We greatly appreciate the letter to the editor written by Xu et al discussing potential mechanisms, future research directions, and clinical implications of the findings from our manuscript. We agree with the authors that inflammation could be a potential mechanism through which endometriosis lesions, independent of surgical intervention, could reduce antimüllerian hormone (AMH) levels. Indeed, future research should integrate measurements of inflammation in addition to serum AMH levels. We also concur with their suggestion of using a more inclusive endometriosis typology to disentangle the association between endometriosis lesion location and serum AMH levels. Furthermore, we agree there could be benefit in future studies that evaluate the effect of endometriosis treatment on serum AMH longitudinally.

Xu et al also introduce salient ideas on how to incorporate these findings into clinical practice. They raise the important question of whether or not routine AMH testing should be incorporated into endometriosis care. AMH is a relatively low-cost, low-burden test that has a good predictive value for ovarian response to controlled ovarian stimulation. In our study, we observed that AMH levels were lower among those with ovarian endometriomas that had not experienced infertility; therefore, future research should investigate the utility of AMH testing in all endometriosis patients who are trying to achieve pregnancy regardless of history of infertility. However, we caution against using AMH as a single marker of ovarian reserve and future work should also incorporate additional measures for ovarian function such as antral follicular count to inform patient counseling.

Thank you to Xu et al for their detailed suggestions on potential mechanisms and suggestions for future research. We appreciate the discussion surrounding clinical implications and look forward to further suggestions on how to incorporate these findings into clinical practice.

References

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