ArticleScientific reports2026
The paradoxical association between endometrioma size and serum anti-Müllerian hormone levels in infertile women.
Article in Scientific reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The impact of endometrioma size on ovarian reserve remains controversial. Although endometriomas are known to reduce anti-Müllerian hormone (AMH) levels, some studies suggest a paradoxical association between larger cysts and higher AMH. This cross-sectional study enrolled 210 infertile women between January 2023 and March 2025: 150 with laparoscopy-confirmed untreated unilateral endometriomas and 60 controls with male-factor infertility and normal ovaries. Serum AMH, follicle-stimulating hormone, luteinizing hormone, and prolactin were measured on cycle day 3. Endometrioma diameter was measured by transvaginal ultrasound. AMH levels were compared across cyst size categories (≤ 30 mm, 31-50 mm, > 50 mm) using one-way analysis of variance and multiple linear regression, adjusting for age and follicle-stimulating hormone. Mean AMH levels did not differ significantly between the endometrioma and control groups (2.24 ± 1.90 vs. 2.38 ± 1.45 ng/mL; p = 0.30). Within the endometrioma cohort, AMH increased with cyst size (F = 4.98, p = 0.008): 1.72 ± 1.26 ng/mL (≤ 30 mm), 2.23 ± 1.78 ng/mL (31-50 mm), and 2.70 ± 1.69 ng/mL (> 50 mm). Post hoc analysis showed significantly higher AMH in cysts > 50 mm compared with ≤ 30 mm (p = 0.01). In multivariable regression analysis, cyst diameter independently predicted AMH levels (β = 0.031, p < 0.001). Larger endometriomas were paradoxically associated with higher AMH levels. Interpretation of AMH in women with endometriomas should be context-dependent, and clinical decisions regarding ovarian reserve should not rely solely on cyst size or AMH values.
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