1
|
Lee JY, Kim CH, Choe SA, Seo S, Kim SH. Measurement of serum anti-Müllerian hormone by revised Gen II or automated assay: Reproducibility under various blood/serum storage conditions. Clin Exp Reprod Med 2023; 50:107-116. [PMID: 37258104 DOI: 10.5653/cerm.2022.05687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/23/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE We investigated the agreement between anti-Müllerian hormone (AMH) levels measured with revised Gen II (rev-Gen II) and automated AMH (Access) assays and evaluated the reproducibility of each method under various blood/serum storage conditions. METHODS AMH levels in blood samples from 74 volunteers were measured by rev-Gen II and Access assays under various conditions: immediate serum separation and AMH measurement (fresh control); serum stored at -20 °C and AMH measured after 48 hours, 1 week, and 2 years; serum stored at 0 to 4 °C and AMH measured after 48 hours and 1 week; and blood kept at room temperature and delayed serum separation after 48 hours and 1 week, with immediate AMH measurement. RESULTS In fresh controls, all rev-Gen II-AMH values were higher than comparable Access-AMH values (difference, 8.3% to 19.7%). AMH levels measured with the two methods were strongly correlated for all sample conditions (r=0.977 to 0.995, all p<0.001). For sera stored at -20 °C or 0 to 4 °C for 48 hours, Access-AMH values were comparable to control measurements, but rev-Gen II-AMH values were significantly lower. AMH levels in sera stored at -20 °C or 0 to 4 °C for 1 week were significantly lower than in fresh controls, irrespective of method. Across methods, long-term storage at -20 °C for 2 years yielded AMH measurements significantly higher than control values. When serum separation was delayed, rev-Gen II-AMH values were significantly lower than control measurements, but Access-AMH values varied. CONCLUSION The rev-Gen II and Access-AMH assays showed varying reproducibility across blood/serum storage conditions, but automated Access yielded superior stability to rev-Gen II.
Collapse
Affiliation(s)
| | | | - Seung-Ah Choe
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Soyeon Seo
- Samkwang Medical Laboratories, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Gonen N, Eozenou C, Mitter R, Elzaiat M, Stévant I, Aviram R, Bernardo AS, Chervova A, Wankanit S, Frachon E, Commère PH, Brailly-Tabard S, Valon L, Barrio Cano L, Levayer R, Mazen I, Gobaa S, Smith JC, McElreavey K, Lovell-Badge R, Bashamboo A. In vitro cellular reprogramming to model gonad development and its disorders. SCIENCE ADVANCES 2023; 9:eabn9793. [PMID: 36598988 PMCID: PMC9812383 DOI: 10.1126/sciadv.abn9793] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 12/02/2022] [Indexed: 05/28/2023]
Abstract
During embryonic development, mutually antagonistic signaling cascades determine gonadal fate toward a testicular or ovarian identity. Errors in this process result in disorders of sex development (DSDs), characterized by discordance between chromosomal, gonadal, and anatomical sex. The absence of an appropriate, accessible in vitro system is a major obstacle in understanding mechanisms of sex-determination/DSDs. Here, we describe protocols for differentiation of mouse and human pluripotent cells toward gonadal progenitors. Transcriptomic analysis reveals that the in vitro-derived murine gonadal cells are equivalent to embryonic day 11.5 in vivo progenitors. Using similar conditions, Sertoli-like cells derived from 46,XY human induced pluripotent stem cells (hiPSCs) exhibit sustained expression of testis-specific genes, secrete anti-Müllerian hormone, migrate, and form tubular structures. Cells derived from 46,XY DSD female hiPSCs, carrying an NR5A1 variant, show aberrant gene expression and absence of tubule formation. CRISPR-Cas9-mediated variant correction rescued the phenotype. This is a robust tool to understand mechanisms of sex determination and model DSDs.
Collapse
Affiliation(s)
- Nitzan Gonen
- The Mina and Everard Goodman Faculty of Life Sciences and the Institute of Nanotechnology and Advanced Materials, Bar-Ilan University, Ramat Gan 5290002, Israel
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK
| | - Caroline Eozenou
- Institut Pasteur, Université de Paris, CNRS UMR3738, Human Developmental Genetics, F-75015 Paris, France
| | - Richard Mitter
- Bioinformatics Core, The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK
| | - Maëva Elzaiat
- Institut Pasteur, Université de Paris, CNRS UMR3738, Human Developmental Genetics, F-75015 Paris, France
| | - Isabelle Stévant
- The Mina and Everard Goodman Faculty of Life Sciences and the Institute of Nanotechnology and Advanced Materials, Bar-Ilan University, Ramat Gan 5290002, Israel
| | - Rona Aviram
- The Mina and Everard Goodman Faculty of Life Sciences and the Institute of Nanotechnology and Advanced Materials, Bar-Ilan University, Ramat Gan 5290002, Israel
| | - Andreia Sofia Bernardo
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Almira Chervova
- Department of Stem Cell and Developmental Biology, Institut Pasteur, Paris 75724, France
| | - Somboon Wankanit
- Institut Pasteur, Université de Paris, CNRS UMR3738, Human Developmental Genetics, F-75015 Paris, France
| | - Emmanuel Frachon
- Biomaterials and Microfluidics Core Facility, Institut Pasteur, F-75015 Paris, France
| | - Pierre-Henri Commère
- Cytometry and Biomarkers, Centre de Ressources et Recherches Technologiques (C2RT), Institut Pasteur, F-75015 Paris, France
| | - Sylvie Brailly-Tabard
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Molecular Genetics, Pharmacogenetics, and Hormonology, Le Kremlin-Bicêtre, France
| | - Léo Valon
- Institut Pasteur, Université de Paris, CNRS UMR3738, Cell Death and Epithelial Homeostasis, F-75015 Paris, France
| | - Laura Barrio Cano
- Cytometry and Biomarkers, Centre de Ressources et Recherches Technologiques (C2RT), Institut Pasteur, F-75015 Paris, France
| | - Romain Levayer
- Institut Pasteur, Université de Paris, CNRS UMR3738, Cell Death and Epithelial Homeostasis, F-75015 Paris, France
| | - Inas Mazen
- Genetics Department, National Research Center, Cairo, Egypt
| | - Samy Gobaa
- Biomaterials and Microfluidics Core Facility, Institut Pasteur, F-75015 Paris, France
| | - James C. Smith
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK
| | - Kenneth McElreavey
- Institut Pasteur, Université de Paris, CNRS UMR3738, Human Developmental Genetics, F-75015 Paris, France
| | | | - Anu Bashamboo
- Institut Pasteur, Université de Paris, CNRS UMR3738, Human Developmental Genetics, F-75015 Paris, France
| |
Collapse
|
3
|
Live-Birth Outcomes Among Women With Infertility and Anti-Müllerian Hormone Levels of 0.3 ng/mL or Lower. Obstet Gynecol 2022; 140:743-750. [DOI: 10.1097/aog.0000000000004895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022]
|
4
|
Jeong HG, Kim SK, Lee JR, Jee BC. Correlation of oocyte number with serum anti-Müllerian hormone levels measured by either Access or Elecsys in fresh in vitro fertilization cycles. Clin Exp Reprod Med 2022; 49:202-209. [PMID: 36097736 PMCID: PMC9468695 DOI: 10.5653/cerm.2022.05211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study was to assess the correlation of oocyte number with serum anti-Müllerian hormone (AMH) levels measured by two automated methods (Access or Elecsys) in fresh stimulated in vitro fertilization (IVF) cycles. Methods In this retrospective study at a university hospital, data were collected from 243 fresh stimulated IVF cycles performed from August 2016 to December 2020. The serum AMH level was measured by Access in 120 cycles and by Elecsys in 123 cycles. The cut-off of serum AMH for prediction of poor responders (three or fewer oocytes) or high responders (15 or more oocytes) was calculated by the receiver operating characteristic curve analysis. Results For the two automated methods, the following equations were derived: total oocyte number=2.378+1.418×(Access-AMH) (r=0.645, p<0.001) and total oocyte number=2.417+2.163×(Elecsys-AMH) (r=0.686, p<0.001). The following combined equation could be derived: (Access-AMH)=0.028+1.525×(Elecsys-AMH). To predict poor responders, the cut-off of Access-AMH was 1.215 ng/mL (area under the curve [AUC], 0.807; 95% confidence interval [CI], 0.730–0.884; p<0.001), and the cut-off of Elecsys-AMH was 1.095 ng/mL (AUC, 0.848; 95% CI, 0.773–0.923; p<0.001). To predict high responders, the cut-off of Access-AMH was 3.450 ng/mL (AUC, 0.922; 95% CI, 0.862–0.981; p<0.001), and the cut-off of Elecsys-AMH was 2.500 ng/mL (AUC, 0.884; 95% CI, 0.778–0.991; p<0.001). Conclusion Both automated methods for serum AMH measurement showed a good correlation with oocyte number and good performance for predicting poor and high responders in fresh stimulated IVF cycles. The Access method usually yielded higher measured serum AMH levels than the Elecsys method.
Collapse
Affiliation(s)
- Hye Gyeong Jeong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Corresponding author: Seul Ki Kim Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Republic of Korea Tel: +82-31-787-7264 Fax: +82-31-787-7264 E-mail:
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Co-corresponding author: Byung Chul Jee Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Republic of Korea Tel: +82-31-787-7254 Fax: +82-31-787-4054 E-mail:
| |
Collapse
|
5
|
Moolhuijsen LME, Louwers YV, Laven JSE, Visser JA. Comparison of 3 Different AMH Assays With AMH Levels and Follicle Count in Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2022; 107:e3714-e3722. [PMID: 35737957 PMCID: PMC9387710 DOI: 10.1210/clinem/dgac370] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Indexed: 11/21/2022]
Abstract
CONTEXT Anti-Müllerian hormone (AMH) levels strongly correlate with the number of antral follicles (total follicle count, TFC) in the ovary. In women with polycystic ovary syndrome (PCOS), this is reflected by significantly increased serum AMH levels. Different assays have been developed to measure AMH. However, little is known about the interassay correlation in women with increased AMH levels. OBJECTIVE To investigate the correlation of AMH values between different AMH assays and with TFC in PCOS patients. METHODS AMH levels were measured in 1660 PCOS patients, using 3 different AMH assays: Gen II (Beckman Coulter); picoAMH (Ansh Labs); and Elecsys (Roche). Passing Bablok regression was used to compare assay methods. Spearman's correlation was used to correlate AMH levels and TFC. RESULTS Strong interassay correlations were present over the total range of AMH levels (0.81-0.94). Stratification in subgroups, revealed an AMH level-dependent interassay correlation with strong interassay correlations in the low (<2.80 ng/mL) and high (>7.04 ng/mL) subgroups (0.62-0.86). However, the correlation in the mid-AMH subgroup (2.80-7.04 ng/mL) was only moderate (0.28-0.56). A strong correlation was present between the total range of AMH levels and TFC (0.57-0.62). However, in all 3 AMH subgroups the correlation became moderate at best, independently of assay method (0.11-0.45). CONCLUSION In conclusion, both the interassay correlation and the correlation between AMH level and follicle count depend on the range of serum AMH levels. This once more emphasizes the need of a standardization of AMH measurement for an accurate interpretation of AMH in clinical practice.
Collapse
Affiliation(s)
- Loes M E Moolhuijsen
- Department of Internal Medicine, Erasmus MC, University Medical CenterRotterdam, Rotterdam, The Netherlands
| | - Yvonne V Louwers
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical CenterRotterdam, Rotterdam, The Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical CenterRotterdam, Rotterdam, The Netherlands
| | - Jenny A Visser
- Correspondence: Jenny A. Visser, Department of Internal Medicine, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| |
Collapse
|
6
|
Han JY, Kim SW, Kim H, Ku SY. The level of vitamin D in follicular fluid and ovarian reserve in an in vitro fertilization program: A pilot study. Sci Prog 2022; 105:368504221103782. [PMID: 35619572 PMCID: PMC10364929 DOI: 10.1177/00368504221103782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The level of vitamin D in follicular fluid (FF) according to the ovarian reserve has never been investigated, and the effect of FF vitamin D on the outcome of assisted reproductive technology (ART) remains controversial. The aim of this study is to evaluate the association between FF vitamin D levels and baseline anti-Müllerian hormone (AMH) / ART outcomes. METHODS Forty-seven patients who underwent controlled ovarian stimulation at the fertility clinic of an academic tertiary care center were enrolled for a prospective observational study. FF was collected from the first aspirated leading follicle of each ovary and assayed by an enzyme-linked immunosorbent assay. Multivariable linear regression analysis was used to assess the association between baseline AMH and FF vitamin D levels with adjustment for basal FSH and serum vitamin D levels. RESULTS Both the AMH and serum vitamin D were significant predictors for FF vitamin D. The estimated marginal mean of FF vitamin D level was higher in women with decreased ovarian reserve (DOR) than those with normal ovarian reserve (24.1 ± 2.1 vs. 18.8 ± 1.4 ng/ml, p = 0.048). However, FF vitamin D did not demonstrate any significant associations with cycle outcomes, including fertilization rate and the number and proportion of good embryos at day three. CONCLUSION We observed significantly higher FF vitamin D levels in women with DOR. However, FF vitamin D did not demonstrate any significant associations with the outcome of ART. A larger prospective study is needed to investigate the effect of FF vitamin D on the clinical pregnancy rate and live birth rate.
Collapse
Affiliation(s)
- Ji Yeon Han
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Sung Woo Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Seung-Yup Ku
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
7
|
Han A, Suh B, Yi G, Lee YJ, Kim SE. Comparison of the Automated Fluorescent Immunoassay System With Roche Elecsys and Beckman Coulter Access 2 Assays for Anti-Müllerian Hormone Measurement. Ann Lab Med 2022; 42:47-53. [PMID: 34374348 PMCID: PMC8368231 DOI: 10.3343/alm.2022.42.1.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/24/2020] [Accepted: 07/21/2021] [Indexed: 12/03/2022] Open
Abstract
Background Since 2017, automated assays have been used in most clinical laboratories for anti-Müllerian hormone (AMH) level measurement. We evaluated the analytical performance of the newly developed automated fluorescent immunoassay system (AFIAS) AMH assay (Boditech Med, Gangwon-do, Korea) in comparison with the Roche Elecsys and Beckman Coulter Access 2 AMH assays. Methods Analytical performance of the AFIAS AMH assay was assessed in terms of linearity, repeatability, and within-laboratory precision (CV%) using human recombinant AMH samples according to the Clinical and Laboratory Standards Institute (CLSI) guidelines EP05 and EP06. Using 293 serum samples collected from an infertility clinic, the AMH levels were compared across AFIAS, Elecsys, and Access 2 AMH assays according to the CLSI EP09 guidelines. Results The AFIAS AMH assay results were linear across the measurement range of 0.420–72.386 pmol/L AMH, with repeatability of 6.341%. CV% of the AFIAS AMH assay for three levels of control, 1.786, 7.143, and 56.857 pmol/L, were 5.801%, 5.714%, and 6.228%, respectively. The results of the three AMH assays showed strong correlation AFIAS and Elecsys [slope, 1.055 (95% confidence interval (CI), 1.022–1.088) and Spearman’s rho, 0.978 (95% CI, 0.973–0.983)], Elecsys and Access 2 [slope, 0.813 (95% CI, 0.791–0.834) and Spearman’s rho, 0.986 (95% CI, 0.983–0.989)], and AFIAS and Access 2 [slope, 0.836 (95% CI, 0.821–0.853) and Spearman’s rho, 0.984 (95% CI, 0.980–0.988)]. Conclusions The AFIAS AMH assay may be an alternative to the Roche Elecsys and Beckman Coulter Access 2 AMH assays.
Collapse
Affiliation(s)
- Aera Han
- I-dream Clinic, Department of Obstetrics and Gynecology, MizMedi Hospital, Seoul, Korea.,Deagu Cha Fertility Center, CHA University, Daegu, Korea
| | - Borum Suh
- Department of Laboratory Medicine, MizMedi Hospital, Seoul, Korea
| | - Gwang Yi
- I-dream Clinic, Department of Obstetrics and Gynecology, MizMedi Hospital, Seoul, Korea
| | - Yoo Jin Lee
- I-dream Clinic, Department of Obstetrics and Gynecology, MizMedi Hospital, Seoul, Korea
| | - Sung Eun Kim
- I-dream Clinic, Department of Obstetrics and Gynecology, MizMedi Hospital, Seoul, Korea
| |
Collapse
|
8
|
Bell RJ, Islam RM, Skiba MA, Herbert D, Martinez Garcia A, Davis SR. Substituting serum anti-Müllerian hormone for polycystic ovary morphology increases the number of women diagnosed with polycystic ovary syndrome: a community-based cross-sectional study. Hum Reprod 2021; 37:109-118. [PMID: 34741176 DOI: 10.1093/humrep/deab232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/15/2021] [Indexed: 12/19/2022] Open
Abstract
STUDY QUESTION Can serum anti-Müllerian hormone (AMH) replace polycystic ovary morphology (PCOM) determined by ultrasound as a diagnostic component of polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Despite good correlations between serum AMH and PCOM, the use of a high serum AMH as a proxy for PCOM resulted in the reclassification of PCOS in 5% of study participants, with the main effect being more women identified, although some women previously classified as having PCOS were no longer classified as such. WHAT IS KNOWN ALREADY AMH has been proposed as an alternative to PCOM as a diagnostic component of PCOS. Previous studies are limited by poorly defining PCOS, use of infertile women as comparators, measurement of hormones by immunoassay that lack precision in the female range, low-resolution ovarian ultrasound and inconsistent handling and storage of serum samples. STUDY DESIGN, SIZE, DURATION This is an Australian cross-sectional study of 163 non-healthcare-seeking women. PARTICIPANTS/MATERIALS, SETTING, METHODS Serum AMH was measured by both the Ansh picoAMH assay and the Beckman Coulter Access 2 (BA2) assay, in parallel with androgens measured by liquid chromatography-tandem mass spectrometry, in blood samples of women, not pregnant, breast feeding or using systemic steroids, who also underwent high-resolution ovarian ultrasound. PCOS was determined by the Rotterdam criteria with PCOM defined by the Androgen Excess-PCOS Taskforce recommendation of ≥25 follicles in at least one ovary. Cut-off serum concentrations that best identified women as having PCOM were identified by receiver operator characteristic (ROC) curves. MAIN RESULTS AND THE ROLE OF CHANCE A total of 163 women, mean (SD) age 32.5 (5.5) years, who provided a blood sample and had both ovaries visualized on ultrasound were included in the analysis. Women with isolated PCOM had higher median (range) Ansh AMH and BA2 AMH concentrations than those with no PCOS characteristics [56.9 pmol/l (34.6, 104.2) versus 18.7 (3.2, 50.9), P = 0.002 and 38.5 pmol/l (22.2, 100.2) versus 16.7 (3.5, 38.9), P = 0.002, respectively]. An AMH ≥ 44.0 pmol/l, suggested by the ROC curve, identified 80.6% of women with PCOM, falsely identified 15.2% of women without PCOM as having PCOS and had a positive predictive value of 55.6%. The negative predictive value was 94.9%. An AMH BA2 assay cut-off of ≥33.2 pmol/l provided a sensitivity of 80.6%, a specificity of 79.5% and a positive predictive value for PCOM of 48.1%. The negative predictive value was 94.6% for PCOM. When serum AMH was used in the place of PCOM as a diagnostic criterion for PCOS, the Ansh assay resulted in an additional seven women classified as having PCOS and no longer classified one woman as having PCOS. For the BA2 assay, eight additional and two fewer women were classified as having PCOS. Overall, both assays resulted in six more women being classified as having PCOS. LIMITATIONS, REASONS FOR CAUTION Women with functional hypogonadotrophic hypogonadism were not excluded and may have been misclassified as having an oligo-amenorrhoea-PCOM phenotype. As study participants were predominantly Caucasian/White, our findings cannot be generalized to women of other ethnicities. WIDER IMPLICATIONS OF THE FINDINGS Although serum AMH reflects the number of developing ovarian follicles, the absolute values vary between assays and specific reference ranges for individual assays are required. Irrespective of the assay used, replacing PCOM with serum AMH to diagnose PCOS in a community-based sample altered the number of women classified as having or not having PCOS. Consequently, although overall the risk of women being identified as having PCOS would be increased, some women would no longer be classified as having this condition. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by the Norman Beischer Research Foundation and the Grollo-Ruzzene Foundation. S.R.D. is an NHMRC Senior Principal Research Fellow (Grant No. 1135843). S.R.D. reports unrelated support that includes grants from the NHMRC Australia, personal fees for educational activities from Besins Healthcare, Abbott Chile, BioFemme and Pfizer Australia, personal Advisory Board/consultancy fees from Theramex, Abbott Laboratories, Astellas, Mayne Pharmaceuticals, Roche Diagnostics, Lawley Pharmaceuticals and Que Oncology and has received institutional grant funding from Que Oncology and Ovoca research. The other authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rakibul M Islam
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marina A Skiba
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dilinie Herbert
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alejandra Martinez Garcia
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Endocrinology, Division of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
9
|
The predictive value of anti-Müllerian hormone for natural conception leading to live birth in subfertile couples. Reprod Biomed Online 2021; 44:557-564. [DOI: 10.1016/j.rbmo.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022]
|
10
|
Wang X, Jin L, Mao YD, Shi JZ, Huang R, Jiang YN, Zhang CL, Liang XY. Evaluation of Ovarian Reserve Tests and Age in the Prediction of Poor Ovarian Response to Controlled Ovarian Stimulation-A Real-World Data Analysis of 89,002 Patients. Front Endocrinol (Lausanne) 2021; 12:702061. [PMID: 34526967 PMCID: PMC8435745 DOI: 10.3389/fendo.2021.702061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022] Open
Abstract
Aims This study aimed to explore the value of ovarian reserve tests (ORTs) for predicting poor ovary response (POR) and whether an age cutoff could improve this forecasting, so as to facilitate clinical decision-making for women undergoing in vitro fertilization (IVF). Methods A retrospective cohort study was conducted on poor ovary response (POR) patients using real-world data from five reproductive centers of university-affiliated hospitals or large academic hospitals in China. A total of 89,002 women with infertility undergoing their first traditional ovarian stimulation cycle for in vitro fertilization from January 2013 to December 2019 were included. The receiver operating characteristic (ROC) curve was performed to estimate the prediction value of POR by the following ORTs: anti-Mullerian hormone (AMH), antral follicle count (AFC), basal FSH (bFSH), as well as patient age. Results In this retrospective cohort, the frequency of POR in the first IVF cycle was 14.8%. Age, AFC, AMH, and bFSH were used as predicting factors for POR, of which AMH and AFC were the best indicators when using a single factor for prediction (AUC 0.862 and 0.842, respectively). The predictive values of the multivariate model included age and AMH (AUC 0.865), age and AFC (AUC 0.850), age and all three ORTs (AUC 0.873). Compared with using a single factor alone, the combinations of ORTs and female age can increase the predictive value of POR. Adding age to single AMH model improved the prediction accuracy compared with AMH alone (AUC 0.865 vs. 0.862), but the improvement was not significant. The AFC with age model significantly improved the prediction accuracy of the single AFC model (AUC 0.846 vs. 0.837). To reach 90% specificity for POR prediction, the cutoff point for age was 38 years old with a sensitivity of 40.7%, 5 for AFC with a sensitivity of 55.9%, and 1.18 ng/ml for AMH with a sensitivity of 63.3%. Conclusion AFC and AMH demonstrated a high accuracy when using ROC regression to predict POR. When testing is reliable, AMH can be used alone to forecast POR. When AFC is used as a prediction parameter, age is suggested to be considered as well. Based on the results of the cutoff threshold analysis, AFC ≤ 5 and AMH ≤ 1.18 ng/ml should be recommended to predict POR more accurately in IVF/ICSI patients.
Collapse
Affiliation(s)
- Xue Wang
- Reproductive Medicine Center, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yun-dong Mao
- State Key Laboratory of Reproductive Medicine, Clinical Center for Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Juan-zi Shi
- Reproductive Medicine Center, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Rui Huang
- Reproductive Medicine Center, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yue-ning Jiang
- Reproductive Medicine Center, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Cui-lian Zhang
- Reproductive Medicine Center, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao-yan Liang
- Reproductive Medicine Center, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
11
|
Zhang J, Wang X, Ren Z, Shao S, Hou Z, Wang Z, Xi J, Bai W. Impact of age and menopausal stage on serum anti-Müllerian hormone levels in middle-aged women. Climacteric 2021; 24:618-623. [PMID: 34427163 DOI: 10.1080/13697137.2021.1965114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to evaluate the association between age, menopausal stage and serum anti-Müllerian hormone (AMH) levels in middle-aged women. METHODS In this cross-sectional study, the serum AMH levels of 288 healthy women aged 40-55 years (divided into age groups: 40-44, 45-49 and 50-55 years) were evaluated. Stages of Reproductive Aging Workshop + 10 criteria were used to categorize these women into menopausal stages: late reproductive, menopausal transition and early postmenopausal stages. The impact of age, menopausal stage and hormone replacement therapy on serum AMH levels was analyzed using multi-factor analysis of variance. Effects of body mass index, smoking status and oral contraceptive use were simultaneously considered. RESULTS The median AMH level was 0.140 ng/ml. Log-AMH levels varied according to age group (variance = 20.113, F = 88.538, p < 0.001) and menopausal stage (variance = 5.543, F = 24.501, p < 0.001). An exponential model defined as AMH = 227,421.757 × e(-0.301 × age) was fit to describe the decline in AMH level with age. The 5th-95th percentiles of the AMH levels ranged from less than 0.020 to 3.150, less than 0.020 to 1.944 and less than 0.020 to 0.030 ng/ml in the aforementioned menopausal stages, respectively. CONCLUSION Age and menopausal stage were associated with AMH levels; age had a greater impact on AMH than menopausal stage in middle-aged women.
Collapse
Affiliation(s)
- J Zhang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - X Wang
- Department of Obstetrics and Gynecology, Ninth School of Clinical Medicine, Peking University, Beijing, China
| | - Z Ren
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - S Shao
- Medical Examination Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Z Hou
- Department of Obstetrics and Gynecology, Beijing Haidian District Maternal and Child Health Hospital, Beijing, China
| | - Z Wang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - J Xi
- Department of Obstetrics and Gynecology, Beijing Xicheng Maternal and Child Health Hospital, Beijing, China
| | - W Bai
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
12
|
Bell RJ, Skiba MA, Sikaris K, Liu A, Islam RM, Davis SR. Differing performance of two assays for the measurement of anti-Mullerian hormone in premenopausal women: A cross-sectional study. Clin Endocrinol (Oxf) 2021; 95:169-175. [PMID: 33705583 DOI: 10.1111/cen.14458] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To compare the performance of two anti-Mullerian (AMH) assays over a range of concentrations, in samples collected from young women. DESIGN A cross-sectional method-comparison study of 168 non-healthcare-seeking women. PARTICIPANTS Included women were aged 18-39 years, not recently pregnant, breast feeding or using systemic hormones. MEASUREMENTS Serum AMH levels were analysed with the Beckman Coulter Access 2 assay from fresh samples and the Ansh picoAMH assay using samples stored at -80°C, in a parallel setting. Comparisons between the two assays were examined using Bland-Altman plots. RESULTS Participants had a mean ± SD age of 32.6 ± 5.4 years and body mass index of 28.1 ± 7.9 kg/m2 , and 60.1% were parous. Although the assay results were highly correlated (Spearman correlation .982, P < .001), the relationship between the assays was nonlinear. Serum AMH values below 4 pmol/L were lower with the picoAMH assay compared with the Access AMH assay (mean difference in this range was -0.49 pmol/L), but for samples with a mean value above 10 pmol/L, the picoAMH assay consistently measured higher than the Access AMH assay (mean difference in this range was +8.2 pmol/L). As AMH concentrations increased the absolute discrepancy between the assays also increased. CONCLUSIONS This study demonstrates that despite the high correlation between two commercially available AMH assays, the assays performed in a discordant manner at high and low concentrations. Hence, the results of these assays are not interchangeable, highlighting the need to establish specific reference limits for individual assays to guide clinical decision-making and the challenge of establishing future universal cut-offs for the application of AMH levels in clinical practice.
Collapse
Affiliation(s)
- Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Marina A Skiba
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Ken Sikaris
- Department of Chemical Pathology, Melbourne Pathology, Melbourne, Vic., Australia
| | - Angela Liu
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Rakibul M Islam
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| |
Collapse
|
13
|
Homburg R, Rao U, Malamas F, Palouki P, Gudi A, Shah A, Brooks S, Drakeley A, Faye S. Automated anti-Mullerian hormone measurement: data review to provide insights and interpretation. Gynecol Endocrinol 2021; 37:511-514. [PMID: 32603200 DOI: 10.1080/09513590.2020.1785419] [Citation(s) in RCA: 1] [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: 10/24/2022] Open
Abstract
RESULTS AMH results were pooled and a table with 2.5 and 97.5 percentiles for each age group constructed. Based on Youden index, the optimal cut off for low responders (0-3 eggs), was 5.5 pmol/l (87% sensitivity, 55% specificity) and for high responders (>15 eggs) 15.6 pmol/l (78% sensitivity, 57% specificity). AMH correlated with number of eggs collected (r = 0.48) and clinical pregnancies (r = 0.14), (p < .0001). CONCLUSIONS The table of AMH levels measured using the Access 2 fully automated immunoassay system according to age may be used as a reference and cutoff levels for high and poor responders are clearly defined to help tailor controlled ovarian stimulation, maximizing efficiency and ensuring patient safety. The use of a random access automated immunoassay system means that blood sampled on arrival can produce an AMH result in 40 mins by the time the subject enters the doctor's clinic together with other relevant endocrine markers.
Collapse
Affiliation(s)
- R Homburg
- Homerton Fertility Centre, Homerton University NHS Foundation Trust Hospital, London, UK
| | - U Rao
- Homerton Fertility Centre, Homerton University NHS Foundation Trust Hospital, London, UK
| | - F Malamas
- Homerton Fertility Centre, Homerton University NHS Foundation Trust Hospital, London, UK
| | - P Palouki
- Homerton Fertility Centre, Homerton University NHS Foundation Trust Hospital, London, UK
| | - A Gudi
- Homerton Fertility Centre, Homerton University NHS Foundation Trust Hospital, London, UK
| | - A Shah
- Homerton Fertility Centre, Homerton University NHS Foundation Trust Hospital, London, UK
| | - S Brooks
- Hewitt Fertility Centre, Liverpool Women's Hospital, Liverpool, UK
| | - A Drakeley
- Hewitt Fertility Centre, Liverpool Women's Hospital, Liverpool, UK
| | - S Faye
- Independent Scientific Consultant, Leeds, UK
| |
Collapse
|
14
|
Baker VL, Glassner MJ, Doody K, Schnell VL, Gracia C, Shin SS, Behera MA, Le Saint CM, Alper MM, Pavone ME, Zbella EA, Coddington CC, Marshall LA, Feinberg RF, Cooper AR, Straseski JA, Broyles DL. Validation study of the Access antimüllerian hormone assay for the prediction of poor ovarian response to controlled ovarian stimulation. Fertil Steril 2021; 116:575-582. [PMID: 33812650 DOI: 10.1016/j.fertnstert.2021.01.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of the antimüllerian hormone (AMH) level determined using the Access AMH assay for predicting poor ovarian response (POR) defined as ≤4 oocytes retrieved, including the validation of the predefined AMH cutoff of 0.93 ng/mL in both serum and plasma. DESIGN Prospective cohort study. SETTING Fifteen private and academic fertility centers (14 in the United States and 1 in Canada). PATIENT(S) Women aged 21-45 years planning controlled ovarian stimulation for in vitro fertilization. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Number of oocytes retrieved, categorized as POR and normal-to-high ovarian response (non-POR). The correlation of AMH level and antral follicle count. RESULT(S) Data were available for 472 participants who completed the study (74 with POR and 398 non-POR). The mean AMH serum level among those with POR was 0.99 ng/mL (median 0.76 ng/mL) compared with 2.83 ng/mL (median 2.36 ng/mL) among the normal-to-high responders. For confirmation of the 0.93 ng/mL AMH level cutoff as a predictor of POR, a receiver operating characteristic analysis gave an area under the curve of 0.852, with corresponding sensitivity and specificity of 63.5% and 89.2%, respectively. The associated positive predictive value was 52.2% and the negative predictive value was 92.9%. The AMH plasma values demonstrated a strong correlation with AMH serum values with an r value = 0.9980. The previously established AMH cutoff of 1.77 ng/mL for antral follicle count >15 resulted in a sensitivity of 83.8% (95% confidence interval [CI] 77.7-88.5) and a specificity of 59.9% (95% CI 54.2-65.4). CONCLUSION(S) This study validated the previously established AMH cut-point for the prediction of POR. Because this cut-point may vary depending on the assay used, the specific AMH assay should be reported in the literature whenever possible.
Collapse
Affiliation(s)
- Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Lutherville, Maryland.
| | | | | | | | - Clarisa Gracia
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sanghyuk S Shin
- Sue & Bill Gross School of Nursing, University of California, Irvine
| | | | | | | | - Mary Ellen Pavone
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | | | - Charles C Coddington
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota
| | | | | | - Amber R Cooper
- Vios Fertility Institute Saint Louis, Saint Louis, Missouri
| | | | | |
Collapse
|
15
|
Wang J, Yao T, Zhang X, Chen Q, Gong S, Jiang L, Yao H, Hu X. Age-specific reference intervals of serum anti-Müllerian hormone in Chinese girls. Ann Clin Biochem 2021; 58:350-357. [PMID: 33657846 DOI: 10.1177/00045632211002879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study aimed to establish anti-Mullerian hormone age-specific reference intervals and determine the correlation between the anti-Mullerian hormone concentration and age, body mass index and concentrations of follicle-stimulating hormones and luteinizing hormone in healthy Chinese girls. METHODS Serum anti-Mullerian hormone concentrations of 1702 healthy girls (0-12 years), recruited between March 2018 and December 2019, were determined using the Beckman Access 2 automated chemiluminescence immunoassay. Single-year-specific medians of anti-Mullerian hormone and effects of age, body mass index, follicle-stimulating hormone and luteinizing hormone on anti-Mullerian hormone concentration were analysed. RESULTS The anti-Mullerian hormone median level continued increasing from birth, reached its peak at age 9 at 4.45 ng/mL (interquartile range [IQR] 2.58-6.90) and then gradually decreased. At age 12, the median reached 1.98 ng/mL (IQR 1.05-3.46). Age-specific reference intervals for anti-Mullerian hormone were established in healthy Chinese girls aged 0-12 years. Anti-Mullerian hormone concentrations showed a moderately positive correlation with age (r = 0.33, P < 0.001). In contrast, follicle-stimulating hormone (r = -0.29, P < 0.001) concentrations were weakly negatively correlated with the serum anti-Mullerian hormone concentration. CONCLUSION We established single-year-specific reference intervals for anti-Mullerian hormone in Chinese girls using the Beckman chemiluminescent platform. This reference range can help clinicians accurately understand anti-Mullerian hormone secretion in healthy girls and promote its clinical use.
Collapse
Affiliation(s)
- Jin Wang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Yao
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinxin Zhang
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine, Chongqing Medical University, Chongqing, China
| | - Qi Chen
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuo Gong
- Sinopharm Hubei Medical Device Co., Ltd, Wuhan, China
| | - Li Jiang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui Yao
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xijiang Hu
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
16
|
Punchoo R, Bhoora S. Variation in the Measurement of Anti-Müllerian Hormone - What Are the Laboratory Issues? Front Endocrinol (Lausanne) 2021; 12:719029. [PMID: 34539570 PMCID: PMC8446602 DOI: 10.3389/fendo.2021.719029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022] Open
Abstract
Anti-Müllerian Hormone (AMH) is a 140 kDa homodimeric glycoprotein consisting of two identical subunits linked by disulphide bonds and is synthesised by the testes and ovaries. Its clinical applications are prediction of ovarian response and gonadotropin dose selection upon in vitro fertilization. In males, AMH is used to investigate sexual developmental disorders and gonadal function. AMH is commonly assayed by enzyme-linked immunosorbent assay or automated immunoassay formats that show variation between methods. This review applies fundamental chemical pathology concepts to explain the observed analytical variation of AMH measurement. We examine the lack of standardisation between AMH assays, the impact of antibody design on variable measurements, consider the analytical detection of AMH isoforms, review analytical interference in AMH measurement, and briefly assess systematic bias between AMH assays. The improved attempt at standardising AMH measurement by the recent approval of a WHO Reference Reagent offers promise for harmonising immunoassay results and establishing consensus medical cut-off points for AMH in disease. Standardisation, however, will need to redress the issue of poor commutability of standard reference material and further assign a standard reference procedure to quantify AMH standard reference material. The improvement of the analytical phase of AMH testing will support harmonised method development and patient care.
Collapse
Affiliation(s)
- Rivak Punchoo
- Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
- Department of Chemical Pathology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- *Correspondence: Rivak Punchoo,
| | - Sachin Bhoora
- Department of Chemical Pathology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
17
|
Moolhuijsen LME, Visser JA. Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function. J Clin Endocrinol Metab 2020; 105:5890022. [PMID: 32770239 PMCID: PMC7486884 DOI: 10.1210/clinem/dgaa513] [Citation(s) in RCA: 208] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/11/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Anti-müllerian hormone (AMH) is produced by granulosa cells of small, growing follicles in the ovary. Serum AMH levels strongly correlate with the number of growing follicles, and therefore AMH has received increasing attention as a marker for ovarian reserve. This review summarizes recent findings and limitations in the application of serum AMH in ovarian reserve assessment. EVIDENCE ACQUISITION A PubMed search was conducted to find recent literature on the measurements and use of serum AMH as a marker for ovarian reserve. EVIDENCE SYNTHESIS Serum AMH levels are measured to assess the "functional ovarian reserve," a term that is preferred over "ovarian reserve," since AMH levels reflect the pool of growing follicles that potentially can ovulate. Serum AMH levels are used in individualized follicle-stimulating hormone dosing protocols and may predict the risk of poor response or ovarian hyperstimulation syndrome but has limited value in predicting ongoing pregnancy. Serum AMH levels are studied to predict natural or disease-related age of menopause. Studies show that the age-dependent decline rates of AMH vary among women. The generalized implementation of serum AMH measurement has also led to an increase in diagnostic assays, including automated assays. However, direct comparison of results remains problematic. CONCLUSION Serum AMH remains the preferred ovarian reserve marker. However, the lack of an international standard for AMH limits comparison between AMH assays. Furthermore, little is known about endogenous and exogenous factors that influence serum AMH levels, which limits proper interpretation of AMH values in a clinical setting.
Collapse
Affiliation(s)
- Loes M E Moolhuijsen
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jenny A Visser
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Correspondence and Reprint Requests: J.A. Visser, Dept of Internal Medicine, Rm Ee532, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail:
| |
Collapse
|
18
|
Roman H, Chanavaz-Lacheray I, Mircea O, Berby B, Dehan L, Braund S, Verspyck E, Puscasiu L. Large ovarian endometriomas are associated with high pre-operative anti-Müllerian hormone concentrations. Reprod Biomed Online 2020; 42:158-164. [PMID: 33060013 DOI: 10.1016/j.rbmo.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 12/27/2022]
Abstract
RESEARCH QUESTION Are large ovarian endometriomas associated with high pre-operative anti-Müllerian hormone (AMH) concentrations? DESIGN Data from 332 women who underwent AMH measurement before surgery for endometriosis were prospectively recorded in a large database. Univariate analysis compared AMH concentrations in terms of the patients' baseline characteristics. A multivariate model was used to identify variables having an independent relationship with AMH concentration. RESULTS Among 332 women included in the study, 47.6% were aged 18-30 years, 67.8% were infertile and 85.5% were nulliparous. A total of 66.3% had ovarian endometriomas, and 10.8% had cysts measuring over 6 cm. Bilateral cysts over 3 cm were recorded in 24.7% of the women. Univariate analysis identified two variables that had a statistically significant relationship with AMH concentration: the woman's age (P = 0.01) and cyst size (P < 0.001). Multivariate analysis revealed that ages of 36-40 years and over 40 years showed a significant association with lower AMH concentrations (P = 0.02 and P = 0.009, respectively), while a cyst size of over 6 cm was statistically associated with high AMH concentrations (P < 0.001), after adjustment for smoking, parity, rectosigmoid endometriotic nodules and a bilateral location of endometriomas. CONCLUSIONS Pre-operative AMH concentration was significantly increased in women with large endometriomas of over 6 cm, independent of their age or the presence of bilateral endometriomas. This is relevant for both surgeons and patients when planning surgery in women with an intention to conceive post-operatively.
Collapse
Affiliation(s)
- Horace Roman
- Endometriosis Centre, Clinique Tivoli-Ducos, Bordeaux, France; Department of Gynaecology and Obstetrics, University Hospital Aarhus, Aarhus, Denmark.
| | | | - Oana Mircea
- Department of Gynecology and Obstetrics, University of Medicine, Pharmacy, Science and Technology, TarguMures, Romania
| | - Benoit Berby
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France
| | - Lise Dehan
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France
| | - Sophia Braund
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France
| | - Eric Verspyck
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France
| | - Lucian Puscasiu
- Department of Gynecology and Obstetrics, University of Medicine, Pharmacy, Science and Technology, TarguMures, Romania
| |
Collapse
|
19
|
Age-specific reference intervals for anti-Müllerian hormone in Chinese boys: A population-based study. Clin Chim Acta 2020; 506:154-159. [DOI: 10.1016/j.cca.2020.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 01/14/2023]
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Marshall V, Siebert TI. Effect of Laparoscopic Cystectomy for Ovarian Endometriomas on Ovarian Reserve, as Measured by Anti-Müllerian Hormone: A Prospective Cohort Study. CURRENT WOMEN S HEALTH REVIEWS 2019. [DOI: 10.2174/1573404814666180724125608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Cystectomy for ovarian endometriomas is commonly performed, however
recent publications have shown a deleterious effect of cystectomy on ovarian reserve.
Objectives:
The study aimed to evaluate what effect laparoscopic cystectomy for ovarian
endometriomas has on the ovarian reserve.
Methods:
This is a prospective cohort study performing standard laparoscopic cystectomies for
ovarian endometriomas. The primary outcome was the assessment of the ovarian reserve using
Anti-Müllerian hormone (AMH), done pre- and six months postoperatively. Secondary outcome
was spontaneous pregnancy during follow up.
Results:
We enrolled 59 participants. Twenty-five participants were lost to follow up and a further
3 were excluded from the analysis. The average age was 33.1 years. Thirty-one participants
completed the six months follow up. The mean preoperative and postoperative AMH value was
3.21ng/mL [95% CI: 2.24 - 4.18ng/mL, SD 2.64] and 1.48ng/mL [95% CI: 1.06 - 1.91ng/mL, SD
1.17] respectively: equating to a 53.89% decline, P=0.002. Twenty participants had unilateral cysts
whilst the remaining 11 had bilateral endometriomas. The mean preoperative and postoperative
AMH for unilateral cysts was 3.22ng/mL [95% CI:1.93 - 4.51ng/mL, SD 2.76] and 1.82ng/mL
[95% CI: 1.23 – 2.41ng/mL, SD 1.26] respectively, representing a 43.48% decrease, P=0.072. Of
the 11 with bilateral endometriomas, the mean preoperative AMH was 3.19ng/mL [95% CI: 1.49 -
4.89ng/mL, SD 2.54] with 0.88ng/mL [95% CI: 0.43 - 1.33ng/mL, SD 0.67] representing the postoperative
AMH, equating to a 72.41% reduction, P=0.005.
Conclusion:
Serum AMH is negatively affected by laparoscopic cystectomy for ovarian
endometriomas, with a significant decline in ovarian reserve as measured six months postoperatively.
A greater decline was seen in patients with bilateral endometriomas compared to unilateral disease.
Collapse
Affiliation(s)
- Vaughan Marshall
- Tygerberg Hospital, Department of Obstetrics and Gynaecology, University of Stellenbosch, Cape Town, South Africa
| | - Thomas Ignatius Siebert
- Tygerberg Hospital, Department of Obstetrics and Gynaecology, University of Stellenbosch, Cape Town, South Africa
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Deshmukh H, Papageorgiou M, Kilpatrick ES, Atkin SL, Sathyapalan T. Development of a novel risk prediction and risk stratification score for polycystic ovary syndrome. Clin Endocrinol (Oxf) 2019; 90:162-169. [PMID: 30339716 DOI: 10.1111/cen.13879] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/10/2018] [Accepted: 10/13/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to develop a simple phenotypic algorithm that can capture the underlying clinical and hormonal abnormalities to help in the diagnosis and risk stratification of polycystic ovary syndrome (PCOS). METHODS The study consisted of 111 women with PCOS fulfilling the Rotterdam diagnostic criteria and 67 women without PCOS. A Firth's penalized logistic regression model was used for independent variable section. Model optimism, discrimination and calibration were assessed using bootstrapping, area under the curve (AUC) and Hosmer-Lemeshow statistics, respectively. The prognostic index (PI) and risk score for developing PCOS were calculated using independent variables from the regression model. RESULTS Firth penalized logistic regression model with backward selection identified four independent predictors of PCOS namely free androgen index [β 0.30 (0.12), P = 0.008], 17-OHP [β = 0.20 (0.01), P = 0.026], anti-mullerian hormone [AMH; β = 0.04 (0.01) P < 0.0001] and waist circumference [β = 0.08 (0.02), P < 0.0001]. The model estimates indicated high internal validity (minimal optimism on 1000-fold bootstrapping), good discrimination ability (bias corrected c-statistic = 0.90) and good calibration (Hosmer-Lemeshow χ2 = 3.7865). PCOS women with a high-risk score (q1 + q2 + q3 vs q4) presented with a worse metabolic profile characterized by a higher 2-hour glucose (P = 0.01), insulin (P = 0.0003), triglycerides (P = 0.0005), C-reactive protein (P < 0.0001) and low HDL-cholesterol (P = 0.02) as compared to those with lower risk score for PCOS. CONCLUSIONS We propose a simple four-variable model, which captures the underlying clinical and hormonal abnormalities in PCOS and can be used for diagnosis and metabolic risk stratification in women with PCOS.
Collapse
Affiliation(s)
- Harshal Deshmukh
- Department of Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Hull, UK
| | - Maria Papageorgiou
- Department of Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Hull, UK
| | - Eric S Kilpatrick
- Department of Pathology, Sidra Medical and Research Center, Doha, Qatar
| | | | - Thozhukat Sathyapalan
- Department of Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Hull, UK
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Ovarian activity regulation by anti-Müllerian hormone in early stages of human female life, an overview. ANTHROPOLOGICAL REVIEW 2018. [DOI: 10.2478/anre-2018-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The present study aimed at describing the anti-Müllerian hormone (AMH), with special focus on molecular background for ovarian activity, in particular the role AMH plays in sex determination and gonadogenesis process in early stages of prenatal life and folliculogenesis in postnatal life. It is a review of the literature currently indexed and abstracted in MEDLINE, SCOPUS and Google Scholars. The process of sex determination and gonad differentiation occurring during embryogenesis was discussed along with underlying molecular mechanisms. In the postnatal life the impact of AMH on the process of folliculogenesis was described. Clinical use of recent findings was shown as well. Genetic studies and molecular analyses have demonstrated that AMH is highly conservative, indicating its significance in reproductive process on the background of evolutionary processes.
Collapse
|
26
|
Ferguson JM, Pépin D, Duru C, Matejtschuk P, Donahoe PK, Burns CJ. Towards international standardization of immunoassays for Müllerian inhibiting substance/anti-Müllerian hormone. Reprod Biomed Online 2018; 37:631-640. [PMID: 30241771 PMCID: PMC6302068 DOI: 10.1016/j.rbmo.2018.08.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 12/12/2022]
Abstract
Research question Is formulated and lyophilized, recombinant human Müllerian inhibiting substance, also known as anti-Müllerian hormone (AMH), suitable for the preparation of a WHO international standard to calibrate AMH immunoassays? Design The AMH content of a trial preparation, coded SS-581, was determined by five laboratories using seven immunoassay methods. Participants were requested to report the content of the preparation in terms of their method calibrators through the measurement of a minimum of five concentrations in the linear part of the dose-response curve. Participants were also asked to measure, concomitantly, a panel of six serum samples containing AMH at concentrations of 0.1–13.0 ng/ml. Results Across all assays, including two automated assays in development, the geometric mean content was 361.76 ng/ampoule with a geometric coefficient of variation (GCV%) of 39.95%. When measured by immunoassays that were commercially available at the time of the study, the mean content was 423.08 ng/ampoule, with a GCV% of 26.67%. The inter-method geometric means of five serum samples with an AMH concentration >0.3 ng/ml and measured concomitantly with dilutions of SS-581 varied with a range of GCV% of 14.90–22.35%, which may reflect the use of serum sample value transfer to calibrate current immunoassays, some of which use non-human AMH calibrators. The AMH in trial preparation SS-581 was shown to be biologically active in the Müllerian duct regression assay. Conclusions A reference material prepared using human recombinant AMH is a promising candidate for the preparation of an international standard for AMH for immunoassays calibrated to recombinant human AMH.
Collapse
Affiliation(s)
- Jackie Mc Ferguson
- Biotherapeutics Division, NIBSC, South Mimms, Potters Bar Hertfordshire, UK.
| | - David Pépin
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, CPZN 6206, MA, USA
| | - Chinwe Duru
- Technology, Development and Infrastructure Division, NIBSC, South Mimms, Potters Bar Hertfordshire, UK
| | - Paul Matejtschuk
- Technology, Development and Infrastructure Division, NIBSC, South Mimms, Potters Bar Hertfordshire, UK
| | - Patricia K Donahoe
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, CPZN 6206, MA, USA
| | - Chris J Burns
- Biotherapeutics Division, NIBSC, South Mimms, Potters Bar Hertfordshire, UK
| |
Collapse
|
27
|
Multicenter evaluation of the Access AMH antimüllerian hormone assay for the prediction of antral follicle count and poor ovarian response to controlled ovarian stimulation. Fertil Steril 2018; 110:506-513.e3. [DOI: 10.1016/j.fertnstert.2018.03.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/02/2018] [Accepted: 03/19/2018] [Indexed: 11/23/2022]
|
28
|
Very low anti-müllerian hormone concentrations are not an independent predictor of embryo quality and pregnancy rate. Reprod Biomed Online 2018; 37:113-119. [DOI: 10.1016/j.rbmo.2018.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 11/22/2022]
|
29
|
Heidar Z, Bakhtiyari M, Foroozanfard F, Mirzamoradi M. Age-specific reference values and cut-off points for anti-müllerian hormone in infertile women following a long agonist treatment protocol for IVF. J Endocrinol Invest 2018; 41:773-780. [PMID: 29235049 DOI: 10.1007/s40618-017-0802-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 11/23/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of this study were to determining the reference value of anti-müllerian hormone (AMH) in infertile women and effect of AMH on different ovarian responses in the stratum of BMI categories. METHODS Through a retrospective cohort study the information of 816 infertile patients referring to the referral infertility clinic of Mahdiyeh Hospital since the beginning of 2011 until the end of January 2016 were used. The normal-based method was undertaken to calculate age-specific AMH percentiles. To determine the effect of AMH on the outcomes of different ovarian responses following adjustment of associated variables, the multinomial regression model was used. RESULTS Estimated reference intervals for AMH corresponding to the 2.5 and 97.5th‰ in patients with normal ovarian response are from 0.096 to 6.2 ng/mL. These values for percentiles of 5, 10, 25, 50, 75, 90, and 95% are, respectively, 0.18, 0.33, 0.77, 1.68, 3.05, 4.45, and 5.36 ng/dL. Also the reference value for the 20-year-old participants has a maximum range (0.12-7.64), while for 43-year-old ones has the lowest range (0.08-5.3). Among participants under and above 35 years old, the optimal cut-off points for predicting normal ovarian response are, respectively, 1.5 and 1.2 ng/dL. With each unit increase in the log of AMH concentration, the odds of having excessive ovarian response in patients with normal weight compared to that of having normal ovarian response is 32% higher. CONCLUSIONS Determining AMH reference values in IVF candidates allows specialists to measure only AMH plasma levels in IVF candidates so as to find whether or not the ovarian response is normal before applying other therapeutic measures; accordingly, they can adjust a treatment plan for each individual separately.
Collapse
Affiliation(s)
- Z Heidar
- Infertility and Reproductive Health Research Center (IRHRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Bakhtiyari
- Non-communicable Disease Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - M Mirzamoradi
- Department of Obstetrics and Gynecology, Mahdiyeh Hospital, Shahid Beheshti University of Medical Sciences, Po.Box: 1185817311, Tehran, Iran.
| |
Collapse
|
30
|
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.
Collapse
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
Abstract
The life of a human female is characterized from teenage years by monthly menstruation which ceases (the menopause) typically between the age of 40 and 60 years. The potential for reproduction declines and ceases as the ovaries become depleted of follicles. A transition period in mid-life, for 2 to 10 years, when menstruation is less regular is called the perimenopause. The menopause is associated with a significant decline in plasma concentrations of sex hormones, an increase in the concentrations of the gonadotrophins and changes in other hormones such as the inhibins. These changes are superimposed with effects of aging, social and metabolic factors, daily activity and well-being. Although the menopause is entirely natural, in some cases ovarian failure can occur earlier than usual; this is pathological and warrants careful biochemical investigations to distinguish it from conditions causing infertility. Elderly females are affected by a range of clinical disorders including endocrine, cardiovascular, skeletal, urogenital tract and immunological systems, body mass, vasomotor tone, mood and sleep pattern. Reference intervals for many diagnostic biochemical tests for the menopause need to be used when interpreting results in clinical investigations for patient management. The standardization and harmonization of assays are being addressed. Many women now choose to develop their career before bearing children, and the health service has had to change services around this. This review does not cover screening for and tests during pregnancy. The review is timely since the population is aging and there will be more demand on healthcare services.
Collapse
Affiliation(s)
- John W Honour
- Institute of Women's Health, University College London, London, UK
| |
Collapse
|
33
|
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]
|
34
|
Pastuszek E, Lukaszuk A, Kunicki M, Mockun J, Kloss G, Malinowska I, Czyzyk A, Meczekalski B, Lukaszuk K. New AMH assay allows rapid point of care measurements of ovarian reserve. Gynecol Endocrinol 2017; 33:638-643. [PMID: 28457181 DOI: 10.1080/09513590.2017.1306735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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
In this study, we compare two commercial automated immunoassays used to evaluate serum anti-Müllerian hormone (AMH) levels as a prognostic value for ovarian response and pregnancy outcome in assisted reproductive technology cycles. Serum AMH was measured for 193 women. We performed a simultaneous measurement in serum AMH with the two alternative kits VIDAS® and Elecsys® AMH assay. For all women undergoing in vitro fertilization cycle, we collected data on their antral follicle count (AFC) and numbers of retrieved cumulus oocyte complexes (OC) and metaphase II oocytes and pregnancy outcome. The AMH values provided by VIDAS® were correlated with the values obtained with Elecsys® (0.977 for fresh and 0.971 for the frozen samples). For both assays AMH exhibited a moderate positive correlation with AFC, OC and MII oocytes (0.612, 0.674, 0.605 for VIDAS® and 0.570, 0.617, 0.530 for Elecsys®, respectively). AMH prediction of biochemical and clinical pregnancy was similar. The present results suggest that the VIDAS® AMH assay is broadly comparable to the Elecsys-AMH assay in terms of technical performance for clinical or epidemiological use. Both automated assays performed in a similar way and the choice of assay can be made depending on the technical configuration of each laboratory.
Collapse
Affiliation(s)
- Ewa Pastuszek
- a INVICTA Fertility and Reproductive Center , Gdansk , Poland
- b Department of Obstetrics and Gynecological Nursing , Faculty of Health Sciences, Medical University of Gdansk , Gdansk , Poland , and
| | - Aron Lukaszuk
- a INVICTA Fertility and Reproductive Center , Gdansk , Poland
| | - Michal Kunicki
- a INVICTA Fertility and Reproductive Center , Gdansk , Poland
| | - Joanna Mockun
- a INVICTA Fertility and Reproductive Center , Gdansk , Poland
- b Department of Obstetrics and Gynecological Nursing , Faculty of Health Sciences, Medical University of Gdansk , Gdansk , Poland , and
| | - Grzegorz Kloss
- a INVICTA Fertility and Reproductive Center , Gdansk , Poland
| | | | - Adam Czyzyk
- c Department of Gynecological Endocrinology , Medical University of Warsaw , Warsaw , Poland
| | - Blazej Meczekalski
- c Department of Gynecological Endocrinology , Medical University of Warsaw , Warsaw , Poland
| | - 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 , Gdansk , Poland , and
| |
Collapse
|
35
|
Helden JV, Weiskirchen R. Age-independent anti-Müllerian hormone (AMH) standard deviation scores to estimate ovarian function. Eur J Obstet Gynecol Reprod Biol 2017; 213:64-70. [DOI: 10.1016/j.ejogrb.2017.04.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/06/2017] [Accepted: 04/15/2017] [Indexed: 12/01/2022]
|
36
|
Catteau-Jonard S, Roux M, Dumont A, Delesalle AS, Robin G, Dewailly D. Anti-Müllerian hormone concentrations and parity in fertile women: the model of oocyte donors. Reprod Biomed Online 2017; 34:541-545. [DOI: 10.1016/j.rbmo.2017.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/15/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
|
37
|
Izhar R, Husain S, Tahir S, Husain S. Occult Form of Premature Ovarian Insufficiency in Women with Infertility and Oligomenorrhea as Assessed by Poor Ovarian Response Criteria. J Reprod Infertil 2017; 18:361-367. [PMID: 29201666 PMCID: PMC5691252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the ability of poor ovarian response criteria to classify women presenting with infertility and oligomenorrhea as having "occult" premature ovarian insufficiency. METHODS This was a cross sectional study conducted at Aziz Medical Center, Karachi, Pakistan from 1st August 2015 to 31st July 2016. Women with infertility and oligomenorrhea were included. All eligible women underwent day 2 FSH level and an early follicular phase transvaginal ultrasound to assess the antral follicular count (AFC). All women then underwent the confirmatory test, of Anti-Mullerian Hormone (AMH) level. The main outcome measure was assignment to occult premature ovarian insufficiency (POI) after screening that used the criteria set out in fertility guideline for predicting the likely ovarian response to gonadotrophin stimulation. Another measure was to compare the sensitivity and specificity of the two index criteria, of FSH and AFC, relative to the emerging reference standard, of the AMH criterion. RESULTS The three criteria together classified 59 (34.91%) women as occult POI in those with oligomenorrhea. The sensitivity, specificity, negative predictive value and positive predictive value of FSH relative to AMH for these women were 77.8%, 95.7%, 90.2% and 89.4%, respectively whereas the same values of AFC relative to AMH were 92.6%, 99.1 %, 96.6% and 98%, respectively. CONCLUSION Women with menstrual irregularity and infertility are at a higher risk for satisfying criteria of poor ovarian response irrespective of age. A policy incorporating these surrogate markers can be used to screen these women for occult premature ovarian insufficiency.
Collapse
Affiliation(s)
- Rubina Izhar
- Department of Gynaecology and Obstetrics, Abbasi Shaheed Hospital and Karachi Medical and Dental College, Karachi, Pakistan,Aziz Medical Center, Karachi, Pakistan
| | - Samia Husain
- Department of Gynaecology and Obstetrics, Abbasi Shaheed Hospital and Karachi Medical and Dental College, Karachi, Pakistan,Corresponding Author: Samia Husain, Department of Gynaecology and Obstetrics, Abbasi Shaheed Hospital and Karachi Medical and Dental College, Karachi, Pakistan E-mail:
| | | | - Sonia Husain
- Department of Gynaecology and Obstetrics, Abbasi Shaheed Hospital and Karachi Medical and Dental College, Karachi, Pakistan
| |
Collapse
|
38
|
New automated antimüllerian hormone assays are more reliable than the manual assay in patients with reduced antral follicle count. Fertil Steril 2016; 106:1800-1806. [DOI: 10.1016/j.fertnstert.2016.08.045] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/16/2016] [Accepted: 08/22/2016] [Indexed: 12/22/2022]
|
39
|
Performance characteristics of the Access AMH assay for the quantitative determination of anti-Müllerian hormone (AMH) levels on the Access* family of automated immunoassay systems. Clin Biochem 2016; 49:1267-1273. [DOI: 10.1016/j.clinbiochem.2016.08.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/01/2016] [Accepted: 08/05/2016] [Indexed: 11/20/2022]
|
40
|
Hadlow N, Brown SJ, Habib A, Wardrop R, Joseph J, Gillett M, Maguire R, Conradie J. Quantifying the intraindividual variation of antimüllerian hormone in the ovarian cycle. Fertil Steril 2016; 106:1230-1237. [PMID: 27351446 DOI: 10.1016/j.fertnstert.2016.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/19/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To quantify intraindividual variability of antimüllerian hormone (AMH) as analytical and biological coefficients of variation and assess the effects of variation on clinical classification. DESIGN Retrospective cohort study. SETTING Not applicable. PATIENT(S) Thirty-eight women referred by general practitioners. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Total intraindividual variability (CVW), analytical (CVA) and biological variability (CVI) for each woman and for AMH ranges: low (<5 pmol/L), reduced (5-10), moderate (>10-30) and high (>30 pmol/L), with calculation of proportion of women crossing clinical cutoffs and expected variability around each cutoff. RESULT(S) Cycling women (n = 38) contributed 238 blood samples (average 6 samples each). The average total intraindividual AMH variability was 20% (range: 2.1% to 73%). Biological variation was 19% (range: 0 to 71%) and at least twice the analytical variation of 6.9% (range: 4.5% to 16%). Reclassification rates were highest in women with low (33%) or reduced AMH (67%) levels. Expected variations around the 5, 10, and 30 pmol/L cutoffs were 3-7, 7-13, and 20-40 pmol/L, respectively. In a woman with mean AMH in the 10-30 pmol/L range, the span of results that could occur was 7-40 pmol/L. CONCLUSION(S) Total variation in AMH was 20%, and the majority of this was biological. Changes in AMH resulted in reclassification in 29% of women and occurred most frequently in those with low and reduced AMH. In cycling women, the variability in AMH should be considered by clinicians, especially if a result is close to a clinical cutoff.
Collapse
Affiliation(s)
- Narelle Hadlow
- Department of Biochemistry, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia; Western Diagnostic Pathology, Myaree, Western Australia, Australia.
| | - Suzanne J Brown
- Department of Endocrinology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Afsana Habib
- Western Diagnostic Pathology, Myaree, Western Australia, Australia
| | - Robert Wardrop
- Department of Biochemistry, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - John Joseph
- Department of Biochemistry, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Melissa Gillett
- Western Diagnostic Pathology, Myaree, Western Australia, Australia
| | - Rhonda Maguire
- Department of Biochemistry, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Johan Conradie
- Western Diagnostic Pathology, Myaree, Western Australia, Australia
| |
Collapse
|