P-337 Does Endometriosis Have More Detrimental Effect on Ovarian Reserve in the Presence of Autoimmunity? A Prospective Observational Study
Authors: Nerimanova C , Aslan K , Kasapoglu I , Uncu G 
Published: June 2023

Abstract

Study question
Is the coexistence of autoimmunity more harmful to ovarian reserve in endometriosis patients?

Summary answer
The presence of autoimmunity does have additional harm to ovarian reserve in patients with endometriosis.

What is known already
It is known that endometriosis has a negative impact on ovarian reserve via different pathways. The presence of inflammation, increased reactive oxygen substances, and iron deposits in ovarian endometrioma have detrimental effects on the ovarian reserve. Although endometriosis was reported to have co-incidence with immunologic disorders up to 50%, there is not enough publication to assess the impact of autoimmunity on ovarian reserve in endometriosis.

Study design, size, duration
A prospective observational study including 100 women with endometriosis was performed between January 2022 and January 2023 in the endometriosis center of a tertiary university hospital.

Participants/materials, setting, methods
Patients who were diagnosed with endometriosis, under age 40, without confirmed systemic disease, enrolled in the study. All patients were assessed by physical examination and routine ultrasound check. Endometriosis diagnosis was based on that assessment or verified previous surgery. The blood samples were collected from all patients. Serum anti-mullerian hormone (AMH) and immunologic panel tests (anti-nuclear antibody profile, lupus anticoagulant antibody, thyroid antibodies) were analyzed.

Main results and the role of chance
A total of 99 patients were enrolled in the analysis (one patient was excluded because of missing parameters). Patients were divided into two groups depending on the presence of any autoimmune antibody. There were 58 patients with negative test (autoimmune (-) group) and 41 patients with at least one positive antibody (autoimmune (+) group). The demographic parameters, including age, fertility situation, abuse, pain scores, endometrioma diameter, and laterality, were similar between the groups. The anti-mullerian hormone levels were significantly lower in the autoimmune (+) group, (Respectively with interquartile ranges; 2.2 ng/ml (0.6-5.3) vs. 0.9 ng/ml (0.19-3.6), p = 0.01) When the results were adjusted according to the age and surgical history, the significant negative effect of autoimmunity on the ovarian reserve disappeared (p = 0.156).

Limitations, reasons for caution
The lack of sufficient studies in this area makes our results important. The small sample size and lack of subgroup analysis depending on different autoimmune diseases limit the study's strength.

Wider implications of the findings
This observational study revealed that almost half of the endometriosis patients have autoimmunity. However, the results supported the existing data; the impact of autoimmunity on ovarian reserve in endometriosis is a novel research field, and the present study suggests it should be further investigated in endometriosis patients.

Trial registration number
Not Applicable