFC) between patients with and without endometriosis, five compared AFC between the affected and contralateral unaffected ovary in patients with unilateral ovarian endometriosis, and one study evaluated both scenarios. Secondary markers assessed included anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH).
What was found
The abstract reports directions of effect without numerical values, effect sizes, or confidence intervals. Patients with endometriosis showed a significant decrease in AFC and AMH and a significant increase in serum FSH compared to controls. AFC was significantly lower in ovaries with endometriomas compared to contralateral unaffected ovaries. AFC did not differ significantly from controls in early-stage disease or when ovaries were not directly involved.
Why it matters
This review indicates that diminished ovarian reserve in endometriosis is driven primarily by ovarian endometriomas and advanced-stage disease rather than early non-ovarian disease, informing fertility counseling and clinical management.
Limits
The abstract reports no numerical effect sizes, confidence intervals, or total participant sample sizes. The underlying studies are observational, introducing potential confounding from age, prior surgical excision, and operator variability in antral follicle counting.
Cited by
- supports Endometriosis reduces ovarian reserve (egg count) and egg quality.
- supports PCOS and endometriosis diminish both ovarian egg count and egg quality.