Is coexistence of autoimmunity more ruinous on ovarian reserve in endometriosis? A prospective observational study

Objective: To determine the incidence of autoimmunity in women with endometriosis and examine whether autoimmunity has any additional negative effects on ovarian reserve beyond the influence of endometriosis alone. Design: The study included women with endometriosis from January 2022 to January 2023. All enrolled patients underwent physical examinations and routine ultrasound checks. The diagnosis of endometriosis was established based on these assessments or confirmed by prior surgeries. Blood samples were collected from the participants, including measuring serum anti-Müllerian hormone (AMH) levels and an immunologic panel that comprised tests for anti-nuclear antibody profile, lupus anticoagulant antibody, and thyroid antibodies. A total of 104 patients were included in the analysis, divided into two groups based on the presence of autoimmune antibodies. Results: The study revealed 56 patients with negative test results (autoimmune (−) group) and 48 patients with at least one positive antibody (autoimmune (+) group), yielding an overall autoimmunity rate of 46%. Demographic parameters were comparable between the two groups. The autoimmune (+) group exhibited significantly lower levels of anti-Müllerian hormone, with respective interquartile ranges of 0.8 ng/ml (0.2–3.2) versus 1.7 ng/ml (0.6–4.8) in the autoimmune (-) group ( p = 0.01). Conclusions: The present study disclosed that almost half of the endometriosis patients tested positive for autoimmune antibodies. The observed rate of autoimmunity aligned with existing data. However, exploring the impact of autoimmune antibodies on ovarian reserve in endometriosis is a relatively new research avenue. This pilot study suggests that the presence of autoimmunity may have a more detrimental effect on ovarian reserve in endometriosis.