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. 2020 Dec 17;9(12):4076.
doi: 10.3390/jcm9124076.

Affected Ovary Relative Volume: A Novel Sonographic Predictor of Ovarian Reserve in Patients with Unilateral Endometrioma-A Pilot Study

Stefano Cosma  1 , Andrea Roberto Carosso  1 , Martina Moretto  2 , Fulvio Borella  2 , Domenico Ferraioli  3 , Marialuisa Bovetti  2 , Fiammetta Gervasoni  2 , Claudia Filippini  3 , Alberto Revelli  1 , Simone Ferrero  4 , Chiara Benedetto  1
Affiliations

Affected Ovary Relative Volume: A Novel Sonographic Predictor of Ovarian Reserve in Patients with Unilateral Endometrioma-A Pilot Study

Stefano Cosma et al. J Clin Med. .

Abstract

Background: The assessment of ovarian reserve in the case of endometrioma is of pivotal importance for planning a tailored management. However, both the antral follicle count (AFC) and the antimüllerian hormone (AMH) dosage are subject to a fair degree of variability in ovarian endometriosis. This study aimed to identify a sonographic parameter of ovarian reserve that could implement current available markers in patients with unilateral endometrioma.

Methods: Patients with unilateral endometrioma admitted to our Endometriosis Center between March 2018 and April 2019 were enrolled. Transvaginal ultrasonography for the evaluation of eight sonographic indicators and AMH level determination were performed. The relationship between AMH level and each indicator was assessed.

Results: Thirty-four women were included. There was a positive significant correlation between AMH level and the healthy ovary AFC (HO-AFC) (r = 0.36 p = 0.034). A stronger, negative correlation between AMH level and the ratio between the volume of the affected and the healthy ovary (affected ovary relative volume, AORV) (r = -0.47; p = 0.005) was evidenced. AORV had a satisfactory accuracy (AUC 0.73; CI 0.61-0.90; p = 0.0008), and the cut-off value of 5.96 had the best balance of sensitivity/specificity in distinguishing between patients with a good ovarian reserve (AMH ≥ 2 ng/mL) and those at risk of ovarian reserve depletion after excisional surgery.

Conclusion: AORV may be a useful tool to assess ovarian reserve in patients with unilateral endometrioma without previous surgery and to guide physicians in clinical management.

Keywords: antimüllerian hormone; antral follicle count; endometrioma; endometriosis; fertility; ovarian reserve; premature ovarian failure; ultrasonography.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Schematic diagram of the four absolute sonographic indicators. Brown circle: Endometrioma; dotted red line: Measure line; grey circle: Antral follicle; pink oval: Contralateral healthy ovary.
Figure 2
Figure 2
Schematic diagram of the four relative sonographic indicators. Brown circle: Endometrioma; dotted red line: Measure line; pink oval: Contralateral healthy ovary; white oval: Affected ovary.
Figure 3
Figure 3
Scatterplots of the four absolute sonographic indicators. Pearson’s correlation coefficient (r) testing the strength of the association between the independent variable (antimüllerian hormone (AMH) level) and the dependent variables (indicators), ranging from −1 to +1. EV: endometrioma volume; HO-AFC: healthy ovary AFC; HOV: healthy ovary volume; mean endometrioma diameter (MED)
Figure 4
Figure 4
Scatterplots of the four relative sonographic indicators. Pearson’s correlation coefficient (r) testing the strength of the association between the independent variable (AMH level) and the dependent variables (indicators), ranging from −1 to +1. AORS: affected ovary relative size; AORV: affected ovary relative volume; ERV1: endometrioma relative volume 1; ERV2: endometrioma relative volume 2
Figure 5
Figure 5
Affected ovary relative volume (AORV) receiver operating characteristic (ROC) curve at the antimüllerian hormone (AMH) cut-off of 2 ng/mL. Red star, AORV cut-off value of 5.96.
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