Медицинский совет (Apr 2021)
Hormonal profile of patients with deep infiltrative endometriosis
Abstract
Introduction. About 30 to 50% of women with endometriosis complain of infertility. The incidence of infertility in all localizations of endometriosis is about 3-4 times higher than that in the general population.Objective of the study: estimate the hormonal profile of patients with deep infiltrative endometriosis (DIE) based on the study of the level of AMH, FSH, LH, progesterone, estradiol, prolactin in the serum of peripheral blood, conduct a comparative analysis of the level of these hormones between groups of patients with DIE and tuboperitoneal infertility.Materials and methods: the main study group consisted of 99 patients of reproductive age (from 18 to 40 years) with DIE, the comparison group consisted of 18 patients with tuboperitoneal infertility. The patients of the main group were divided into 2 subgroups: subgroup IA - DIE with colorectal endometriosis (n = 63), subgroup IB - DIE without colorectal endometriosis (n = 36). AH patients underwent determination of the level of AMH, LH, FSH, progesterone, estradiol, prolactin in the serum of peripheral blood before surgery.Results and discussion: a significant decrease in AMH level was revealed in patients with DIE. The level of AMH in the main and comparison groups was 1.80 and 3.28 ng/ml, respectively (p = 0.01). At the same time, subgroup IA has a more decreased AMH level (1.37 ng/ml) than in the comparison group (p = 0.003). In subgroup IB (the median AMH level - 2.50 ng/ml) were no significant differences with the comparison group (p = 0.14). It was also noted that in the group of patients with colorectal endometriosis (subgroup IA) the percentage of patients with reduced ovarian reserve (AMH 0.01 - 1.0 ng / ml) was significantly higher than in the comparison group (30.2% versus 5, 6%, p = 0.03), there were no significant differences between the subgroups. There were no significant differences in the level of LH, FSH, E2, prolactin in serum between the groups (p> 0.05).Assessment of the level of anti-mullerian hormone, as the most accurate marker of ovarian reserve, revealed a significant decrease in AMH levels in patients with DIE, more decreased in the group of patients with colorectal endometriosis. Every 3rd patient with DIE had an AMH level of less than 1, which is a risk factor for a “poor” response to ovarian stimulation according to the Bologna criteria.Conclusion. A significant decrease in the level of serum AMH, along with a high percentage of previous surgeries for endometriosis, including ovarian resections, may be one of the factors in a decrease in the reproductive potential of patients with DIE.
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