(103) Plasma Anti-Müllerian Hormone Concentrations in Adolescents and Young Adults with Endometriosis

Background: Endometriosis is associated with infertility. A key component of reproductive potential is ovarian reserve as assessed by anti-Müllerian hormone (AMH). We examined AMH levels in adolescents and young adults (AYA; < 25y) with and without surgically-confirmed endometriosis to elucidate early indication of diminished ovarian reserve (DOR), and assess differences in AMH related to demographics, pain symptoms, and age at diagnosis.

Methods: We measured plasma AMH [ultra-sensitive ELISA (ANSH Labs); study-specific CV=5.5%] in 442 AYA (254 with endometriosis, 188 without) from the Women’s Health Study from Adolescence to Adulthood. Participants completed an expanded WERF EPHect survey capturing demographics, severity/frequency of pain subtypes, and medication use. AMH values were square root transformed to achieve a normal distribution. We used linear regression (adjusted for age at blood draw, hormone use within 30 days, race, BMI) to compare mean AMH levels with 95% confidence intervals (CI) by endometriosis status and by pelvic pain characteristics separately among cases and controls. We assessed heterogeneity (p-het) by case status using the Wald test statistic. This study was IRB approved.

Results: Plasma AMH [mean 4.54 ng/mL (IQR 2.66-6.88)] was not significantly different between AYA with and without endometriosis [mean=4.63 (CI=4.53, 4.73) vs. 5.29 ng/mL (5.17, 5.41), p=0.11]. For AYA with endometriosis, AMH was higher in those experiencing dysmenorrhea often/usually [6.22 (5.80, 6.64)] and always [4.56 (4.41, 4.72)] compared to never/occasional [2.49 (2.05, 2.92)] (p=0.01). No such trend was seen in those without endometriosis (p=0.89; p-het=0.01). Among AYA with endometriosis experiencing acyclic pain, mean AMH was lowest in those with severe [3.95 (3.83, 4.08)] compared to moderate [5.86 (5.62, 6.11)] and mild [(4.49 (4.05, 4.93)] acyclic pain (p=0.01); this trend was not seen in those without endometriosis (p=0.38). Among AYA with endometriosis, AMH levels increased with older age at diagnosis (p=0.02). Among those age ≤ 15y at diagnosis, mean AMH was 3.59 (3.44, 3.74); AMH was 5.28 (5.03, 5.52) for those ≥ 19y at diagnosis (p=0.02). AMH levels were not associated with age at symptom onset.

Conclusions: AYA with endometriosis do not have significantly different plasma AMH levels compared to AYA without endometriosis. This finding suggests young patients with endometriosis do not have an early indication of DOR. The lower AMH levels in those with younger age of endometriosis diagnosis or symptom onset merits further study to elucidate whether an aberrant menarchal and hormonal milieu may drive earlier symptoms and concern for DOR.