Endometriosis, autoimmunity and ovarian reserve: a research note

Souza, Alex Sandro Rolland; Ferreira, Maria Eduarda Rodrigues; Gomes, Rafaella Carvalho; Rios, Sofia Valença; Chacon, Victor de Oliveira; Viana, Maria Alice Bastos; Notaro, Adriana Leal Griz

doi:10.1590/1806-9304202520240276-en

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RESEARCH NOTE • Rev. Bras. Saude Mater. Infant. 25 • 2025 • https://doi.org/10.1590/1806-9304202520240276-en linkcopy

Endometriosis, autoimmunity and ovarian reserve: a research note

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives: to assess ovarian reserve in women with endometriosis according to the presence of antithyroid antibodies.

Methods: retrospective cross-sectional study conducted in assisted reproduction clinics in Recife, Brazil, from February 2017 to August 2021. Women aged 18-49 years with endometriosis and recorded measurements of anti-TPO and/or anti-Tg, anti-Müllerian hormone (AMH), and antral follicle count (AFC) were included. Women with other causes of diminished ovarian reserve were excluded. Numerical variables were compared using the Mann-Whitney test, with p<0.05 considered significant.

Results: of 83 eligible women, 48 were analyzed: 14 (29.2%) antibody-positive and 34 (70.8%) negative. Age and body mass index were similar between groups. No significant differences were found in TSH or free T4 levels. Median AMH was 0.66 ng/mL in the positive group and 1.37 ng/mL in the negative group (p=0.09), and AFC was 7.5 vs. 10.0, respectively (p=0.41).

Conclusions: among women with endometriosis, a high prevalence of thyroid autoantibodies was observed. There were no statistically significant differences in ovarian reserve markers between groups, although a trend toward lower AMH values was seen among antibody-positive participants. Future studies with larger samples may confirm or modify these findings.

Key words
Hashimoto disease; Autoimmune thyroiditis; Ovarian reserve; Fertility; Endometriosis; Autoimmunity

Variable	Anticorpos antitireoidianos		PR (95%CI)	p
Variable	Positive (N=14)	Negative (N=34)	PR (95%CI)	p
Age, years (Med; IQR)	37.5; 36.0 - 40.0	37.0; 35.0 - 39.0	-	0.51*
BMI, kg/m² (Med; IQR)	25.4; 22.90 - 27.81	24.61; 21.80 - 26.70	-	0.34*
Infertility (n; %)
Yes	11; 78.57	29; 85.29	0.92 (0.68 - 1.25)	0.67**
No	3; 21.43	5; 14.71
Autoimmune diseases (n; %)
Yes	0; 0	2; 5.88	-	1.00**
No	14; 100.0	32; 94.12
Overt hypothyroidism (n; %)
Yes	2; 14.29	1; 2.94	4.86 (0.48-49.35)	0.20**
No	12; 85.71	33; 97.06

Variable	Antithyroid antibodies		PR (95%CI)	p
Variable	Positive (N=14)	Negative (N=34)	PR (95%CI)	p
TSH mIU/L (Med; IQR)	2.03; 1.0 - 2.86	2.09; 1.5 - 2.5	-	0.52*
FT4 ng/dL (Med; IQR)	1.18; 1.0 - 1.22	1.13; 1.04 - 1.29	-	0.75*
AMH ng/ml (Med; IQR)	0.66; 0.39 - 1.49	1.37; 0.7 - 2.5	-	0.09*
AFC (Med; IQR)	7.5; 4 - 11	10; 5 - 19	-	0.41*
Anti-TPO IU/ml (n; %)	11; 78.57	-	-	-
Anti-Tg IU/ml (n; %)	6; 42.86	-	-	-

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Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
E-mail: revista@imip.org.br

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[TFN1] ^*
Mann-Whitney Test;

[TFN2] ^**
Fisher’s Exact Test; BMI= body mass index; Med= Median; IQR= interquartile range; PR= Prevalence Ratio; CI= Confidence Interval.