الفهرس 
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Abstract
One of the important issues for in vitro fertilization-embryo transfer (IVF-ET) is to decrease the occurrence of multiple pregnancies without decreasing the success rate. This implies the need to obtain oocytes that are of a good quality for fertilization and implantation.
Endometriosis is a disease defined by the presence of endometrial glands and stroma located outside the uterine cavity. These ectopic implants can be found throughout the pelvis, on and within the ovaries, abutting the uterine ligaments, occupying the rectovaginal septum, invading the intestinal serosa, and along the parietal peritoneum. Endometrial implantation at distant sites such as the pleura, lung, within surgical scars, and along the diaphragm also has been reported.
Anti-Mullerian hormone (AMH) or Mullerian-inhibiting substance (MIS) is a glycoprotein hormone of the transforming growth factor beta (TGF-β) family with a molecular weight of 140 kD.
The possible relationship between AMH production by an individual follicle and its functional quality (i.e. follicle aptitude to release an oocyte able to become a developing embryo) remains to be demonstrated. Indeed, previous studies conducted in different species such as the rat the sheep and humans have shown that granulosa cells from atretic follicles fail to express AMH.
This prospective study was performed in assisted reproductive technology unit in Ain Shams maternity hospital in the period between (2012-2015). The aim was to compare serum basal and follicular fluid levels of Anti-Mullerian hormone as a predictor of Intra-cytoplasmic sperm injection (ICSI) outcome in patients with and without endometriosis. This study included 70 patients: 30 of them were diagnosed to have endometriosis by laparoscopic examination and 40 non endometriotic control group. Ovarian hyperstimulation protocol was performed according to a long GnRh agonist protocol starting from midlueteal phase. Then samples were collected from serum and dominant follicles.
Serum samples from each patient were obtained at the time of ovum pick up and follicular fluid was pooled from the retrieved follicles. Both samples were centrifuged to separate the cellular contents and debris. Serum and Follicular fluid AMH levels were measured by enzyme-linked immunosorbent assay kit.
The mean age of women in the control and endometriotic groups was similar. The range in both groups was (25-35) to minimize age effect on AMH level as AMH seems to show continuous decline in the oocyte / follicle pool with age. There was no significant difference between the two groups regarding BMI and the mean BMI was below 30 kg/m2 in both groups.
Women with endometriosis had lower amounts of AMH in serum and follicular fluid as compared with the control group. The reduction of serum AMH level in endometriotic patients is more than the reduction of follicular AMH. This denotes that the main cause of that reduction is reduced follicle number rather than decreased per follicle secretion.
Highly significant correlations between serum and follicular fluid concentrations of AMH were also found. Also a wider range of AMH was found in follicular fluid than in serum in both endometriotic and control groups. This may be explained by the fact that measured AMHff was pooled from several follicles varied in number from patient to patient. AMHs & AMHff levels showed a stronger correlation with total number of follicles in control group more than in endometiotic group
There is no significant correlation between both AMHs and AMHff levels with number of embryos available for transfer in both groups. Also there is no relation found between both AMHs and AMHff levels with biochemical pregnancy test in both groups
It was concluded that in endometriosis there is both quantitative & qualitative oocytes dysfunction with a less favorable ICSI outcome. Numerous studies including this study had confirmed the utility of AMH level as a predictor of quantitative function of oocytes in ICSI. However data on the utility of AMH level as a predictor of qualitative function of oocytes in ICSI are still contradictory necessitating further studies to elucidate that utility.