Journal of Innovative Clinical Trials and Case Reports

Abstract

Background: Endometriosis is associated with infertility and may compromise ovarian reserve. However, the relationship between disease severity and ovarian reserve remains incompletely defined.

Objective: To assess the association between endometriosis severity and preoperative ovarian reserve markers among infertile women.

Methods: This analytical cross-sectional study included 80 infertile women with laparoscopically confirmed endometriosis at hospitals in Babil, Iraq, between March 2025 and September 2026. Disease severity was classified using the revised American Society for Reproductive Medicine (rASRM) staging system. Serum anti-Müllerian hormone (AMH) was measured before surgery, and antral follicle count (AFC) was assessed using early follicular-phase transvaginal ultrasonography. Demographic characteristics, infertility characteristics, and ovarian reserve markers were compared across stages using one-way analysis of variance and the chi-square test.

Results: Participants had a mean age of 31.2 ± 5.7 years. Stage I, II, III, and IV disease occurred in 20%, 33.8%, 30.0%, and 16.3%, respectively. Age, body mass index, infertility duration, and infertility type did not differ significantly across stages (all p>0.05). Mean AMH concentrations across stages I–IV were 3.1 ± 1.3, 2.6 ± 1.2, 1.8 ± 1.0, and 1.2 ± 0.8 ng/mL, respectively (p<0.001). Corresponding total AFC values were 14.2 ± 5.3, 12.5 ± 5.1, 9.1 ± 4.6, and 7.2 ± 3.2 (p<0.001). Right and left ovarian AFC also differed significantly across stages (both p<0.001).

Conclusion: Higher rASRM stage was associated with lower preoperative AMH and AFC. These findings support individualised ovarian reserve assessment and fertility counselling, particularly in advanced endometriosis. Longitudinal studies are needed to clarify causality and reproductive implications.