assessment of ovarian reserve and the impact of medical and surgical management on ovarian reserve in women with endometriosis

Ovarian reserve is determined by non-growing primordial follicles in the ovary. These follicles determine the reproductive potential of women. Age is one of the main determinants of ovarian reserve and fertility but other factors like surgery, medications, chemotherapy and radiation can reduce the ovarian reserve. Some of the other biochemical markers are follicle stimulating hormone (FSH), Anti mullerian hormone (AMH), Inhibin B. An ultrasound marker for ovarian reserve is antral follicle count (AFC). Laparoscopic ovarian cystectomy is one of the modalities of treating endometriosis and other benign ovarian cysts in young women to preserve fertility. There is some evidence that ovarian reserve is reduced in women with endometriosis per se and after ovarian cystectomy for endometriosis. The intention of the present study is to assess the ovarian reserve in women with endometriosis at diagnosis prior to intervention using cycle day2 FSH, AMH and inhibin B and on follow-up. Then women will be counseled for management options depending on the severity of the disease, pain symptoms and desire for pregnancy. After the management plan is decided for medical or surgical intervention; For those who are planned for medical management will have a follow-up at 4 weeks for AMH level and at 12 weeks for both AMH and inhibin B. For those who get surgery, they will also have follow-up at 4 weeks for AMH level and at 12 weeks for both AMH and inhibin B. The two groups will be compared for the observed changes in biochemical indicators of ovarian reserve. Detailed methodology in the F1 form attached