Diminished Ovarian Reserve in Advanced Endometriosis: Prevalence, Clinical Predictors, and Patient Awareness of Fertility Preservation

Background & Objective: Advanced endometriosis is recognized as a potential cause of Diminished Ovarian Reserve (DOR), yet data on its prevalence, predictors, and patient awareness in Central Asia are scarce. The present study was conducted with aim to determine the prevalence of DOR, identify its clinical predictors, and assess awareness of fertility preservation among women with moderate-to-severe endometriosis in Uzbekistan.Materials & Methods: This cross-sectional analytical study was conducted from March to September 2025 at tertiary care centers in Tashkent, Uzbekistan. The study enrolled 180 women aged 25-38 years with surgically confirmed stage III-IV endometriosis. Ovarian reserve was assessed via serum Anti-Müllerian Hormone (AMH), Antral Follicle Count (AFC), and day-3 Follicle-Stimulating Hormone (FSH). Clinical and sonographic data were collected, and participants completed a validated questionnaire on fertility preservation knowledge and attitudes. Data were analyzed using SPSS software (Version 28.0) and Spearman’s correlation, multivariate linear regression, and Mann-Whitney U tests. P<0.05 was considered significant.Results: The prevalence of DOR was 33.9% based on AMH (<1.1 ng/mL) and 26.7% based on AFC (<5). The cohort's median AMH was 1.6 ng/mL (IQR: 0.8-2.5) and median AFC was 7 (IQR: 4-11). Significant negative correlations were found between AMH and age (r=-0.42, P<0.001), endometrioma size (r=-0.24, P=0.002), and rASRM stage (r=-0.29, P<0.01). Multivariate analysis identified age (β=-0.11, P<0.001) and endometrioma size >3cm (β=-0.65, P=0.001) as independent predictors of lower AMH. Despite the high prevalence of DOR, only 18.3% of participants were aware of oocyte cryopreservation, with high cost (65.6%) and lack of information (47.2%) as major barriers.Conclusion: A significant proportion of women with advanced endometriosis exhibit DOR, driven primarily by age and large endometriomas. A critical gap exists between clinical risk and patient awareness of fertility preservation. These findings advocate for the routine integration of ovarian reserve testing and early tailored fertility counseling into the standard management protocol for endometriosis.