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Tan Z, Gong X, Wang CC, Zhang T, Huang J. Diminished Ovarian Reserve in Endometriosis: Insights from In Vitro, In Vivo, and Human Studies-A Systematic Review. Int J Mol Sci 2023; 24:15967. [PMID: 37958954 PMCID: PMC10647261 DOI: 10.3390/ijms242115967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Endometriosis, a prevalent disorder in women of reproductive age, is often associated with undesired infertility. Ovarian reserve, an essential measure of ovarian function that is crucial for maintaining fecundity, is frequently diminished in women with endometriosis. Though the causative relationship between endometriosis and reduced ovarian reserve is not fully understood due to the lack of standardized and precise measurements of ovarian reserve, there is ongoing discussion regarding the impact of interventions for endometriosis on ovarian reserve. Therefore, in this review, we investigate articles that have related keywords and which were also published in recent years. Thereafter, we provide a comprehensive summary of evidence from in vitro, in vivo, and human studies, thereby shedding light on the decreased ovarian reserve in endometriosis. This research consolidates evidence from in vitro, in vivo, and human studies on the diminished ovarian reserve associated with endometriosis, as well as enhances our understanding of whether and how endometriosis, as well as its interventions, contribute to reductions in ovarian reserve. Furthermore, we explore potential strategies to modify existing therapy options that could help prevent diminished ovarian reserve in patients with endometriosis.
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Affiliation(s)
- Zhouyurong Tan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.T.); (X.G.); (C.C.W.)
| | - Xue Gong
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.T.); (X.G.); (C.C.W.)
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital, The Chinese University of Hong Kong, Shenzhen 518172, China
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.T.); (X.G.); (C.C.W.)
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Chinese University of Hong Kong-Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Reproduction and Development, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tao Zhang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.T.); (X.G.); (C.C.W.)
| | - Jin Huang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.T.); (X.G.); (C.C.W.)
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital, The Chinese University of Hong Kong, Shenzhen 518172, China
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2
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Hagen CP, Fischer MB, Mola G, Mikkelsen TB, Cleemann LH, Gravholt CH, Viuff MH, Juul A, Pedersen AT, Main KM. AMH and other markers of ovarian function in patients with Turner syndrome - a single center experience of transition from pediatric to gynecological follow up. Front Endocrinol (Lausanne) 2023; 14:1173600. [PMID: 37455919 PMCID: PMC10339808 DOI: 10.3389/fendo.2023.1173600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
Turner syndrome (TS) is a chromosomal disorder that affects about 1 in 2500 female births and is characterized by the partial or complete absence of the second X chromosome. Depending on karyotype, TS is associated with primary ovarian insufficiency (POI). Approximately 50% of girls with a mosaic 45, X/46, XX karyotype may enter puberty spontaneously, but only 5-10% of women with TS achieve pregnancy without egg donation. In this review, we will evaluate the clinical use of markers of ovarian function in TS patients. Based on longitudinal studies of serum concentrations of reproductive hormones as well as ovarian morphology in healthy females and patients with TS, we will evaluate how they can be applied in a clinical setting. This is important when counseling patients and their families about future ovarian function essential for pubertal development and fertility. Furthermore, we will report on 20 years of experience of transition from pediatric to gynecological and adult endocrinological care in our center at Rigshospitalet, Copenhagen, Denmark.
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Affiliation(s)
- Casper P. Hagen
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Rigshospitalet, Denmark
| | - Margit Bistrup Fischer
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Rigshospitalet, Denmark
| | - Gylli Mola
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Rigshospitalet, Denmark
| | - Theis Bech Mikkelsen
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Rigshospitalet, Denmark
| | - Line Hartvig Cleemann
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Rigshospitalet, Denmark
| | - Claus Højbjerg Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Diabetes and Endocrine Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Mette H. Viuff
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anette Tønnes Pedersen
- Department of Gynecology, The Fertility Clinic, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Katharina Maria Main
- Department of Growth and Reproduction, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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3
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Goux HJ, Vu BV, Wasden K, Alpadi K, Kumar A, Kalra B, Savjani G, Brosamer K, Kourentzi K, Willson RC. Development of a quantitative fluorescence lateral flow immunoassay (LFIA) prototype for point-of-need detection of anti-Müllerian hormone. Pract Lab Med 2023; 35:e00314. [PMID: 37181647 PMCID: PMC10172895 DOI: 10.1016/j.plabm.2023.e00314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/27/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Objective Anti-Müllerian Hormone (AMH) is a quantitative marker for ovarian reserve and is used to predict response during ovarian stimulation. Streamlining testing to the clinic or even to the physician's office would reduce inconvenience, turnaround time, patient stress and potentially also the total cost of testing, allowing for more frequent monitoring. In this paper, AMH is used as a model biomarker to describe the rational development and optimization of sensitive, quantitative, clinic-based rapid diagnostic tests. Design and Methods We developed a one-step lateral-flow europium (III) chelate-based fluorescent immunoassay (LFIA) for the detection of AMH on a portable fluorescent reader, optimizing the capture/detection antibodies, running buffer, and reporter conjugates. Results A panel of commercial calibrators was used to develop a standard curve to determine the analytical sensitivity (LOD = 0.41 ng/ml) and the analytical range (0.41-15.6 ng/ml) of the LFIA. Commercial controls were then tested to perform an initial evaluation of the prototype performance and showed a high degree of precision (Control I CV 2.18%; Control II CV 3.61%) and accuracy (Control I recovery 126%; Control II recovery 103%). Conclusions: This initial evaluation suggests that, in future clinical testing, the AMH LFIA will likely have the capability of distinguishing women with low ovarian reserve (<1 ng/ml AMH) from women with normal (1-4 ng/ml AMH) ovarian reserve. Furthermore, the LFIA demonstrated a wide linear range, indicating the assay's applicability to the detection of other health conditions such as PCOS, which requires AMH measurement at higher concentrations (>6 ng/ml).
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Affiliation(s)
- Heather J. Goux
- Department of Biology and Biochemistry, University of Houston, Houston, TX, USA
| | - Binh V. Vu
- William A. Brookshire Department of Chemical and Biomolecular Engineering, University of Houston, Houston, TX, USA
| | - Katherine Wasden
- William A. Brookshire Department of Chemical and Biomolecular Engineering, University of Houston, Houston, TX, USA
| | | | | | | | | | - Kristen Brosamer
- Department of Biomedical Engineering, University of Houston, Houston, TX, USA
| | - Katerina Kourentzi
- William A. Brookshire Department of Chemical and Biomolecular Engineering, University of Houston, Houston, TX, USA
| | - Richard C. Willson
- Department of Biology and Biochemistry, University of Houston, Houston, TX, USA
- William A. Brookshire Department of Chemical and Biomolecular Engineering, University of Houston, Houston, TX, USA
- Department of Biomedical Engineering, University of Houston, Houston, TX, USA
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
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4
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Wong E, Ng EHY, Li RHW, Ko JKY. Comparing the intercycle variation of serum anti-Mullerian hormone and antral follicle count measurements over four consecutive menstrual cycles. Clin Endocrinol (Oxf) 2023; 98:394-399. [PMID: 36325996 DOI: 10.1111/cen.14843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/21/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the intercycle variation of serum anti-Mullerian hormone (AMH) and antral follicle count (AFC) measurements over four consecutive menstrual cycles. DESIGN Observational study with secondary analysis using data from two previous randomized controlled trials. PATIENTS Seventy-eight women from two previous randomized trials on the effect of dehydroepiandrosterone pretreatment on ovarian response in women undergoing in vitro fertilization (IVF) treatment. MEASUREMENTS The intraclass correlation coefficients (ICC) for AFC and AMH across the four study cycles, as well as their predictive performance on poor ovarian response, were compared. RESULTS No significant difference was observed in AMH (p = .608) across the four study cycles. AFC was significantly higher at 4 weeks before ovarian stimulation compared with 0, 8 and 12 weeks before ovarian stimulation (p < .05, Conover posthoc test). Both single-measures and average-measures ICC were significantly higher with AMH than with AFC. The areas under the receiver operating characteristic curve of the four AFC measurements in predicting poor ovarian response (defined as three or less oocytes retrieved) in the IVF cycle ranged from 0.657 to 0.743 with no significant difference (p > .05) among the four cycles, whereas those of the four AMH measurement ranged from 0.730 to 0.780 with no significant difference (p > .05) among the four cycles. CONCLUSIONS Although both AFC and AMH are good predictors of ovarian response, intercycle repeatability was significantly better with serum AMH than AFC measurement. Both have no significant difference in their predictive performance on poor ovarian response when assessed within three months before IVF treatment, hence allowing pre-IVF assessment at more flexible timing.
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Affiliation(s)
- Evelyn Wong
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong
| | - Ernest H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong
| | - Raymond H W Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong
| | - Jennifer K Y Ko
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong
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5
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Wu M, Guo Y, Wei S, Xue L, Tang W, Chen D, Xiong J, Huang Y, Fu F, Wu C, Chen Y, Zhou S, Zhang J, Li Y, Wang W, Dai J, Wang S. Biomaterials and advanced technologies for the evaluation and treatment of ovarian aging. J Nanobiotechnology 2022; 20:374. [PMID: 35953871 PMCID: PMC9367160 DOI: 10.1186/s12951-022-01566-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/17/2022] [Indexed: 12/26/2022] Open
Abstract
Ovarian aging is characterized by a progressive decline in ovarian function. With the increase in life expectancy worldwide, ovarian aging has gradually become a key health problem among women. Over the years, various strategies have been developed to preserve fertility in women, while there are currently no clinical treatments to delay ovarian aging. Recently, advances in biomaterials and technologies, such as three-dimensional (3D) printing and microfluidics for the encapsulation of follicles and nanoparticles as delivery systems for drugs, have shown potential to be translational strategies for ovarian aging. This review introduces the research progress on the mechanisms underlying ovarian aging, and summarizes the current state of biomaterials in the evaluation and treatment of ovarian aging, including safety, potential applications, future directions and difficulties in translation.
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Affiliation(s)
- Meng Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Yican Guo
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Simin Wei
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Liru Xue
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Weicheng Tang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Dan Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Jiaqiang Xiong
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Yibao Huang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Fangfang Fu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Chuqing Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Ying Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Su Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Jinjin Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Yan Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Wenwen Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China. .,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China. .,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China.
| | - Jun Dai
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China.,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China. .,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China. .,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China.
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Benderradji H, Barbotin AL, Leroy-Billiard M, Prasivoravong J, Marcelli F, Decanter C, Robin G, Mitchell V, Rigot JM, Bongiovanni A, Sauve F, Buée L, Maurage CA, Cartigny M, Villers A, Prevot V, Catteau-Jonard S, Sergeant N, Giacobini P, Pigny P, Leroy C. Defining Reference Ranges for Serum Anti-Müllerian Hormone on a Large Cohort of Normozoospermic Adult Men Highlights New Potential Physiological Functions of AMH on FSH Secretion and Sperm Motility. J Clin Endocrinol Metab 2022; 107:1878-1887. [PMID: 35396994 PMCID: PMC9202722 DOI: 10.1210/clinem/dgac218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Few studies to date have attempted to measure serum anti-Müllerian hormone (AMH) levels in adult men, and solid references ranges have not yet been defined in a large cohort. OBJECTIVE In this study, we aimed, first, to establish the reference ranges for serum AMH and AMH-to-total testosterone ratio (AMH/tT) in adult males. Second, we investigated the relationship between serum AMH and both reproductive hormones and semen parameters. METHODS This single-center retrospective study included 578 normozoospermic adult men. Serum AMH concentrations were determined with an automated sandwich chemiluminescent immunoassay. RESULTS The median serum AMH was 43.5 pmol/L. The 2.5th and 97.5th percentile values for serum AMH and AMH/tT were 16.4 and 90.3 pmol/L and 0.45 and 3.43, respectively. AMH was positively correlated with inhibin B and sperm concentration and negatively correlated with age, follicle-stimulating hormone (FSH), and progressive sperm motility. Interestingly, using immunofluorescence, we documented for the first time that AMH type II receptor (AMH-R2) is expressed in ejaculated human spermatozoa and gonadotrophic cells in the postmortem pituitary gland. CONCLUSIONS We establish a new age-specific reference range for serum AMH and AMH/tT. Moreover, AMH-R2 expression in human spermatozoa and gonadotrophic cells, together with the relationship between serum AMH levels and sperm motility or mean FSH levels, highlight new potential functions of AMH in regulating sperm motility or FSH secretion in adult men.
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Affiliation(s)
- Hamza Benderradji
- Hamza Benderradji, MD, PhD, Department of Andrology, Urology and Renal Transplantation, Claude Huriez Hospital, Lille University Hospital, 1 Place de Verdun 59045 Lille Cedex, France.
| | - Anne-Laure Barbotin
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
- Department of Reproductive Biology-Spermiology-CECOS, University of Lille, CHU Lille, Lille, France
| | - Maryse Leroy-Billiard
- Department of Endocrine Gynecology and Reproductive Medicine, University of Lille, CHU Lille, Lille, France
| | - Julie Prasivoravong
- Department of Andrology, Urology and Renal Transplantation, University of Lille, CHU Lille, Lille, France
| | - François Marcelli
- Department of Andrology, Urology and Renal Transplantation, University of Lille, CHU Lille, Lille, France
| | - Christine Decanter
- Department of Endocrine Gynecology and Reproductive Medicine, University of Lille, CHU Lille, Lille, France
| | - Geoffroy Robin
- Department of Andrology, Urology and Renal Transplantation, University of Lille, CHU Lille, Lille, France
- Department of Endocrine Gynecology and Reproductive Medicine, University of Lille, CHU Lille, Lille, France
| | - Valérie Mitchell
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
- Department of Reproductive Biology-Spermiology-CECOS, University of Lille, CHU Lille, Lille, France
| | - Jean-Marc Rigot
- Department of Andrology, Urology and Renal Transplantation, University of Lille, CHU Lille, Lille, France
| | - Antonino Bongiovanni
- University of Lille, Institut Pasteur de Lille, BioImaging Center Lille, Lille, France
| | - Florent Sauve
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
| | - Luc Buée
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
| | - Claude-Alain Maurage
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
- University of Lille, CHU Lille, Department of Pathological Anatomy, Lille, France
| | - Maryse Cartigny
- Department of Pediatric Endocrinology, DevGen, Reference Centre for Genital Development Abnormalities, University of Lille, CHU Lille, Lille, France
| | - Arnauld Villers
- Department of Andrology, Urology and Renal Transplantation, University of Lille, CHU Lille, Lille, France
| | - Vincent Prevot
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
| | - Sophie Catteau-Jonard
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
- Department of Endocrine Gynecology and Reproductive Medicine, University of Lille, CHU Lille, Lille, France
| | - Nicolas Sergeant
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
| | - Paolo Giacobini
- Lille Neuroscience & Cognition (UMR-S1172), CHU Lille, Inserm, University of Lille, Lille, France
| | | | - Clara Leroy
- Correspondence: Clara Leroy, MD, Department of Andrology, Urology and Renal Transplantation, Claude Huriez Hospital, Lille University Hospital, 1 Place de Verdun 59045 Lille Cedex, France.
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di Clemente N, Racine C, Pierre A, Taieb J. Anti-Müllerian Hormone in Female Reproduction. Endocr Rev 2021; 42:753-782. [PMID: 33851994 DOI: 10.1210/endrev/bnab012] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 12/26/2022]
Abstract
Anti-Müllerian hormone (AMH), also called Müllerian inhibiting substance, was shown to be synthesized by the ovary in the 1980s. This article reviews the main findings of the past 20 years on the regulation of the expression of AMH and its specific receptor AMHR2 by granulosa cells, the mechanism of action of AMH, the different roles it plays in the reproductive organs, its clinical utility, and its involvement in the principal pathological conditions affecting women. The findings in respect of regulation tell us that AMH and AMHR2 expression is mainly regulated by bone morphogenetic proteins, gonadotropins, and estrogens. It has now been established that AMH regulates the different steps of folliculogenesis and that it has neuroendocrine effects. On the other hand, the importance of serum AMH as a reliable marker of ovarian reserve and as a useful tool in the prediction of the polycystic ovary syndrome (PCOS) and primary ovarian failure has also been acknowledged. Last but not least, a large body of evidence points to the involvement of AMH in the pathogenesis of PCOS.
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Affiliation(s)
- Nathalie di Clemente
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France.,Institut Hospitalo-Universitaire ICAN, Paris, France
| | - Chrystèle Racine
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France.,Institut Hospitalo-Universitaire ICAN, Paris, France.,Sorbonne Paris Cité, Paris-Diderot Université, Paris, France
| | - Alice Pierre
- Sorbonne Paris Cité, Université Paris-Diderot, CNRS, INSERM, Biologie Fonctionnelle et Adaptative UMR 8251, Physiologie de l'Axe Gonadotrope U1133, Paris, France
| | - Joëlle Taieb
- Sorbonne Paris Cité, Université Paris-Diderot, CNRS, INSERM, Biologie Fonctionnelle et Adaptative UMR 8251, Physiologie de l'Axe Gonadotrope U1133, Paris, France
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8
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Li HWR, Robertson DM, Burns C, Ledger WL. Challenges in Measuring AMH in the Clinical Setting. Front Endocrinol (Lausanne) 2021; 12:691432. [PMID: 34108942 PMCID: PMC8183164 DOI: 10.3389/fendo.2021.691432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/11/2021] [Indexed: 11/13/2022] Open
Abstract
Serum anti-Mullerian hormone (AMH) is a widely used marker of functional ovarian reserve in the assessment and treatment of infertility. It is used to determine dosing of gonadotropins used for superovulation prior to in vitro fertilization, as well as to determine the degree of damage to ovarian reserve by cytotoxic treatments such as chemotherapy. AMH is also now used to predict proximity to menopause and potentially provides a sensitive and specific test for polycystic ovarian syndrome. Twenty one different AMH immunoassay platforms/methods are now commercially available. Of those compared, the random-access platforms are the most reliable. However, to date there has not been an agreed common international AMH reference preparation to standardize calibration between the various immunoassays. Recently, a purified human AMH preparation (code 16/190) has been investigated by the World Health Organization as a potential international reference preparation. However, this was only partially successful as commutability between it and serum samples was observed only in some but not all immunoassay methods. Development of a second generation reference preparation with wider commutability is proposed.
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Affiliation(s)
- Hang Wun Raymond Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - David Mark Robertson
- Discipline of Obstetrics & Gynaecology, School of Women’s & Children’s Health, University of New South Wales, Sydney, NSW, Australia
| | - Chris Burns
- Biotherapeutics Division, National Institute for Biological Standards and Control, Potters Bar, United Kingdom
| | - William Leigh Ledger
- Discipline of Obstetrics & Gynaecology, School of Women’s & Children’s Health, University of New South Wales, Sydney, NSW, Australia
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9
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Fu YX, Wang H, Hu T, Wang FM, Hu R. Factors affecting the accuracy and reliability of the measurement of anti-Müllerian hormone concentration in the clinic. J Int Med Res 2021; 49:3000605211016161. [PMID: 34044635 PMCID: PMC8165850 DOI: 10.1177/03000605211016161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We aimed to identify the factors that influence serum anti-Müllerian hormone (AMH) concentration measurements. METHODS We collected serum samples between May and September 2018 and compared the effect on AMH concentration measured by ELISA of conditions including venepuncture, storage time, storage temperature, locations of the reaction microplate, and the use of the oral contraceptive pill and gonadotrophin-releasing hormone (GnRH). RESULTS AMH concentration was not affected by food intake but was affected by haemolysis. It was also much higher in samples on the edge of the ELISA microtitre plate. AMH concentration increased after incubation at room temperature for 1 day, 4°C for 3 days, -20°C for 1 month and -40°C for 4 months, but no change occurred during storage at -80°C for 9 months. AMH concentration was high in patients following GnRH agonist treatment but was not affected by oral contraceptives. CONCLUSIONS No fasting is required prior to AMH measurement. Placement of serum samples on the edge of microtitre plates affects the results of the AMH ELISA. If serum samples cannot be assayed immediately, it is best to store them at -80°C. Basal AMH concentration cannot be used as a measure of ovarian reserve after GnRH agonist treatment.
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Affiliation(s)
- Yun-Xing Fu
- Ningxia Medical University, General Hospital of Ningxia Medical
University, Yinchuan, Ningxia, China
| | - Hui Wang
- Reproductive Medicine Center, Yinchuan Maternal and Child Health
Hospital, Yinchuan, Ningxia, China
| | - Ting Hu
- Gansu Province Maternity and Child-care hospital, Lan zhou,
Gansu, China
| | - Fei-Miao Wang
- Reproductive Medicine Center, Key Laboratory of Fertility
Preservation and Maintenance of Ministry of Education, Ningxia Medical
University, General Hospital of Ningxia Medical University, Yinchuan, Ningxia,
China
| | - Rong Hu
- Reproductive Medicine Center, Key Laboratory of Fertility
Preservation and Maintenance of Ministry of Education, Ningxia Medical
University, General Hospital of Ningxia Medical University, Yinchuan, Ningxia,
China
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10
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Peluso C, Oliveira RD, Laporta GZ, Christofolini DM, Fonseca FLA, Laganà AS, Barbosa CP, Bianco B. Are ovarian reserve tests reliable in predicting ovarian response? Results from a prospective, cross-sectional, single-center analysis. Gynecol Endocrinol 2021; 37:358-366. [PMID: 32613875 DOI: 10.1080/09513590.2020.1786509] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJETIVE Several biomarkers of ovarian reserve have been proposed as possible predictors of the response to controlled ovarian stimulation (COS). We aimed to evaluate age, FSH, AMH, antral follicle count (AFC), and ovarian response prediction index (ORPI), as potential predictors of response to COS. METHODS Cross-sectional study enrolling of 188 infertile women who underwent the first cycle of IVF/ICSI. AFC was evaluated; serum FSH and AMH levels were measured by ELISA. ORPI was calculated as AMH x AFC/patient´s age. RESULTS As expected, hypo-responder group had less retrieved oocytes, MII, and embryos compared to the good responders. The hyper-response patients were younger, with lower FSH, increased AMH, AFC, and ORPI values. Regarding the assessment of the predictive capacity of ovarian reserve tests, none of them individually or combined showed a good predictive capacity for hypo-response. With respect to the hyper-responder group, individually AMH was the best predictor, while in the multivariable model, ORPI demonstrated the best predictive capacity. Furthermore, patients with serum AMH < 2.09 ng/mL (p25) had fewer AFC than patients with higher AMH values. CONCLUSIONS Our findings suggest that none of the ovarian reserve tests showed a good predictive capacity for hypo-response, while the ORPI was the strongest predictor of hyper-response in normovulatory infertile women.
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Affiliation(s)
- Carla Peluso
- Discipline of Sexual and Reproductive Health, and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC, Santo André/SP, Brazil
| | - Renato de Oliveira
- Discipline of Sexual and Reproductive Health, and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC, Santo André/SP, Brazil
| | - Gabriel Zorello Laporta
- Program of Postgraduate, Research and Innovation, Faculdade de Medicina do ABC, Santo André/SP, Brazil
| | - Denise Maria Christofolini
- Discipline of Sexual and Reproductive Health, and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC, Santo André/SP, Brazil
| | | | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Caio Parente Barbosa
- Discipline of Sexual and Reproductive Health, and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC, Santo André/SP, Brazil
| | - Bianca Bianco
- Discipline of Sexual and Reproductive Health, and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC, Santo André/SP, Brazil
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11
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Bulletti C, Allegra A, Mignini Renzini M, Vaiarelli A. How fixed versus variable gonadotropin dose during controlled ovarian stimulation could influence the management of infertility patients undergoing IVF treatment: a national Delphi consensus. Gynecol Endocrinol 2021; 37:255-263. [PMID: 32588675 DOI: 10.1080/09513590.2020.1770214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
AIM Define how and when fixed starting gonadotropin doses can be used in current clinical ART practices in Italy. METHODS A Delphi conference consisting of three rounds was performed in order to define the ideal clinical conditions in which fixed-gonadotropin-dose during COS should be applied. During the conference, 19 statements about the current ART practice were provided to a panel of twenty-nine national experts. Median score was 5 (IQ:4-6) in all Delphi rounds. RESULTS Eleven statements (57.9%) were classified as shareable with high-degree of convergence, 2 (10.5%) as shareable with low convergence and 6 (31.6%) as un-shareable with high convergence. The panel reached high consensus regarding some statements: (i) fixed FSH-dose in normoresponders and poor-responder, (ii) importance of predicting ovarian response before COS, considering multiple markers to select the right stimulation protocol for each patient, (iii) importance of therapy simplification and standardization to improve efficiency during COS. Moreover, a low-convergence was reached about use of GnRH antagonist as first treatment line and drug storage at room temperature. However from these findings, the debate remains open regarding some other statements: (a) usefulness of Bologna-criteria to define poor-responders; (b) efficacy to change always stimulation protocol after a failure IVF; (c) utility of AMH-dosed with standardized automatic mode to define normo-responder patients; (d) usefulness to modify the dosage of 12.5 IU/die during COS to improve stimulation effectiveness. CONCLUSION Controlled ovarian stimulation remains a challenging clinical step in Assisted Reproductive Technique, especially in some specific patient groups for which no clinical consensus is available. This study is the first attempt to describe the shared clinical opinion regarding the fixed versus variable gonadotropin dose in the real IVF practice.
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Affiliation(s)
- Carlo Bulletti
- Ostetricia e Ginecologia, EXTRA OMNES Medicina e Salute Riproduttiva, Cattolica, Italy
| | | | | | - Alberto Vaiarelli
- GENERA Centers for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
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12
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Zhu X, Ni Y, Cheng M, Chen Q, Zhang A. Evaluation of a fluorescence flow cytometry reagent for anti-Müllerian hormone detection. Acta Biochim Biophys Sin (Shanghai) 2020; 52:1427-1429. [PMID: 33249447 DOI: 10.1093/abbs/gmaa122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Xiaobin Zhu
- Reproductive Medical Center, Department of Obstetrics and Gynecology of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Ying Ni
- Reproductive Medical Center, Department of Obstetrics and Gynecology of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Meiyu Cheng
- Reproductive Medical Center, Department of Obstetrics and Gynecology of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Qian Chen
- Reproductive Medical Center, Department of Obstetrics and Gynecology of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Aijun Zhang
- Reproductive Medical Center, Department of Obstetrics and Gynecology of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
- Department of Histo-Embryology, Genetics and Developmental Biology, Shanghai Key Laboratory of Reproductive Medicine, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
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13
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Tian Z, Zhang Y, Zhang C, Wang Y, Zhu HL. Antral follicle count is reduced in the presence of endometriosis: a systematic review and meta-analysis. Reprod Biomed Online 2020; 42:237-247. [PMID: 33168492 DOI: 10.1016/j.rbmo.2020.09.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/16/2020] [Accepted: 09/08/2020] [Indexed: 12/29/2022]
Abstract
Studies suggest that the presence of endometriosis may lead to impaired ovarian reserve, while results evaluating the changes in antral follicle count (AFC) in endometriosis remain controversial. A systematic search returned 15 studies, of which nine compared AFC between patients with and without endometriosis, five articles reported differences in AFC between affected and unaffected ovaries in patients with unilateral ovarian endometriosis and one reported both of the above two situations. Overall results showed a significant decrease in AFC and anti-Müllerian hormone (AMH) and increase in serum FSH concentrations in patients with endometriosis when compared with controls. Additionally, the AFC for the ovary with the endometrioma was also significantly lower than that of the contralateral ovary in patients with unilateral ovarian endometriosis. Moreover, it appears that the AFC in patients with endometriosis where the ovaries are not affected or in early stage were not significantly different in the control group. These findings demonstrate that endometriosis is associated with reduced AFC and AMH and elevated serum concentrations of FSH, suggesting a reduction in ovarian reserve in patients with endometriosis, especially in those with ovarian endometrioma and advanced stage.
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Affiliation(s)
- Zhao Tian
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing 100044, China
| | - Yang Zhang
- Department of Pediatrics, People's Hospital, Peking University, Beijing 100044, China
| | - Chen Zhang
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing 100044, China
| | - Yue Wang
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing 100044, China
| | - Hong-Lan Zhu
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing 100044, China.
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14
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Abstract
PURPOSE OF REVIEW Diminished ovarian reserve, in general, implies a quantitative decline in the oocyte pool. However, whether this quantitative decline is necessarily accompanied by a qualitative decline, remains to be determined. RECENT FINDINGS Studies of natural conception suggest that fecundity of women with a quantitative decline in ovarian reserve is similar to age-matched women with normal ovarian reserve. Data on rates of pregnancy loss and fetal chromosomal abnormality do not consistently suggest a decline in oocyte quality in women who has a lower ovarian reserve. In assisted reproductive technology (ART) cycles, oocytes from women with diminished ovarian reserve have similar potential for euploid blastocyst development. Likewise, available evidence does not strongly suggest an increased risk of pregnancy loss in women with diminished reserve undergoing ART treatment as compared with similarly aged woman with normal ovarian reserve. SUMMARY Quantitative decline in ovarian reserve may not be necessarily accompanied by a qualitative decline. Although a decreased number of follicles and poor response to ovarian stimulation are hallmarks of ovarian aging, younger women with diminished ovarian reserve may not be experiencing the distinct effects of aging on oocyte quality.
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15
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Wiles K, Anckaert E, Holden F, Grace J, Nelson-Piercy C, Lightstone L, Chappell LC, Bramham K. Anti-Müllerian hormone concentrations in women with chronic kidney disease. Clin Kidney J 2019; 14:537-542. [PMID: 33623676 PMCID: PMC7886554 DOI: 10.1093/ckj/sfz164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/23/2019] [Indexed: 01/01/2023] Open
Abstract
Background Serum anti-Müllerian hormone (AMH) is a biomarker of ovarian reserve. There are limited data to guide the clinical interpretation of AMH in women with chronic kidney disease (CKD). The purpose of this study was to examine AMH concentrations in women with CKD compared with women without CKD. Methods We conducted a prospective cohort study of serum AMH concentrations in 163 non-pregnant women with CKD. Serum AMH concentrations were compared with age-specific AMH centiles from 887 healthy female controls. Results Participants included 30 women with Stage 1 CKD, 37 women with Stage 2 CKD, 26 women with Stage 3a CKD, 31 women with Stage 3b CKD and 39 women with Stages 4 and 5 CKD. The median estimated glomerular filtration rate (eGFR) was 51 (interquartile range 31–80) mL/min/1.73 m2. Serum AMH concentrations were lower in all CKD stages compared with women without CKD. Women ages 20–24 years with CKD had comparable serum AMH concentrations (median 1.959 ng/mL) to women ages 35–39 years without CKD (median 1.995 ng/mL). There was no evidence that eGFR was an independent modifier of serum AMH concentrations. More than half of women with CKD (58%) were predicted to have a low response to gonadotrophin stimulation. Conclusions Women with CKD have a lower ovarian reserve and are predicted to have a lower ovarian response to gonadotrophin stimulation compared with women without CKD of a similar age. Women with CKD who fail to conceive within 6 months of regular unprotected intercourse should be considered for fertility assessment and intervention.
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Affiliation(s)
- Kate Wiles
- Department of Women and Children's Health, King's College London, London, UK.,Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Ellen Anckaert
- Laboratory of Hormonology and Tumour Markers, Universitair Ziekenhuis Brussel, Free University of Brussels, Brussels, Belgium
| | - Francesca Holden
- Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Jan Grace
- Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Catherine Nelson-Piercy
- Guy's and St Thomas NHS Foundation Trust, London, UK.,Imperial Healthcare NHS Trust, London, UK
| | - Liz Lightstone
- Imperial Healthcare NHS Trust, London, UK.,Faculty of Medicine, Centre for Inflammatory Disease, Imperial College London, London, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, King's College London, London, UK.,Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Kate Bramham
- Department of Women and Children's Health, King's College London, London, UK.,Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, UK
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16
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Volodarsky-Perel A, Cai E, Tulandi T, Son WY, Suarthana E, Buckett W. Influence of stage and grade of breast cancer on fertility preservation outcome in reproductive-aged women. Reprod Biomed Online 2019; 40:215-222. [PMID: 31953011 DOI: 10.1016/j.rbmo.2019.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/03/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
RESEARCH QUESTION Does breast cancer spread and aggressiveness affect fertility-preservation results? DESIGN Retrospective cohort study of women with breast cancer undergoing fertility-preservation treatment. INCLUSION CRITERIA age 18-38 years and use of gonadotrophin releasing hormone antagonist protocol; exclusion criteria: recurrent cancer, previous oncological treatment, previous ovarian surgery and known ovarian pathology. Stimulation cycle outcomes of women with low-stage breast cancer were compared with those with high-stage disease. Patients with low-grade (G1-2) were compared with those with high-grade (G3) malignancies. PRIMARY OUTCOME total number of mature oocytes; secondary outcomes: oestradiol level and number of follicles wider than 14 mm on the day of trigger, number of retrieved oocytes and cryopreserved embryos. RESULTS The final analysis included 155 patients. Patients with high-grade tumours (n = 80; age 32 years [28-35]) had significantly lower number of mature oocytes compared with patients with low-grade cancer (n = 75; age 32 years [28-35]; seven mature oocytes [4-10] versus 13 mature oocytes [7-17]; P = 0.0002). The number of cryopreserved embryos was also lower in the high-grade group (three [2-5] versus five [3-9]; P = 0.02). Stage-based analysis revealed a similar number of mature oocytes in high-stage (n = 73; age 32 years [28-35]) compared with low-stage group (n = 82; age 33 years [28-35]; eight mature oocytes [4-13] versus nine mature oocytes [7-15]; P = 0.06). CONCLUSIONS High-grade breast cancer has a negative effect on total number of mature oocytes and cryopreserved embryos.
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Affiliation(s)
- Alexander Volodarsky-Perel
- Department of Obstetrics and Gynecology, McGill University Health Centre, 888 Boul de Maisonneuve E #200, QC, Montréal H2L 4S8.
| | - Emmy Cai
- Department of Obstetrics and Gynecology, McGill University Health Centre, 888 Boul de Maisonneuve E #200, QC, Montréal H2L 4S8
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University Health Centre, 888 Boul de Maisonneuve E #200, QC, Montréal H2L 4S8
| | - Weon-Young Son
- Department of Obstetrics and Gynecology, McGill University Health Centre, 888 Boul de Maisonneuve E #200, QC, Montréal H2L 4S8
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University Health Centre, 888 Boul de Maisonneuve E #200, QC, Montréal H2L 4S8
| | - William Buckett
- Department of Obstetrics and Gynecology, McGill University Health Centre, 888 Boul de Maisonneuve E #200, QC, Montréal H2L 4S8
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17
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Garnett ER, Jariwala P, Rector K, Gibbons WE, Zarutskie PW, Devaraj S. Validation of the picoAMH assay on the Dynex DS2 platform. Pract Lab Med 2019; 17:e00140. [PMID: 31646166 PMCID: PMC6804432 DOI: 10.1016/j.plabm.2019.e00140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Anti-Müllerian hormone (AMH) is increasingly used as a biomarker of ovarian reserve in clinical practice, and is used both for management of fertility treatments and prediction of menopause. We sought to validate the newly FDA-approved Ansh Laboratories MenoCheck picoAMH ELISA on the Dynex-DS2 platform for clinical use in our obstetrics and gynecology center. DESIGN Validation of the picoAMH ELISA on the Dynex-DS2 was performed according to CLSI guidelines. Intra- and inter-assay CV, assay linearity, and method comparison studies were carried out to verify assay precision and accuracy. The manufacturer's reference range was verified using 26 volunteer samples, and interference for hemolysis, lipemia, icterus, and biotin was evaluated. picoAMH results were additionally correlated with antral follicle count by ultrasound. RESULTS Intra- and inter-assay CV of the picoAMH assay on the DS2 was ≤4% and the assay was linear between concentrations of 0.0067-16.24 ng/mL (0.048-116.0 pmol/L) AMH. Method comparison was performed with the manufacturer's laboratory and indicated good correlation, with Deming regression yielding slope of 0.928 and intercept of -0.0421. The assay displayed no significant interference from hemolysis (1000 mg/dL), lipemia (2000 mg/dL), conjugated bilirubin (66 mg/dL), or biotin (10,000 ng/mL). Measurement of AMH on the DS2 was also correlated with antral follicle count, with R = 0.7128. CONCLUSIONS Our results indicate that the picoAMH ELISA on the DS2 has good analytical performance suitable for clinical use.
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Affiliation(s)
- Emily R Garnett
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Purviben Jariwala
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Kesha Rector
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - William E Gibbons
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Paul W Zarutskie
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Sridevi Devaraj
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
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18
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Turner KA, Larson BJ, Kreofsky NC, Willrich MAV, Bornhorst JA, Algeciras-Schimnich A. Assessment of complement interference in anti-Müllerian hormone immunoassays. ACTA ACUST UNITED AC 2019; 58:e8-e10. [DOI: 10.1515/cclm-2019-0496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/14/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Katherine A. Turner
- Department of Laboratory Medicine and Pathology , Mayo Clinic , Rochester, MN , USA
| | - Bethany J. Larson
- Department of Laboratory Medicine and Pathology , Mayo Clinic , Rochester, MN , USA
| | - Nina C. Kreofsky
- Department of Laboratory Medicine and Pathology , Mayo Clinic , Rochester, MN , USA
| | | | - Joshua A. Bornhorst
- Department of Laboratory Medicine and Pathology , Mayo Clinic , Rochester, MN , USA
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19
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Gorkem U, Togrul C. Is There a Need to Alter the Timing of Anti-Müllerian Hormone Measurement During the Menstrual Cycle? Geburtshilfe Frauenheilkd 2019; 79:731-737. [PMID: 31303661 PMCID: PMC6620182 DOI: 10.1055/a-0840-3817] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction
There are numerous conflicting studies which have addressed the question whether the measurement of anti-Müllerian hormone (AMH) concentrations should be done at a certain time during the menstrual cycle. We aimed to investigate AMH fluctuations during the follicular and luteal phases of the menstrual cycle and to determine whether AMH variations, if present, might influence the clinical utility of ovarian reserve markers.
Materials and Methods
A total of 257 infertile women eligible for inclusion were categorized into three groups based on their total antral follicle count: 1. hypo-response group (< 7 follicles, n = 66), 2. normo-response group (7 – 19 follicles, n = 98), and 3. hyper-response group (> 19 follicles, n = 93).
Results
Mean follicular AMH levels were elevated compared to levels in the luteal phase in all response groups (p < 0.001). There were significant and strong positive correlations between follicular and luteal AMH levels in all response groups (Spearmanʼs r = 0.822, r = 0.836, and r = 0.899, respectively; p < 0.001 for all groups). Fisherʼs Z-test comparisons of these correlations in all response groups demonstrated that there was no statistically significant difference (Z = 0.277, Z = − 1.001, and Z = − 1.425, respectively; p < 0.001).
Conclusion
We found that serum AMH levels in the follicular phase were higher than those in the luteal phase in all three response groups. In current practice, fluctuations in serum AMH concentrations are not large enough to alter the timing of AMH measurements during the menstrual cycle. The issue is important for the assessment of ovarian reserve in infertile women with AMH levels near to the cut-off value.
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Affiliation(s)
- Umit Gorkem
- Hitit University Faculty of Medicine, Department of Obstetrics and Gynecology, Corum, Turkey
| | - Cihan Togrul
- Hitit University Faculty of Medicine, Department of Obstetrics and Gynecology, Corum, Turkey
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20
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Palinska-Rudzka KE, Ghobara T, Parsons N, Milner J, Lockwood G, Hartshorne GM. Five-year study assessing the clinical utility of anti-Müllerian hormone measurements in reproductive-age women with cancer. Reprod Biomed Online 2019; 39:712-720. [PMID: 31471141 DOI: 10.1016/j.rbmo.2019.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/03/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION An important discussion point before chemotherapy is ovarian toxicity, a side-effect that profoundly affects young women with cancer. Their quality of life after successful treatment, including the ability to conceive, is a major concern. We asked whether serum anti-Müllerian hormone (AMH) measurements before chemotherapy for two most common malignancies are predictive of long-term changes in ovarian reserve? DESIGN A prospective cohort study measured serum AMH in 66 young women with lymphoma and breast cancer, before and at 1 year and 5 years after chemotherapy, compared with 124 healthy volunteers of the same age range (18-43 years). Contemporaneously, patients reported their menses and live births during 5-year follow-up. RESULTS After adjustment for age, serum AMH was 1.4 times higher (95% CI 1.1 to 1.9; P < 0.02) in healthy volunteers than in cancer patients before chemotherapy. A strong correlation was observed between baseline and 5-year AMH in the breast cancer group (P < 0.001, regression coefficient = 0.58, 95% CI 0.29 to 0.89). No significant association was found between presence of menses at 5 years and serum AMH at baseline (likelihood ratio test from logistics regression analysis). CONCLUSIONS Reproductive-age women with malignancy have lower serum AMH than healthy controls even before starting chemotherapy. Pre-chemotherapy AMH was significantly associated with long-term ovarian function in women with breast cancer. At key time points, AMH measurements could be used as a reproductive health advisory tool for young women with cancer. Our results highlight the unsuitability of return of menstruation as a clinical indicator of ovarian reserve after chemotherapy.
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Affiliation(s)
- K E Palinska-Rudzka
- Warwick Medical School, University of Warwick Coventry CV4 7AL, UK; University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road Coventry CV2 2DX, UK
| | - T Ghobara
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road Coventry CV2 2DX, UK
| | - N Parsons
- Warwick Medical School, University of Warwick Coventry CV4 7AL, UK
| | - J Milner
- CARE Fertility Tamworth House, Ventura Park Road, Tamworth B78 3HL, UK
| | - G Lockwood
- CARE Fertility Tamworth House, Ventura Park Road, Tamworth B78 3HL, UK
| | - G M Hartshorne
- Warwick Medical School, University of Warwick Coventry CV4 7AL, UK; University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road Coventry CV2 2DX, UK.
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21
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Nelson SM, Larsson P, Mannaerts BMJL, Nyboe Andersen A, Fauser BCJM. Anti-Müllerian hormone variability and its implications for the number of oocytes retrieved following individualized dosing with follitropin delta. Clin Endocrinol (Oxf) 2019; 90:719-726. [PMID: 30801744 DOI: 10.1111/cen.13956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The stability of anti-Müllerian hormone (AMH) across and between menstrual cycles has been the subject of debate. The objective of this analysis was to study the inter- and intracycle variability in repeated measurements and assess the impact on an individualized gonadotropin dosing algorithm and predicted oocyte yield. DESIGN Retrospective analysis of repeat AMH measures from a randomized controlled trial. PATIENTS A total of 1326 women aged 18-40 years. MEASUREMENTS Serum AMH levels at screening and at cycle day 2-3 in up to three ovarian stimulation cycles. AMH variability and its impact on gonadotropin dose and the predicted number of oocytes. RESULTS Repeat serum AMH measurements were strongly correlated within individual women (correlation coefficient 0.92). AMH exhibited limited within-subject variation (coefficient of variation 23%), a small time-related decline (mean 6% decrease/y), but no systematic variation across the menstrual cycle. Irrespective of whether the AMH screening value or the AMH at the initiation of ovarian stimulation was used, for women with an AMH level <15 pmol/L, 93% would receive the same gonadotropin dose and attain an identical number of oocytes in 97% of cases. For women with an AMH level ≥15 pmol/L, 80% would receive an individualized dose within ±1.5 μg and 90% would attain ±1 oocyte. CONCLUSION AMH variability had limited impact on individualized gonadotropin dosing, with 95% of women predicted to obtain an oocyte yield that does not vary beyond 1 oocyte count, irrespective of whether a random or early follicular AMH measurement was used to determine the individualized gonadotropin dose.
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Affiliation(s)
| | - Per Larsson
- Biometrics - Global Clinical R&D, Ferring Pharmaceuticals, Copenhagen, Denmark
| | | | - Anders Nyboe Andersen
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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22
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Segawa T, Omi K, Watanabe Y, Sone Y, Handa M, Kuroda M, Miyauchi O, Osada H, Teramoto S. Age-specific values of Access anti-Müllerian hormone immunoassay carried out on Japanese patients with infertility: a retrospective large-scale study. BMC WOMENS HEALTH 2019; 19:57. [PMID: 31023297 PMCID: PMC6485128 DOI: 10.1186/s12905-019-0752-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 04/04/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The ovarian reserve in women is known to correlate with anti-Müllerian hormone (AMH) levels, and currently the latest, third-generation, fully-automated AMH immunoassays, such as Access and Cobas, are beginning to be used for measuring AMH levels. However, the age-specific reference values obtained for AMH levels have been based on samples from an American population, measured using first-generation immunoassays. In this study, we attempted to determine the age-specific AMH reference values based on a large set of samples taken from Japanese infertile women measured by Access so that they could be used by infertility centers treating Japanese and those with similar racial and life-style characteristics. METHODS The study included 5483 Japanese patients who enrolled in infertility treatment programs at two in-vitro fertilization centers, Shimbashi YUME Clinic and Natural ART Clinic Nihombashi in Tokyo, and who had their serum AMH levels measured between December 2015 and November 2017 by Access. Each patient was represented only once in the study. The mean, median, and standard deviation values were obtained from the measured values for single-year intervals from 28 through 48 years of age (21 age groups in total). The 3D-fitted curve of age-specific mean and median values measured by Access was obtained by regression analysis. RESULTS The mean and median values decreased with advancing age (mean: R2 = 0.9864; median: R2 = 0.9926). In all age groups, the mean values were higher than the median values; however, the differences between these values decreased with increasing age. CONCLUSIONS The age-specific AMH reference values measured by Access in this study may serve as a useful diagnostic marker in infertility centers, especially those treating Japanese patients or patients with similar characteristics.
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Affiliation(s)
- Tomoya Segawa
- Shimbashi YUME Clinic, Excel Shimbashi, 2-5-1, Shimbashi, Minato-ku, Tokyo, 105-0004, Japan.
| | - Kenji Omi
- Shimbashi YUME Clinic, Excel Shimbashi, 2-5-1, Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yoshiaki Watanabe
- Shimbashi YUME Clinic, Excel Shimbashi, 2-5-1, Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yaeko Sone
- Shimbashi YUME Clinic, Excel Shimbashi, 2-5-1, Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Masaki Handa
- Shimbashi YUME Clinic, Excel Shimbashi, 2-5-1, Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Masako Kuroda
- Natural ART Clinic Nihombashi, 8F Nihombashi Tower, 2-7-1 Nihombashi, Chuo-ku, Tokyo, 103-6028, Japan
| | - Osamu Miyauchi
- Natural ART Clinic Nihombashi, 8F Nihombashi Tower, 2-7-1 Nihombashi, Chuo-ku, Tokyo, 103-6028, Japan
| | - Hisao Osada
- Natural ART Clinic Nihombashi, 8F Nihombashi Tower, 2-7-1 Nihombashi, Chuo-ku, Tokyo, 103-6028, Japan
| | - Shokichi Teramoto
- Natural ART Clinic Nihombashi, 8F Nihombashi Tower, 2-7-1 Nihombashi, Chuo-ku, Tokyo, 103-6028, Japan
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23
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Yates AP, Jopling HM, Burgoyne NJ, Hayden K, Chaloner CM, Tetlow L. Paediatric reference intervals for plasma anti-Müllerian hormone: comparison of data from the Roche Elecsys assay and the Beckman Coulter Access assay using the same cohort of samples. Ann Clin Biochem 2019; 56:536-547. [PMID: 30889973 PMCID: PMC6688133 DOI: 10.1177/0004563219830733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Autoanalyser methods for the measurement of anti-Müllerian hormone have been
introduced into clinical laboratories but few reports of paediatric
reference intervals using these new assays have been published. Methods After prior evaluation of the Roche Elecsys anti-Müllerian hormone assay
against the Beckman Coulter modified second generation anti-Müllerian
Hormone enzyme-linked immunosorbent assay using samples from adult females,
a cohort of paediatric samples which had previously been assessed using the
Beckman Coulter Access anti-Müllerian hormone assay was analysed using the
Roche Elecsys anti-Müllerian hormone assay. Results The Roche Elecsys anti-Müllerian hormone assay measured significantly lower
than the Beckman Coulter modified second generation anti-Müllerian Hormone
enzyme-linked immunosorbent assay. In the paediatric cohort measured with
the Roche Elecsys assay, male levels are very high from birth to puberty
after which they fall towards postpubertal female levels. Male results were
similar to those previously obtained using the Beckman Coulter Access
anti-Müllerian hormone assay on the same cohort. Roche Elecsys
anti-Müllerian hormone in the females was very low in the neonatal and
prepubertal years and the postpubertal trend, with a steady rise from 15
years, was smoother than previously modelled using the Beckman Coulter
Access anti-Müllerian hormone assay. Conclusion Anti-Müllerian hormone levels measured with the Roche Elecsys assay were
significantly lower than the Beckman Coulter modified second generation
enzyme-linked immunosorbent assay suggesting the need for new reference
ranges. In the paediatric cohort, Roche Elecsys anti-Müllerian hormone
levels between boys and girls showed good prepubertal delineation and small
but statistically significant differences to previously measured levels
using the Beckman Coulter Access anti-Müllerian hormone assay on the same
sample cohort.
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Affiliation(s)
- Allen P Yates
- 1 Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen M Jopling
- 1 Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Katharine Hayden
- 1 Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Christopher M Chaloner
- 1 Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lesley Tetlow
- 1 Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK
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24
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Anckaert E, Denk B, He Y, Torrance HL, Broekmans F, Hund M. Evaluation of the Elecsys ® anti-Müllerian hormone assay for the prediction of hyper-response to controlled ovarian stimulation with a gonadotrophin-releasing hormone antagonist protocol. Eur J Obstet Gynecol Reprod Biol 2019; 236:133-138. [PMID: 30909009 DOI: 10.1016/j.ejogrb.2019.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/23/2018] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This non-interventional study aimed to validate a pre-specified anti-Müllerian hormone (AMH) cut-off of 15 pmol/L (2.10 ng/mL) for the prediction of hyper-response to controlled ovarian stimulation (COS) using the fully automated Elecsys® AMH immunoassay. STUDY DESIGN One hundred and forty-nine women aged <44 years with regular menstrual cycles underwent COS with 150 IU/day follicle-stimulating hormone in a gonadotrophin-releasing hormone (GnRH) antagonist protocol. Response to COS (poor vs normal vs hyper-response) was defined by number of oocytes retrieved and occurrence of ovarian hyper-stimulation syndrome (OHSS). RESULTS Significant differences were seen between response classes for the number of follicles prior to follicle puncture (p < 0.001), the number of retrieved oocytes (p < 0.001) and the occurrence of OHSS (p < 0.001), which were all highest in hyper-responders. The area under the receiver operating characteristic curve for AMH to predict hyper-response was 82.1% (95% confidence interval [CI]: 72.5-91.7). When applying the AMH cut-off of 15.0 pmol/L, a sensitivity of 81.3% (95%CI: 54.4-96.0) to predict hyper-response and a specificity of 64.7% (95%CI: 55.9-72.8) to identify poor/normal responders was reached. CONCLUSION The Elecsys® AMH assay can reliably predict hyper-response to COS in women undergoing a GnRH antagonist treatment protocol.
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Affiliation(s)
- Ellen Anckaert
- Laboratory of Hormonology and Tumour Markers, Universitair Ziekenhuis Brussel, Free University of Brussels, Brussels, Belgium.
| | | | - Ying He
- Roche Diagnostics GmbH, Penzberg, Germany
| | - Helen L Torrance
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Frank Broekmans
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Martin Hund
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
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25
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Younis JS, Shapso N, Fleming R, Ben-Shlomo I, Izhaki I. Impact of unilateral versus bilateral ovarian endometriotic cystectomy on ovarian reserve: a systematic review and meta-analysis. Hum Reprod Update 2019; 25:375-391. [DOI: 10.1093/humupd/dmy049] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/14/2018] [Accepted: 01/11/2019] [Indexed: 01/03/2023] Open
Affiliation(s)
- Johnny S Younis
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya, Israel
- Azrieili Faculty of Medicine, Galilee, Bar-Ilan University, Israel
| | - Nora Shapso
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya, Israel
| | | | - Izhar Ben-Shlomo
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya, Israel
- Azrieili Faculty of Medicine, Galilee, Bar-Ilan University, Israel
| | - Ido Izhaki
- Department of Evolutionary and Environmental Biology, University of Haifa, Haifa, Israel
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26
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Grynnerup AG, Løssl K, Pilsgaard F, Lunding SA, Storgaard M, Bogstad JW, Prætorius L, Zedeler A, Bungum L, Nyboe Andersen A, Pinborg A. Prediction of the lower serum anti-Müllerian hormone threshold for ovarian stimulation prior to in-vitro fertilization using the Elecsys® AMH assay: a prospective observational study. Reprod Biol Endocrinol 2019; 17:11. [PMID: 30634990 PMCID: PMC6330486 DOI: 10.1186/s12958-019-0452-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/03/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In assisted reproductive technology, prediction of treatment failure remains a great challenge. The development of more sensitive assays for measuring anti-Müllerian hormone (AMH) has allowed for the possibility to investigate if a lower threshold of AMH can be established predicting very limited or no response to maximal ovarian stimulation. METHODS A prospective observational multicenter study of 107 women, < 40 years of age with regular menstrual cycle and serum AMH levels ≤ 12 pmol/L, treated with 300 IU/day of HP-hMG in a GnRH-antagonist protocol. AMH was measured before treatment start using the Elecsys® AMH assay by Roche Diagnostics. The ability of AMH to predict follicular development and ovarian response was assessed by receiver operating characteristics (ROC). Furthermore, the relationship between AMH at start of stimulation and cycle outcome was investigated using multivariate logistic regression analysis. RESULTS Five out of 107 cycles (4.7%) were cancelled due to lack of follicular development and 60/107 (56%) women did not reach the classical hCG criteria for ovulation induction (≥ 3 follicles of ≥17 mm). An AMH threshold of 4 pmol/L predicted failure to reach the classical hCG criteria with 89% specificity and 53% sensitivity and an area under the curve (AUC) of 0.76 (95% CI 0.66-0.85). AMH predicted cycle cancellation due to lack of follicular development, using a cut-off value of 1.5 pmol/L, with a specificity of 96% and sensitivity of 80% (AUC = 0.92, 95% CI 0.79-1.00). A single-unit increase in AMH was associated with a 29% decrease in odds of failure to reach the classical hCG criteria (OR 0.71 95% CI 0.59-0.85, p < 0.01). The lowest AMH value compatible with a live birth was 1.3 pmol/L. CONCLUSIONS Among women with a limited ovarian reserve, pre-treatment serum AMH levels significantly predicted failure to reach the classical hCG triggering criteria and predicted lack of follicular development using a new sensitive assay, but AMH was not suitable for withholding fertility treatment, as even very low levels were associated with live births. TRIAL REGISTRATION Not relevant.
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Affiliation(s)
- A. G. Grynnerup
- 0000 0004 0646 8202grid.411905.8Fertility Clinic, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| | - K. Løssl
- grid.475435.4Fertility Clinic, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - F. Pilsgaard
- 0000 0004 0646 8202grid.411905.8Fertility Clinic, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| | - S. A. Lunding
- grid.475435.4Fertility Clinic, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - M. Storgaard
- 0000 0004 0646 8202grid.411905.8Fertility Clinic, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| | - J. W. Bogstad
- 0000 0004 0646 8202grid.411905.8Fertility Clinic, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
- grid.475435.4Fertility Clinic, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - L. Prætorius
- 0000 0004 0646 8202grid.411905.8Fertility Clinic, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| | - A. Zedeler
- 0000 0004 0646 8202grid.411905.8Fertility Clinic, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| | - L. Bungum
- 0000 0004 0646 8325grid.411900.dFertility Clinic, Copenhagen University Hospital Herlev, Herlev ringvej 75, DK-2730 Herlev, Denmark
| | - A. Nyboe Andersen
- grid.475435.4Fertility Clinic, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - A. Pinborg
- 0000 0004 0646 8202grid.411905.8Fertility Clinic, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
- grid.475435.4Fertility Clinic, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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Condorelli RA, Cannarella R, Calogero AE, La Vignera S. Evaluation of testicular function in prepubertal children. Endocrine 2018; 62:274-280. [PMID: 29982874 DOI: 10.1007/s12020-018-1670-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/01/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The assessment of testicular function is not currently performed in childhood. The aim of this review was to address the usefulness of serum Anti-Müllerian Hormone (AMH), inhibin B, and testicular volume (TV) evaluation in children. REVIEW Serum AMH and inhibin B levels reflect Sertoli cells (SCs) health and number, SCs maturation degree and their exposure to FSH and to intra-tubular testosterone (T). These hormones might be helpful in discriminating between congenital central hypogonadism (cHH) and constitutional delay in growth and puberty (CDGP) and in case of clinical suspicious of precocious puberty. Furthermore, low AMH and/or inhibin B levels have been observed in children with primary testicular disorders, suggesting the existence of SC dysfunction. TV also provides useful information on testicular health. Recently, a medical calculator, requiring testis length and the stage of genital development, has been developed to easily derive TV. CONCLUSIONS The evidence supports the usefulness of AMH, inhibin B and TV evaluation for the early diagnosis of puberty disorders and primary testicular damage. We suggest the measurement of TV by using the medical calculator in all children and to reserve AMH and inhibin B measurements to those cases of no testicular growth, clinical suspicious of puberty disorders or in children at risk for spermatogenesis damage. This work-up might allow the early detection of testicular tubular damage which, in turn, may be useful to prevent the oncoming male infertility in adulthood.
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Affiliation(s)
- Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", via S. Sofia 78, 95123, Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", via S. Sofia 78, 95123, Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", via S. Sofia 78, 95123, Catania, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", via S. Sofia 78, 95123, Catania, Italy.
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Jopling H, Yates A, Burgoyne N, Hayden K, Chaloner C, Tetlow L. Paediatric Anti-Müllerian Hormone measurement: Male and female reference intervals established using the automated Beckman Coulter Access AMH assay. Endocrinol Diabetes Metab 2018; 1:e00021. [PMID: 30815559 PMCID: PMC6354749 DOI: 10.1002/edm2.21] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/18/2018] [Accepted: 05/19/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Anti-Müllerian Hormone (AMH) concentration is high at birth in males, demonstrating the presence of functional testicular tissue in the prepubertal period, and acting as a useful marker in the investigation of paediatric reproductive disorders. AMH also provides a tool in the investigation of female virilization, premature ovarian failure and polycystic ovarian syndrome in childhood. Robust, assay-specific paediatric AMH reference intervals are therefore required for clinical interpretation of results. The aim of this study was to derive age-specific AMH reference intervals for males and females aged 0-18 years. DESIGN AND PATIENTS Plasma samples were obtained from patients at Royal Manchester Children's Hospital and analysed for AMH using the automated Beckman Coulter Access AMH Assay. Patients under investigation for paediatric reproductive or endocrine disorders were excluded from the study. MEASUREMENTS Seven hundred and 2 patient plasma samples (465 male, 237 female) were subject to AMH measurement, and results were analysed in order to derive continuous and discrete reference intervals for the paediatric age range. RESULTS Clear discrimination between male and female AMH results was evident in the prepubertal age range, with some overlap between the genders following pubertal onset. CONCLUSIONS We have derived age-related reference intervals for plasma AMH in the paediatric age range (0-18 years) using the automated Beckman Coulter Access AMH assay which will aid in the investigation of paediatric endocrine disorders such as disorders of sexual development.
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Affiliation(s)
- Helen Jopling
- Department of Clinical BiochemistryManchester University NHS Foundation TrustManchesterUK
| | - Allen Yates
- Department of Clinical BiochemistryManchester University NHS Foundation TrustManchesterUK
| | | | - Katharine Hayden
- Department of Clinical BiochemistryManchester University NHS Foundation TrustManchesterUK
| | - Christopher Chaloner
- Department of Clinical BiochemistryManchester University NHS Foundation TrustManchesterUK
| | - Lesley Tetlow
- Department of Clinical BiochemistryManchester University NHS Foundation TrustManchesterUK
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29
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Di Paola R, Garzon S, Giuliani S, Laganà AS, Noventa M, Parissone F, Zorzi C, Raffaelli R, Ghezzi F, Franchi M, Zaffagnini S. Are we choosing the correct FSH starting dose during controlled ovarian stimulation for intrauterine insemination cycles? Potential application of a nomogram based on woman's age and markers of ovarian reserve. Arch Gynecol Obstet 2018; 298:1029-1035. [PMID: 30242498 DOI: 10.1007/s00404-018-4906-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/12/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the potential application of a nomogram based on woman's age and ovarian reserve markers as a tool to optimize the follicle-stimulating hormone (FSH) starting dose in intrauterine insemination (IUI) cycles. METHODS We conducted a retrospective analysis enrolling 179 infertile women undergoing controlled ovarian stimulation (COS), followed by IUI. Each woman received an FSH starting dose according to clinical decision. After collecting data about COS and IUI procedures, we calculated the FSH starting dose according to the nomogram. The main outcomes measured were women's baseline characteristics, COS, and clinical outcomes. RESULTS The FSH starting dose calculated by the nomogram was significantly lower than the one actually prescribed (p < 0.001), in only 14.8% of the cycles nomogram calculated a higher starting dose. When gonadotropin dose was decreased during COS, and similarly in case of hyper-response (more than two follicles ≥ 16 mm retrieved), the FSH starting dose calculated by the nomogram would have been lower in most of the cases (81.8% and 48.8%, respectively). Conversely, when gonadotropin dose was increased during COS and in case of low ovarian response (no follicle ≥ 16 mm retrieved), the FSH starting dose calculated by the nomogram would have been lower in most of the cases (64.7% and 100%, respectively); in these groups median anti-Müllerian hormone (AMH) level was 5.62 ng/mL. CONCLUSIONS The application of this nomogram in IUI cycles would lead to a more tailored FSH starting dose and improved cost-effectiveness, although in PCOS women, particularly the ones with high AMH, it does not seem adequate.
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Affiliation(s)
- Rossana Di Paola
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy.
| | - Sara Giuliani
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, VA, Italy
| | - Marco Noventa
- Department of Woman and Child Health, University of Padua, Via Nicolò Giustiniani, 3, 35128, Padua, PD, Italy
| | - Francesca Parissone
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Carlotta Zorzi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, VA, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Stefano Zaffagnini
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
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Vaiarelli A, Cimadomo D, Trabucco E, Vallefuoco R, Buffo L, Dusi L, Fiorini F, Barnocchi N, Bulletti FM, Rienzi L, Ubaldi FM. Double Stimulation in the Same Ovarian Cycle (DuoStim) to Maximize the Number of Oocytes Retrieved From Poor Prognosis Patients: A Multicenter Experience and SWOT Analysis. Front Endocrinol (Lausanne) 2018; 9:317. [PMID: 29963011 PMCID: PMC6010525 DOI: 10.3389/fendo.2018.00317] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/28/2018] [Indexed: 01/15/2023] Open
Abstract
A panel of experts known as the POSEIDON group has recently redefined the spectrum of poor responder patients and introduced the concept of suboptimal response. Since an ideal management for these patients is still missing, they highlighted the importance of tailoring the ovarian stimulation based on the chance of each woman to obtain an euploid blastocyst. Interestingly, a novel pattern of follicle recruitment has been defined: multiple waves may arise during a single ovarian cycle. This evidence opened important clinical implications for the treatment of poor responders. For instance, double stimulation in the follicular (FPS) and luteal phase (LPS) of the same ovarian cycle (DuoStim) is an intriguing option to perform two oocyte retrievals in the shortest possible time. Here, we reported our 2-year experience of DuoStim application in four private IVF centers. To date, 310 poor prognosis patients completed a DuoStim protocol and underwent IVF with blastocyst-stage preimplantation-genetic-testing. LPS resulted into a higher mean number of oocytes collected than FPS; however, their competence (i.e., fertilization, blastocyst, euploidy rates, and clinical outcomes after euploid single-embryo-transfer) was comparable. Importantly, the rate of patients obtaining at least one euploid blastocyst increased from 42.3% (n = 131/310) after FPS to 65.5% (n = 203/310) with the contribution of LPS. A summary of the putative advantages and disadvantages of DuoStim was reported here through a Strengths-Weaknesses-Opportunities-Threats analysis. The strengths of this approach make it very promising. However, more studies are needed in the future to limit its weaknesses, shed light on its putative threats, and realize its opportunities.
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Affiliation(s)
- Alberto Vaiarelli
- Clinica Valle Giulia, G.en.e.r.a. Centers for Reproductive Medicine, Rome, Italy
| | - Danilo Cimadomo
- Clinica Valle Giulia, G.en.e.r.a. Centers for Reproductive Medicine, Rome, Italy
| | - Elisabetta Trabucco
- Clinica Ruesch, G.en.e.r.a. Centers for Reproductive Medicine, Naples, Italy
| | - Roberta Vallefuoco
- Clinica Ruesch, G.en.e.r.a. Centers for Reproductive Medicine, Naples, Italy
| | - Laura Buffo
- G.en.e.r.a. Veneto, G.en.e.r.a. Centers for Reproductive Medicine, Marostica, Italy
| | - Ludovica Dusi
- G.en.e.r.a. Veneto, G.en.e.r.a. Centers for Reproductive Medicine, Marostica, Italy
| | - Fabrizio Fiorini
- G.en.e.r.a. Umbria, G.en.e.r.a. Centers for Reproductive Medicine, Umbertide, Italy
| | - Nicoletta Barnocchi
- G.en.e.r.a. Umbria, G.en.e.r.a. Centers for Reproductive Medicine, Umbertide, Italy
| | | | - Laura Rienzi
- Clinica Valle Giulia, G.en.e.r.a. Centers for Reproductive Medicine, Rome, Italy
- Clinica Ruesch, G.en.e.r.a. Centers for Reproductive Medicine, Naples, Italy
- G.en.e.r.a. Veneto, G.en.e.r.a. Centers for Reproductive Medicine, Marostica, Italy
- G.en.e.r.a. Umbria, G.en.e.r.a. Centers for Reproductive Medicine, Umbertide, Italy
| | - Filippo Maria Ubaldi
- Clinica Valle Giulia, G.en.e.r.a. Centers for Reproductive Medicine, Rome, Italy
- Clinica Ruesch, G.en.e.r.a. Centers for Reproductive Medicine, Naples, Italy
- G.en.e.r.a. Veneto, G.en.e.r.a. Centers for Reproductive Medicine, Marostica, Italy
- G.en.e.r.a. Umbria, G.en.e.r.a. Centers for Reproductive Medicine, Umbertide, Italy
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Selcuk S, Bilgic BE, Kilicci C, Kucukbas M, Cam C, Kutlu HT, Karateke A. Comparison of ovarian responsiveness tests with outcome of assisted reproductive technology - a retrospective analysis. Arch Med Sci 2018; 14:851-859. [PMID: 30002704 PMCID: PMC6040134 DOI: 10.5114/aoms.2016.62447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/18/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This study aims to compare the association between the most commonly used ovarian responsiveness markers - age, anti-Müllerian hormone levels (AMH), antral follicle count (AFC), ovarian sensitivity index (OSI), and ovarian response prediction index (ORPI) - and ovarian responsiveness to gonadotropin stimulation in assisted reproductive technology (ART) cycles. MATERIAL AND METHODS Patients who underwent intracytoplasmic sperm injection treatment using either a gonadotropin releasing hormone (GnRH) antagonist or agonist protocol were enrolled in the study. Data of the patients were abstracted from the hospital's database. Tests were compared for total number of retrieved oocytes, metaphase II (MII) oocytes, embryos, good quality embryos on day 1 and day 3, and ongoing pregnancies per cycle. RESULTS The OSI was the ovarian response test that had the strongest relationship with the ART outcomes. The level of association between the ovarian response tests and poor ovarian response data was (in descending order): OSI, ORPI, AFC, AMH, and age (AUCOSI = 0.976, AUCORPI = 0.905, AUCAFC = 0.899, AUCAMH = 0.864, AUCage = 0.617). The overall association between OSI and poor ovarian response was significantly higher than the other parameters (p1 = 0.0023, p2 = 0.0014, p3 = 0.0001, p4 ≤ 0.0001). In patients with high ovarian response data, OSI had the highest association, followed by AFC and ORPI age (AUCOSI = 0.984, AUCAFC = 0.907, AUCORPI = 0.887). There was no statistically significant difference among the tests for the data of patients with ongoing pregnancies. CONCLUSIONS In this study, which is the first study comparing the five most frequently used ovarian responsiveness markers and the second study signifying the role of OSI in an antagonist protocol, OSI was found to be more convenient to calculate, and it could be superior to other ovarian responsiveness markers for poor and high ovarian responses on cycles with agonist or antagonist protocols.
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Affiliation(s)
- Selcuk Selcuk
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Bulent Emre Bilgic
- Department of IVF, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Cetin Kilicci
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Mehmet Kucukbas
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Cetin Cam
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Huseyin Tayfun Kutlu
- Department of IVF, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Ates Karateke
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
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Pilsgaard F, Grynnerup AGA, Løssl K, Bungum L, Pinborg A. The use of anti-Müllerian hormone for controlled ovarian stimulation in assisted reproductive technology, fertility assessment and -counseling. Acta Obstet Gynecol Scand 2018; 97:1105-1113. [DOI: 10.1111/aogs.13334] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/18/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Fie Pilsgaard
- The Fertility Clinic; Obgyn Section of Infertility; Hvidovre Hospital; Hvidovre Denmark
| | | | - Kristine Løssl
- The Fertility Clinic; Obgyn Section of Infertility; Rigshospitalet University Hospital; Copenhagen Denmark
| | - Leif Bungum
- The Fertility Clinic; Obgyn Section of Infertility; Herlev Hospital; Herlev Denmark
| | - Anja Pinborg
- The Fertility Clinic; Obgyn Section of Infertility; Hvidovre Hospital; Hvidovre Denmark
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Plociennik L, Nelson SM, Lukaszuk A, Kunicki M, Podfigurna A, Meczekalski B, Lukaszuk K. Age-related decline in AMH is assay dependent limiting clinical interpretation of repeat AMH measures across the reproductive lifespan. Gynecol Endocrinol 2018; 34:115-119. [PMID: 28792788 DOI: 10.1080/09513590.2017.1358708] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The aim of the study was to determine whether the assays exhibit an interaction with age and exhibit heterogeneous age related declines in AMH. Apart of chronological age, AMH variation was investigated with relation to menstrual cycle day (MCD). The goal implicates two questions: Are distributions of AMH concentrations homogenous after adjustment for the specific AMH assay? Does age-assay product has an effect on AMH depletion? METHODS The study was conducted by examining results of AMH tests performed for 12,917 women with four types of AMH assays: Immunotech I generation kit (IMI, 4016 samples), Beckman Coulter II generation kit RUO (BCII RUO, 3430 samples), Beckman Coulter II generation kit with IVD certificate (BCII IVD, 830 samples), and Ansh Labs I generation kit (AnshLabs, 4641 samples). Statistical analysis included ACNOVA and least square regression technique. RESULTS Menstrual cycle day has no effect on AMH measurements. On the other hand, AMH values differed substantially between the four assays, with a marked discordance in the rate of age-related AMH decline for the four assays (ranging from -8.16% (95% CI: -8.79, -7.54) to -11.53% (95% CI -12.20, -10.87), with a significant interaction between age and assay. CONCLUSIONS (1) The distribution of AMH concentration is heterogeneous after controlling the age across assays; (2) the rate of AMH decline as a function of age is different for the four manual AMH ELISA assays.
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Affiliation(s)
| | - Scott M Nelson
- b School of Medicine , University of Glasgow , Glasgow , UK
| | - Aron Lukaszuk
- a INVICTA Fertility and Reproductive Center , Gdansk , Poland
| | - Michal Kunicki
- c INVICTA Fertility and Reproductive Clinic , Warsaw , Poland
| | - Agnieszka Podfigurna
- d Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
| | - Blazej Meczekalski
- d Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
| | - Krzysztof Lukaszuk
- a INVICTA Fertility and Reproductive Center , Gdansk , Poland
- c INVICTA Fertility and Reproductive Clinic , Warsaw , Poland
- e Department of Nursing , Medical University , Gdansk , Poland
- f Department of Gynecological Endocrinology , Medical University Warsaw , Warszawa , Poland
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Abstract
PURPOSE OF REVIEW Biomarkers are useful tool to help clinicians to estimate the chances of pregnancy of an infertile couple prior to assisted reproductive treatment. One proposed candidate is anti-Müllerian hormone (AMH), but its role as a predictor of reproductive success, especially in patients with low or very low levels, is under discussion. This review highlights recent findings from literature regarding to reproductive outcome in women with very low levels of AMH. RECENT FINDINGS Although there is a general agreement about the lower pregnancy rates of patients with very low levels of AMH compared with patients with normal AMH levels, the role of AMH as a predictor of success is still under discussion. In this sense, some authors establish a cutoff level below which the reproduction treatment is not successful; by contrast, other published data show a significant percentage of success is still observed in this group of patients, especially in young women. SUMMARY In the following review, we discuss the usefulness of AMH as a predictor of reproductive outcome in patients with very low AMH levels and provide an update of the clinical results after assisted reproductive treatment in this group of patients. We also analyzed the different assays used to measure the AMH, focused on the differences between the manual and the new automated systems.
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Bungum L, Tagevi J, Jokubkiene L, Bungum M, Giwercman A, Macklon N, Andersen CY, Klausen TW, Tørring N, Kumar A, Skouby SO. The Impact of the Biological Variability or Assay Performance on AMH Measurements: A Prospective Cohort Study With AMH Tested on Three Analytical Assay-Platforms. Front Endocrinol (Lausanne) 2018; 9:603. [PMID: 30459709 PMCID: PMC6232665 DOI: 10.3389/fendo.2018.00603] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/21/2018] [Indexed: 12/28/2022] Open
Abstract
This study examined longitudinal, age-related and intra-individual variation in Anti-Müllerian Hormone (AMH) in regular menstruating women and correlated the hormonal levels to the antral follicle count (AFC). The impact of variations on an algorithm for calculation of follitropin-dose for ovarian stimulation were also tested. The study was carried out at a fertility clinic of a tertiary university hospital and had a prospective trial design. Twenty-six healthy women not receiving infertility treatment aged 22 to 50 years participated. Blood sampling for hormonal analysis was done every fifth day throughout three consecutive menstrual cycles, AFC was determined with 3-dimentional ultrasound and AMH measured by different assays from Beckman Coulter, Roche and Ansh Labs. Outcome measures were maximum and minimum difference in absolute and relative terms for each study subject during the test-period, coefficient of variation (Cv) for AMH for each cycle and cycle-day and correlation between AMH and AFC. The impact from variable AMH levels on an algorithm calculating follitrophin-delta dose in ovarian stimulation was explored. A significant longitudinal age-independent variation in AMH-levels and coefficient of variation in cycles and cycle days was found. A strong correlation between AMH-levels and AFC was confirmed and a case of significant divergence between assays was seen. Variations in AMH had a significant impact on an algorithm calculated dosage of gonadotrophins in ovarian stimulation. The finding of a substantial longitudinal variation in AMH question one recording being sufficient in quantifying gonadotrophins for ovarian stimulation, decision making and prognostication related to infertility treatment and counseling. Occasionally, commercial assays may fail to recognize specific AMH cleavage-products.
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Affiliation(s)
- Leif Bungum
- Department of Obstetrics and Gynecology, Herlev Gentofte Hospital, Herlev, Denmark
- *Correspondence: Leif Bungum
| | - Julia Tagevi
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Ligita Jokubkiene
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmø, Sweden
| | - Mona Bungum
- Reproductive Medicine Centre, Skanes University Hospital, Malmø, Sweden
| | | | - Nick Macklon
- Obsterics and Gynecology, Denmark and London Women's Clinic, Zealand University Hospital, London, United Kingdom
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Niels Tørring
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Ajay Kumar
- Ansh Labs LLC, Medical Center Blvd, Webster, IA, United States
| | - Sven Olaf Skouby
- Department of Obstetrics and Gynecology, Herlev Gentofte Hospital, Herlev, Denmark
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Magnusson Å, Oleröd G, Thurin-Kjellberg A, Bergh C. The correlation between AMH assays differs depending on actual AMH levels. Hum Reprod Open 2017; 2017:hox026. [PMID: 30895238 PMCID: PMC6277007 DOI: 10.1093/hropen/hox026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/07/2017] [Accepted: 11/23/2017] [Indexed: 12/21/2022] Open
Abstract
STUDY QUESTION What is the correlation of serum anti-Müllerian hormone (AMH) levels between two frequently used laboratory assays? SUMMARY ANSWER A considerable difference was found in serum AMH levels measured with the two different assays, particularly for low AMH values. WHAT IS KNOWN ALREADY AMH is regarded as being a robust, highly sensitive and specific biomarker for ovarian response and has become widely used as the basis for fertility treatment decisions. However, several available assays with different reference values, in addition to inter-laboratory variations and issues of sample stability, make interpretation of the AMH values and their clinical implications complicated. STUDY DESIGN SIZE DURATION An observational study was performed including 269 serum samples from infertile women, originating from a RCT conducted in 2013-2016 (www.clinicaltrials.gov NCT02013973). PARTICIPANTS/MATERIALS SETTING METHOD Serum AMH levels analysed with the Modified Beckman Coulter Gen II ELISA assay (Premix method) were compared to AMH levels analysed with the Beckman Coulter Gen II ELISA original assay (Gen II original). All samples were handled identically and analysed with the two assays in a parallel setting. MAIN RESULTS AND THE ROLE OF CHANCE The slope of the regression line showed a mean of 18% higher values with the Premix method compared to the Gen II original assay, and more than 40% higher values for AMH levels in the lower range. LIMITATIONS REASONS FOR CAUTION The Gen II original assay is no longer in clinical use as it has been replaced by the Premix method, which, in turn, recently has been further developed into an automated method. WIDER IMPLICATIONS OF THE FINDINGS The finding of differences in AMH levels between assays is clinically important and may imply an incorrect classification in the assessment of ovarian reserve. The robustness of serum AMH as a marker for ovarian reserve and as a tool for fertility counselling has to be investigated further. There is an urgent need for international standards on interpretation of AMH values for different assays. STUDY FUNDING/COMPETING INTERESTS Financial support was received through Sahlgrenska University Hospital (ALFGBG-70940) and the Hjalmar Svensson Research Foundation. None of the authors declares any conflict of interest.
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Affiliation(s)
- Å Magnusson
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University
| | - G Oleröd
- Department of Clinical Chemistry, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - A Thurin-Kjellberg
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University
| | - C Bergh
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University
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Quinn MM, Kao CN, Ahmad AK, Haisenleder DJ, Santoro N, Eisenberg E, Legro RS, Cedars MI, Huddleston HG. Age-stratified thresholds of anti-Müllerian hormone improve prediction of polycystic ovary syndrome over a population-based threshold. Clin Endocrinol (Oxf) 2017; 87:733-740. [PMID: 28681949 DOI: 10.1111/cen.13415] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/22/2017] [Accepted: 07/02/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Due to its consistent elevation in polycystic ovary syndrome (PCOS) and correlation with polycystic ovarian morphology (PCOM), anti-Mullerian hormone (AMH) has been proposed as a marker of the syndrome. However, prior studies reporting thresholds of AMH for a PCOS diagnosis have been limited by small sample size, inappropriate controls, and heterogeneous AMH assays. We sought to evaluate the suitability of a standardized AMH assay as a biomarker of PCOS. DESIGN Cross-sectional study at academic medical centres across the United States. PATIENTS Women with PCOS were diagnosed by Rotterdam criteria and included 282 subjects from the multisite PPCOS II trial and 109 patients from a tertiary academic centre's multidisciplinary PCOS clinic. Controls included 245 participants in the ovarian ageing (OVA) study, a community-based cohort of ovulatory women not seeking treatment for fertility. MEASUREMENTS Determination of AMH by a central laboratory. Receiver-operating characteristic (ROC) analyses were used to investigate the accuracy of AMH thresholds for prediction of PCOS diagnosis with stratification by age. RESULTS The optimal threshold of AMH to distinguish PCOS from controls was 55.36 pmol/L (sensitivity: 0.82, specificity: 0.78, J: 0.60). When examining the population by age groups, the optimal AMH threshold decreased with increasing age. CONCLUSIONS AMH is an effective biomarker of PCOS. Age-stratified thresholds more accurately predicted PCOS than an overall population-based threshold.
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Affiliation(s)
- Molly M Quinn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Chia-Ning Kao
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Asima K Ahmad
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Daniel J Haisenleder
- Ligand Core Laboratory, University of Virginia Center for Research in Reproduction, Charlottesville, VA, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, USA
| | - Esther Eisenberg
- Fertility and Infertility Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, PA, USA
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Heather G Huddleston
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA
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Rustamov O, Wilkinson J, La Marca A, Fitzgerald C, Roberts SA. How much variation in oocyte yield after controlled ovarian stimulation can be explained? A multilevel modelling study. Hum Reprod Open 2017; 2017:hox018. [PMID: 30895232 PMCID: PMC6276674 DOI: 10.1093/hropen/hox018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/21/2017] [Accepted: 10/05/2017] [Indexed: 01/07/2023] Open
Abstract
STUDY QUESTION How much variation in oocyte yield after controlled ovarian stimulation (COS) can be accounted for by known patient and treatment characteristics? SUMMARY ANSWER There is substantial variation in the COS responses of similar women and in repeated COS episodes undertaken by the same woman, which cannot be accounted for at present. WHAT IS ALREADY KNOWN The goal of individualized COS is to safely collect enough oocytes to maximize the chance of success in an ART cycle. Personalization of treatment rests on the ability to reduce variation in response through modifiable factors. STUDY DESIGN, SIZE, DURATION Multilevel modelling of a routine ART database covering the period 1 October 2008–8 August 2012 was employed to estimate the amount of variation in COS response and the extent to which this could be explained by immutable patient characteristics and by manipulable treatment variables. A total of 1851 treatment cycles undertaken by 1430 patients were included. The study was not subject to attrition, as cancelled cycles were included in the analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Women aged 21–43 years undergoing ovarian stimulation for IVF (possibly with ICSI) using their own eggs at a tertiary care centre. MAIN RESULTS AND THE ROLE OF CHANCE Substantial unexplained variation in COS response (oocyte yield): was observed (3.4-fold (95% CI: 3.12 to 3.61)). Only a relatively small amount of this variation (around 19%) can be explained by modifiable factors. A significant, previously undescribed predictor of response was the practitioner performing oocyte retrieval, with 1.5-fold variation between surgeons with the highest and lowest yields. LIMITATIONS REASONS FOR CAUTION Although a large number of covariables were adjusted for in the analysis, including those that were used for dosing and determination of the stimulation regimen, this study is subject to confounding due to unmeasured variables and measurement error. WIDER IMPLICATIONS OF THE FINDINGS The present study suggests that there are limits to the extent that COS response can be predicted on the basis of known factors, or controlled by manipulation of treatment factors. Moreover, modifiable variation in response appears to be partially attributable to differences between surgeons performing oocyte retrieval. Consequently, consistent prevention of ineffective or unsafe responses to COS is not likely to be possible at present. Our results highlight the importance of blinding surgeons in RCTs. The data also suggest that there is likely to be limited scope for personalized treatment unless additional predictors of ovarian response can be identified. STUDY FUNDING/COMPETING INTERESTS J.W. is funded by a Doctoral Research Fellowship from the National Institute for Health Research (DRF-2014-07-050) supervised by S.A.R. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. J.W. is a statistical editor of the Cochrane Gynaecology and Fertility Group. S.A.R. is a statistical editor for Human Reproduction. J.W. also declares that publishing peer-reviewed articles benefits his career. A.L.M. has received consultation fees from MSD, Merck Serono, Ferring, TEVA, Roche, Beckman Coulter.
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Affiliation(s)
- Oybek Rustamov
- Department of Reproductive Medicine, St Mary's Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre (MAHSC), Manchester, England M13 0JH, UK.,Primary IVF, Primary Health Care Limited, Brisbane, QLD 4075, Australia
| | - Jack Wilkinson
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester M13 9PL, UK.,Research and Development, Salford Royal NHS Foundation Trust, Salford, England M6 8HD, UK
| | - Antonio La Marca
- Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Cheryl Fitzgerald
- Department of Reproductive Medicine, St Mary's Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre (MAHSC), Manchester, England M13 0JH, UK
| | - Stephen A Roberts
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester M13 9PL, UK
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Peigné M, Robin G, Catteau-Jonard S, Giacobini P, Dewailly D, Pigny P. Les différentes trousses de dosage d’AMH en France en 2017 : comment s’y retrouver en pratique clinique quotidienne ? ACTA ACUST UNITED AC 2017; 45:558-565. [DOI: 10.1016/j.gofs.2017.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/29/2017] [Indexed: 02/06/2023]
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Liss J, Kunicki M, Czyzyk A, Pastuszek E, Zabielska J, Meczekalski B, Lukaszuk K. Clinical utility of different anti-Müllerian hormone - AMH assays for the purpose of pregnancy prediction. Gynecol Endocrinol 2017; 33:791-796. [PMID: 28447513 DOI: 10.1080/09513590.2017.1318370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Comparison of outcomes of IVF cycles where the AMH levels was measured with five different AMH kits: Immunotech (IOT), Beckman Coulter II Gen. RUO, Beckman Coulter II Gen. IVD (BC II IVD), Ansh Labs ultrasensitive (Ansh) and the automated Elecsys Roche assay. METHODS Retrospective analysis of clinical data for 3693 cycles. RESULTS In women < 35 years with low (<0.6 ng/ml) and high (>1.4 ng/ml) AMH concentrations, and in those > 39 years with medium (≥0.6 and ≤1.4 ng/ml) and high AMH concentrations the clinical pregnancy rate differed significantly among groups of patients whose AMH level was measured with different kits. In those subgroups, the highest rates were recorded for the BC II IVD and Ansh groups, while the lowest in the IOT group. AMH concentrations differed significantly between different kits in all age groups (the highest in each age group was for the IOT kit and the lowest for BC II IVD). AMH correlates positively with antral follicle count, MII and number of oocytes retrieved. CONCLUSIONS This study demonstrated that we could expect very different pregnancy rates with the same AMH results depending on the AMH kit used. That would means, different values of AMH could similarly lead to misleading clinical decisions in IVF.
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Affiliation(s)
- Joanna Liss
- a INVICTA Fertility and Reproductive Center , Gdansk , Poland
| | - Michal Kunicki
- c INVICTA Fertility and Reproductive Center , Warsaw , Poland
| | - Adam Czyzyk
- d Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland , and
| | - Ewa Pastuszek
- a INVICTA Fertility and Reproductive Center , Gdansk , Poland
| | - Judyta Zabielska
- a INVICTA Fertility and Reproductive Center , Gdansk , Poland
- b Department of Obstetrics and Gynecological Nursing , Faculty of Health Sciences, Medical University of Gdansk , Poland
| | - Blazej Meczekalski
- d Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland , and
| | - Krzysztof Lukaszuk
- a INVICTA Fertility and Reproductive Center , Gdansk , Poland
- b Department of Obstetrics and Gynecological Nursing , Faculty of Health Sciences, Medical University of Gdansk , Poland
- c INVICTA Fertility and Reproductive Center , Warsaw , Poland
- e Department of Gynecological Endocrinology , Warsaw Medical University , Warsaw , Poland
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Gat I, AlKudmani B, Wong K, Zohni K, Weizman NF, Librach C, Sharma P. Significant correlation between anti-müllerian hormone and embryo euploidy in a subpopulation of infertile patients. Reprod Biomed Online 2017; 35:602-608. [PMID: 28826601 DOI: 10.1016/j.rbmo.2017.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 06/24/2017] [Accepted: 06/27/2017] [Indexed: 11/30/2022]
Abstract
Anti-Müllerian hormone (AMH) is a standard marker of ovarian reserve. Correlation between AMH and egg euploidy is controversial. We evaluated the association between AMH and blastocyst euploidy rate examined by pre-implantation genetic screening (PGS). This retrospective study was conducted at the CReATe Fertility Centre. We included single IVF cycles of 216 infertile couples, which resulted in 911 blastocysts subjected to array comparative genomic hybridization and evaluated IVF outcome after embryo transfer. The average age and median AMH of female patients were 37.2 (SD = 3.8) and 20 pmol/l, respectively, and the average euploidy rate was 38.3%. Using multivariate regression controlling for age, antral follicle count, body mass index and parity, there was a significant association between serum AMH and proportion of euploid embryos (P = 0.02), due to the dominant ≤36 age group in which significant correlation between AMH and euploidy rate (P = 0.02) was demonstrated. Clinical outcome was similar, including biochemical, clinical and ongoing pregnancy rates as well as pregnancy loss. This study shows a correlation between AMH and aneuploidy rate, specifically among infertile patients younger than 37 years old. Study limitations are discussed.
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Affiliation(s)
- Itai Gat
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada; Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Centre, Tel Hashomer, Israel; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
| | - Basheer AlKudmani
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada
| | - Karen Wong
- CReATe Fertility Centre, Toronto, Ontario, Canada
| | - Khaled Zohni
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada
| | - Noga Fuchs Weizman
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada
| | - Clifford Librach
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Prati Sharma
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Peddie VL, Maheshwari A. Successful controlled ovarian stimulation and vitrification of oocytes in an adolescent diagnosed with myelodysplastic/pre-malignant clone with monosomy 7. HUM FERTIL 2017; 21:39-44. [PMID: 28683583 DOI: 10.1080/14647273.2017.1347288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
An improvement in long-term outcomes for malignancies and non-malignant conditions, together with a review of the NICE Guideline, has led to a need to provide clinical services to deal with the sequelae of disease, its treatment, and subsequent survival of young people diagnosed with cancer. In this article, we describe fertility preservation in an adolescent female diagnosed with Myelodysplastic/pre-malignant Clone with Monosomy 7 with pathophysiology like that of chronic myeloid leukaemia (CML) with known genetic markers in the tumour cells. We used random start controlled ovarian stimulation (COS) leading to oocyte collection and vitrification of metaphase II oocytes. Despite successful COS and vitrification, there remain numerous ethical considerations that merit more focussed discussion. Not least, in determining best practice for informed consent, but consideration of individualised protocols for ovarian stimulation, monitoring follicular development, together with prevention of ovarian hyperstimulation syndrome (OHSS) when considering most appropriate trigger for oocyte maturation. Random-start controlled ovarian stimulation and oocyte vitrification for adolescent girls diagnosed with cancer can be safely achieved through a collaborative, multidisciplinary and expert team approach. This case study offers a promising approach to fertility preservation, and would minimise the risk of introducing malignant cells after recovery.
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Affiliation(s)
- Valerie Laura Peddie
- a Department of Obstetrics and Gynaecology, Division of Applied Health Sciences, School of Medicine and Dentistry , University of Aberdeen , Aberdeen , UK
| | - Abha Maheshwari
- a Department of Obstetrics and Gynaecology, Division of Applied Health Sciences, School of Medicine and Dentistry , University of Aberdeen , Aberdeen , UK
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Subirá J, Alberola-Rubio J, Núñez MJ, Escrivá AM, Pellicer A, Montañana V, Díaz-García C. Inter-cycle and inter-observer variability of the antral follicle count in routine clinical practice. Gynecol Endocrinol 2017; 33:515-518. [PMID: 28277111 DOI: 10.1080/09513590.2017.1291614] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Antral follicle count (AFC) is a reliable predictor of ovarian response to stimulation and its inter-cycle and inter-observer variability has been extensively studied on in vitro fertilization (IVF), mostly in highly selected populations within studies not originally designed for this purpose. In this retrospective cohort study, we assess the inter-cycle variation of AFC in a setting similar to that of the daily practice. We included only patients undergoing mild stimulation for intrauterine insemination (IUI). One hundred and forty-eight patients had two (62 patients, group A), three (49 patients, group B) or four (37 patients, group C) IUI cycles and AFC was measured on early follicular phase of each cycle by one of the members of the medical team within daily practice. Intra-class correlation coefficients were used to estimate variability. Inter-cycle variability rendered ICCs above 0.70 in all groups improving along with the number of cycles [Group A ICC 0.78 (95%CI 0.66-0.86), Group B ICC 0.87 (95%CI 0.80-0.92) and Group C ICC 0.91 (95%CI 0.85-0.95)]. Inter-observer variability showed a high degree of concordance with ICCs above 0.95. We provide the closest approximation to real inter-cycle and inter-observer AFC variability expected in routine clinical practice.
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Affiliation(s)
- Jessica Subirá
- a Woman's Health Area, La Fe University Hospital , Valencia , Spain
- b Reproductive Medicine Research Group, IIS La Fe , Valencia , Spain
| | | | - María Jose Núñez
- a Woman's Health Area, La Fe University Hospital , Valencia , Spain
| | - Alicia Marzal Escrivá
- a Woman's Health Area, La Fe University Hospital , Valencia , Spain
- b Reproductive Medicine Research Group, IIS La Fe , Valencia , Spain
- c Instituto Valenciano de Infertilidad (IVI) , Valencia , Spain , and
| | - Antonio Pellicer
- a Woman's Health Area, La Fe University Hospital , Valencia , Spain
- b Reproductive Medicine Research Group, IIS La Fe , Valencia , Spain
- c Instituto Valenciano de Infertilidad (IVI) , Valencia , Spain , and
- d Department of Obstetrics and Gynecology , University of Valencia , Valencia , Spain
| | | | - César Díaz-García
- a Woman's Health Area, La Fe University Hospital , Valencia , Spain
- b Reproductive Medicine Research Group, IIS La Fe , Valencia , Spain
- c Instituto Valenciano de Infertilidad (IVI) , Valencia , Spain , and
- d Department of Obstetrics and Gynecology , University of Valencia , Valencia , Spain
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Dondik Y, Virji N, Butler TS, Gaskins JT, Pagidas K, Sung L. The Value of Anti-Müllerian Hormone in Predicting Clinical Pregnancy After Intrauterine Insemination. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017. [PMID: 28647445 DOI: 10.1016/j.jogc.2017.01.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the utility of anti-Müllerian hormone (AMH) in predicting clinical pregnancy with intrauterine insemination (IUI) and compare it to other markers of quantitative ovarian reserve. METHODS Retrospective cohort study of women undergoing natural and stimulated IUI cycles. All patients achieved a clinical pregnancy within three IUI cycles or completed three IUI cycles without pregnancy. Receiver operating curves were generated to determine the ability of AMH, antral follicle count, age, BMI, and day 3 FSH to predict clinical pregnancy with IUI. Characteristics of those with and without pregnancy were compared using Mann-Whitney U, chi-square, and Fisher exact tests. RESULTS Of 209 women included, 49% achieved clinical pregnancy. Pregnant patients were more likely to have a higher AMH (2.76 vs. 1.55 ng/mL, P = 0.0004). The area under the curve was 0.642 in predicting clinical pregnancy within three IUI cycles using AMH (0.608 if excluding polycystic ovarian syndrome patients); 0.639 using antral follicle count; 0.549 using age; 0.599 using day 3 FSH; and 0.639 using BMI. CONCLUSION Although serum AMH appears significantly higher in women achieving clinical pregnancy, the predictive value of AMH alone was no better than that for other markers of quantitative ovarian reserve in a patient who clinically qualifies for IUI.
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Affiliation(s)
- Yelena Dondik
- Winthrop University Hospital, Mineola, NY, USA; University of Louisville, Louisville, KY, USA.
| | - Nassim Virji
- Reproductive Specialists of New York, Mineola, NY, USA
| | | | | | | | - Linda Sung
- Winthrop University Hospital, Mineola, NY, USA; Reproductive Specialists of New York, Mineola, NY, USA
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Fleming R, Fairbairn C, Gaudoin M. Objective multicentre performance of the automated assays for AMH and estimation of established critical concentrations. HUM FERTIL 2017; 21:269-274. [DOI: 10.1080/14647273.2017.1331298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - Marco Gaudoin
- Glasgow Centre for Reproductive Medicine, Glasgow, UK
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Özcan P, Fiçicioğlu C, Ateş S, Can MG, Kaspar Ç, Akçin O, Yesiladali M. The cutoff values of serum AMH levels and starting recFSH doses for the individualization of IVF treatment strategies. Gynecol Endocrinol 2017; 33:467-471. [PMID: 28277814 DOI: 10.1080/09513590.2017.1294154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The main purpose of our study is to categorize starting doses of recombinant follicle-stimulating hormone (recFSH) based on various cutoff values of anti-Mullerian hormone (AMH) and to determine the effectiveness of serum AMH levels in the prediction of poor ovarian response. MATERIAL AND METHODS Prospective data analysis was conducted at IVF center. A total of 323 patients were included. All patients were divided into four groups according to the patients' serum AMH concentrations: Group 1 (AMH < 1 ng/ml; 450 IU/day n = 157); Group 2 (AMH 1-2 ng/ml; 375 IU/day, n = 55); Group 3 (AMH 2-3 ng/ml; 225 IU/day, n = 48); and Group 4 (AMH > 3 ng/ml; 150 IU/day, n = 63). Collected data included age, total gonadotropin dosage, duration of stimulations, the total number of oocytes retrieved, ovarian response, cancelation rate, and cPRs. RESULTS As serum AMH levels increased, there were significant decreases in the starting recFSH dose and total gonadotropin dosage, and a significant increase in the total number of oocytes retrieved. There was a significant trend toward increasing cycle cancelation rates and decreasing cPRs with decreasing serum AMH levels. Although there were no significant differences with regard to the proportion of cycles with hypo-response between all groups. A result of ≤0.83 was considered the cutoff value of AMH to predict a hypo-response to ovarian stimulation. CONCLUSIONS AMH is a useful marker in selecting the starting dose of recFSH and prediction of poor ovarian response. Our protocol may allow clinicians to modulate the starting dose of recFSH according to these cutoff values for serum AMH levels.
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Affiliation(s)
- Pinar Özcan
- a Department of Obstetrics and Gynecology , Bezmialem University Faculty of Medicine , İstanbul , Turkey
- b Department of Obstetrics , Gynecology and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA
| | - Cem Fiçicioğlu
- c Department of Obstetrics and Gynecology , Yeditepe University, Faculty of Medicine , Istanbul , Turkey
| | - Seda Ateş
- a Department of Obstetrics and Gynecology , Bezmialem University Faculty of Medicine , İstanbul , Turkey
| | - Meltem Güner Can
- d Department of Anesthesiology , Acibadem University, Faculty of Medicine , Istanbul , Turkey , and
| | - Çiğdem Kaspar
- e Department of Medical Informatics , Yeditepe University, Faculty of Medicine , Istanbul , Turkey
| | - Oya Akçin
- c Department of Obstetrics and Gynecology , Yeditepe University, Faculty of Medicine , Istanbul , Turkey
| | - Mert Yesiladali
- c Department of Obstetrics and Gynecology , Yeditepe University, Faculty of Medicine , Istanbul , Turkey
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47
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Lee JY, Ahn S, Lee JR, Jee BC, Kim CH, Seo S, Suh CS, Kim SH. Reference Values for the Revised Anti-Müllerian Hormone Generation II Assay: Infertile Population-based Study. J Korean Med Sci 2017; 32:825-829. [PMID: 28378557 PMCID: PMC5383616 DOI: 10.3346/jkms.2017.32.5.825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/30/2017] [Indexed: 11/20/2022] Open
Abstract
Anti-Müllerian hormone (AMH) is now accepted as an important clinical marker of ovarian reserve and is increasingly measured as an initial evaluation at infertility clinics. The aim of this study was to establish reference values for the revised second generation (Gen II) assay using population-based data. In this population-based cohort study, AMH data from unselected infertile women aged 25-45 years from June 2013 to June 2014 (n = 15,801) were collected. The AMH values were measured using the revised Gen II assay. We established and validated 5 AMH-age regression models. Based on the optimal AMH-age model, reference values and centile charts were obtained. The quadratic model (log AMH = 0.410 × age -0.008 × age² -3.791) was the most appropriate for describing the age-dependent decrease in AMH measured using the revised Gen II assay. This is the largest population-based study to establish age-specific reference values of AMH using the revised Gen II assay. These reference values may provide more specific information regarding the ovarian reserve estimation of infertile women.
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Affiliation(s)
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | - Soyeon Seo
- Samkwang Medical Laboratories, Seoul, Korea
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
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Preimplantation genetic diagnosis for aneuploidy testing in women older than 44 years: a multicenter experience. Fertil Steril 2017; 107:1173-1180. [DOI: 10.1016/j.fertnstert.2017.03.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/20/2017] [Accepted: 03/07/2017] [Indexed: 11/23/2022]
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49
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Gorkem U, Kucukler FK, Togrul C, Gungor T. Anti-Müllerian hormone exhibits a great variation in infertile women with different ovarian reserve patterns. Aust N Z J Obstet Gynaecol 2017; 57:464-468. [PMID: 28419409 DOI: 10.1111/ajo.12625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/13/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Several conflicting studies with results on the biological variability of serum anti-Müllerian hormone (AMH) levels have been reported. Most of the studies have not focused on whether the level of AMH fluctuations shows variability by a baseline ovarian follicular reserve. AIM To reveal whether intracyclic variation in AMH levels occurs among women with adequate, high and diminished ovarian reserve patterns. STUDY DESIGN In this prospective cross-sectional study, 171 infertile women between the ages of 18 and 42 years were recruited. All participants were divided into three types of ovarian reserve patterns (adequate, high and diminished). Serum samples were tested for levels of follicular AMH (F-AMH), luteal AMH (L-AMH), estradiol (E2), and follicle stimulating hormone (FSH) and progesterone. RESULTS The median age of the 171 participating women was 28 (18-42) years. The three ovarian reserve groups had similar body mass index (BMI) and E2 (P = 0.797 and P = 0.135, respectively). The serum AMH levels of all women and the three ovarian reserve groups in the follicular phase were higher compared to those in the luteal phase (P < 0.001). There were strong positive correlations between follicular and luteal AMH levels in adequate, high and diminished reserve groups (Spearman r = 0.864, P < 0.001 vs r = 0.899, P < 0.001 vs r = 0.863, P < 0.001, respectively). CONCLUSION Serum AMH levels were higher during the follicular phase than the luteal phase in women with adequate, high and diminished ovarian patterns. Since the highest AMH levels are demonstrated during the follicular phase, the optimal time to measure AMH concentration might be during the follicular phase.
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Affiliation(s)
- Umit Gorkem
- Department of Obstetrics and Gynaecology, Hitit University Faculty of Medicine, Corum, Turkey
| | - Ferit Kerim Kucukler
- Department of Endocrinology, Hitit University Faculty of Medicine, Corum, Turkey
| | - Cihan Togrul
- Department of Obstetrics and Gynaecology, Hitit University Faculty of Medicine, Corum, Turkey
| | - Tayfun Gungor
- Department of Obstetrics and Gynaecology, Hitit University Faculty of Medicine, Corum, Turkey
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50
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de Kat AC, Broekmans FJM, van Westing AC, Lentjes E, Verschuren WMM, van der Schouw YT. A quantitative comparison of anti-Müllerian hormone measurement and its shifting boundaries between two assays. Maturitas 2017; 101:12-16. [PMID: 28539163 DOI: 10.1016/j.maturitas.2017.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/05/2017] [Accepted: 04/07/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Anti-Müllerian hormone (AMH), a quantitative marker of ovarian reserve, is used for both clinical and research purposes in the field of reproductive medicine. Numerous AMH assays have been developed. Among other factors, the lack of large-scale comparisons of the various assays hinders the universal interpretation of AMH levels. Moreover, little is known of the practical performance of highly sensitive assays compared with conventional assays with regard to the very low AMH levels found in women nearing menopause. This study aimed to compare the measurements of the Gen II (Beckman Coulter) assay with those of the highly sensitive picoAMH (AnshLabs) assay. METHODS This cross-sectional study included 1985 premenopausal women who completed the second visit of the population-based Doetinchem Cohort Study, with a mean age of 42±7years. AMH levels were measured with the Gen II and picoAMH assays. Passing-Bablok and Bland Altman analyses were performed and differences in the proportion of detectable samples were assessed. RESULTS The results from the Gen II and picoAMH assays were highly correlated, with a Spearman correlation coefficient of 0.91. The Passing-Bablok regression formula was picoAMH=0.01+1.69*GenII, meaning that on average picoAMH levels were 69% higher than Gen II levels. Of the 670 samples with an undetectable AMH value with the Gen II assay, AMH could be detected in 78% with the picoAMH assay, at a median concentration [interquartile range] of 0.05 [0.01-0.14] ng/mL. CONCLUSION These results indicate that, despite a high correlation, there is a large relative difference between results of the Gen II and picoAMH assays. The use of a highly sensitive AMH assay is likely to result in a large increase in the proportion of samples with detectable levels. This may enable research into women's health across the menopausal transition and research into the potential clinical benefits of distinguishing between women with very low ovarian reserve.
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Affiliation(s)
- A C de Kat
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - F J M Broekmans
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - A C van Westing
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - E Lentjes
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - W M M Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Y T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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