Does preoperative antimüllerian hormone level influence postoperative pregnancy rate in women undergoing surgery for severe endometriosis?

Objective: To compare postoperative pregnancy rates as they relate to presurgery antim€ullerian hormone (AMH) level in patients with stage 3 and 4 endometriosis. Design: Retrospective comparative study using data prospectively recorded in the North-West Inter-Regional Female Cohort for Patients with Endometriosis (CIRENDO) database. Setting: University tertiary referral center. Patient(s): One hundred eighty patients with stage 3 and 4 endometriosis and pregnancy intention, managed from June 2010 to March 2015, were divided into two groups according to their preoperative AMH levels: group A (AMH R2 ng/mL) and group B (AMH<2 ng/mL). Intervention(s): Surgical procedure involved ovarian endometrioma ablation by plasma energy along with resection of various localizations of the disease. Postoperative conception was either spontaneous or used assisted reproductive technology, depending on patient characteristics. Main Outcome Measure(s): Patient characteristics, preoperative symptoms, infertility history, intraoperative findings, and probability of pregnancy were recorded and compared between the two groups. Result(s): Among 180 women enrolled in the study, 134 (74.4%) were assigned to group A and 46 (25.6%) to group B. The women's ages were, respectively, 303.8 and 324.6 years. Pregnancy was achieved by 134 (74.4%) patients, and conception was spontaneous in 74 of them (55.2%). Pregnancy rates in groups A and B were, respectively, 74.6% (100 women) and 73.9% (34 women), while spontaneous conception represented 54% (54 women) and 58.8% (20 women). The probability of pregnancy at 12, 24, and 36 months after surgery in groups A and B was comparable, respectively, 65% (95% confidence interval [CI], 55%–75%), 77% (95% CI, 86%–68%), and 83% (95% CI, 90%–75%) versus 50% (95% CI, 69%–34%), 77% (95% CI, 90%–61%), and 83% (95% CI, 94%–68%). Supplementary analysis in women with normal (R2 ng/mL), low (1–1.99 ng/mL), and very low (