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Anti-M�¼llerian Hormone (AMH) testing prior to endometrioma surgery in reproductive age women not seeking assisted fertility care: a cross-sectional survey of current clinical practice in the United Kingdom

Sarah Wali, Akanksha Garg, Kate Maclaran, Amer Raza and Robert Richardson

Objective: To evaluate current practice amongst gynaecologists in the United Kingdom with regards to measuring serum Anti-Müllerian Hormone (AMH) prior to endometriod cystectomy in women who are not seeking assisted reproduction.

Study Design: Cross-sectional survey. Practising gynaecologists (n= 121) from 67 endometriosis centres across the United Kingdom were sent an online survey. The main outcome of interest was to determine the proportion of gynaecologists who have access to AMH testing, perform pre and post-operative AMH testing in National Health Service (NHS) and Private practice, and considerations of other patient risk factors for testing. Both quantitative and qualitative data analysis was conducted where appropriate.

Results: 43% (n=52) responses were received from consultants working at 58% (n=39) British Society of Gynaecological Endoscopy (BSGE) endometriosis centres across the UK. 79% (n=41) of consultants routinely counsel patients preoperatively regarding the impact of endometrioma surgery on ovarian reserve, whilst 17% (n=9) of consultants will counsel patients if their family is incomplete. 4% (n=2) of consultant’s report not counselling patients regarding the above. 50% (n=26), 21% (n=11) and 21% (n=11) reported preoperative AMH testing to be desirable, mandatory (important medico-legally) or not useful (not evidenced based) respectively. Our results showed an association between access to AMH testing and its routine use; 69% (n= 35) with access to testing will routinely test preoperatively.

Conclusion: There is widespread pre and postoperative AMH testing in this patient group in NHS and Private practice. If there is access to the test, consultants are likely to consider it as mandatory or desirable (p<.05). Only 21% consultants view this test as not evidenced or useful. The use of AMH is strictly in the management of the infertile woman as levels in women without infertility do not correlate with fertility potential or the time to pregnancy. AMH should not be used to predict fertility or onset of menopause in women not diagnosed with infertility.