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Dermolo M, Ansa M, Siferih M. Ovarian response to controlled stimulation and its predictors in a limited-resource setting. BMC Womens Health 2024; 24:279. [PMID: 38714986 PMCID: PMC11075256 DOI: 10.1186/s12905-024-02991-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/22/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Infertility remains a serious health concern for Ethiopian women. Most of its treatment approaches entail controlled ovarian stimulation, the responses of which vary. However, there are no data on ovarian response to stimulation or its predictors in our situation. Thus, the current study aimed to assess the ovarian response to controlled stimulation and identify predictors. METHODS A retrospective follow-up study was undertaken from April 1, 2021, to March 31, 2022, among patients who had first-cycle controlled ovarian stimulation at St.Paul's Hospital Fertility Center in Addis Ababa, Ethiopia. Clinical data were extracted using a checklist. SPSS-26 for data analysis and Epidata-4.2 for data entry were employed. The binary logistic regression model was fitted. A p-value < 0.05 indicated a significant association. The ROC curve was used to determine cutoff values and identify accurate predictors. RESULTS A total of 412 study participants were included in the final analysis. The patients had a mean age of 32.3 ± 5.1 years (range: 20 - 4). The good ovarian response rate was 67% (95% CI: 62.2-71.5). An anti-Mullerian hormone (AMH) concentration < 1.2ng/ml (AOR = 0.19, 95% CI (0.06-0.57)), an antral follicle count (AFC) < 5 (AOR = 0.16, 95% CI (0.05-0.56)), and an induction length < 10 days (AOR = 0.23, 95% CI (0.06-0.93)) were significantly associated with ovarian response. The prediction accuracies for the AFC and AMH concentrations were 0.844 and 0.719, respectively. The optimal cutoff point for prediction was 5.5 AFC, which had a sensitivity of 77.2% and a specificity of 72.8%. However, its positive and negative predictive values were 85.2% and 61.1%, respectively. For AMH, the optimal cutoff value was 0.71ng/mL, with a corresponding sensitivity and specificity of 65.2% and 66%. At this value, the positive and negative predictive values were 63.8% and 67.3%, respectively. CONCLUSION Only two-thirds of our patients achieved a good ovarian response. Induction duration, AMH concentration, and AFC were found to be predictors, with the AFC being the strongest predictor. Therefore, the AFC should be performed on all of our patients, and the AMH is selectively employed. Future research must verify the best cutoff points and investigate additional factors affecting ovarian response.
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Affiliation(s)
- Munira Dermolo
- Department of Obstetrics and Gynecology, St.Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Meseret Ansa
- Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, St.Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Melkamu Siferih
- Department Obstetrics and Gynecology, School of Medicine, Debremarkos University, Debremarkos, Amhara, Ethiopia.
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Namvar Z, Mohseni-Bandpei A, Shahsavani A, Amini H, Mousavi M, Hopke PK, Shahhosseini E, Khodagholi F, Hashemi SS, Azizi F, Ramezani Tehrani F. Long-term exposure to air pollution and anti-mullerian hormone rate of decline: a population-based cohort study in Tehran, Iran. Environ Sci Pollut Res Int 2023; 30:86987-86997. [PMID: 37418184 DOI: 10.1007/s11356-023-28394-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
Anti-mullerian hormone (AMH) concentration is a marker of ovarian reserve that decreases with age. However, a decrease in AMH may occur more rapidly under the influence of environmental factors. The present study investigated the association between long-term exposure to ambient air pollutants with serum concentrations of AMH and the AMH rate of decline. This study included 806 women with median age of 43 years (interquartile range: 38-48) participating in the Tehran Lipid and Glucose Study (TLGS) that were followed from 2005 to 2017. The AMH concentration and the demographic, anthropometric, and personal health parameters of the study participants were obtained from the TLGS cohort database. Air pollutant data were collected from the monitoring stations and the individual exposures were estimated by previously developed land use regression (LUR) models. Multiple linear regression analysis was used to estimate linear relationships between the air pollutant exposures and serum concentration of AMH and with the AMH declination rate. The results show no statistically significant associations between exposures to any of the air pollutants (including PM10, PM2.5, SO2, NO, NO2, NOX, and benzene, toluene, ethylbenzene, p-xylene, m-xylene, o-xylene (BTEX), and total BTEX) with serum concentration of AMH. Compared to the first tertile, no statistically significant associations were observed between the second or third tertiles of air pollutants, with the AMH rate of decline. In this study, we did not find significant association between air pollution and AMH in middle age women in Tehran, Iran. Future work may study such associations in younger women.
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Affiliation(s)
- Zahra Namvar
- Air Quality and Climate Change Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anoushiravan Mohseni-Bandpei
- Air Quality and Climate Change Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Shahsavani
- Air Quality and Climate Change Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Heresh Amini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Maryam Mousavi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Philip K Hopke
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Institute for a Sustainable Environment, Clarkson University, Potsdam, NY, USA
| | - Elahe Shahhosseini
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Khodagholi
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Saeed Hashemi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Johnson A, Thompson R, Nickel B, Shih P, Hammarberg K, Copp T. Websites Selling Direct-to-Consumer Anti-Mullerian Hormone Tests. JAMA Netw Open 2023; 6:e2330192. [PMID: 37603332 PMCID: PMC10442712 DOI: 10.1001/jamanetworkopen.2023.30192] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
Importance The recent provision of direct-to-consumer (DTC) Anti-Mullerian Hormone (AMH) testing in several countries has been contentious, particularly due to concerns about judicious testing and informed consent. Objective To describe and analyze information on websites that sell DTC AMH tests. Design, Setting, and Participants Qualitative study including content analysis of text information from websites in multiple countries that sell AMH tests DTC. The top 50 search results from 4 different internet search strings were captured and reviewed for eligibility. Data were extracted in March 2022 and analyzed from April 2022 to July 2023. Main outcomes and measures Themes and categories were derived from the website content using a conventional inductive approach, with a particular focus on information content, quality and accuracy, as well as the tone and language used. Results Twenty-seven websites across 7 different countries formed the sample for analysis. Information varied considerably across websites and was organized into 6 overarching categories: (1) whether a test description was included (25 websites [93%]); (2) statements about what the test can do, which included indicating ovarian reserve (26 websites [96%]) and indicating likelihood of conceiving (20 websites [74%]); (3) statements about the usefulness of the test result, which included enabling women to adjust their reproductive timeline (11 websites [41%]) and determining whether egg freezing was a viable option (8 websites [30%]); (4) blood collection method (ie, through a laboratory or an at-home sample); (5) promotion tactics, such as stating the convenience of testing (24 websites [89%]) and using language promoting empowerment and control (7 websites [26%]); and (6) statements about limitations of the test, which included polycystic ovary syndrome falsely inflating AMH levels (13 websites [48%]) and that it cannot accurately predict chances of conceiving (9 websites [33%]). Conclusion and relevance In this qualitative study including content analysis, most websites selling DTC AMH tests included false and misleading claims which might lead consumers to purchase an AMH test in the belief that it can reliably predict fertility potential and age of menopause. Depending on the test result, this may in turn lead to misplaced anxiety or reassurance about one's fertility and modifications to subsequent conception or contraceptive plans and behavior.
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Affiliation(s)
- Alexis Johnson
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Thompson
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Nickel
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patti Shih
- Faculty of Arts, Social Sciences and Humanities, School of Health and Society, Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, New South Wales, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tessa Copp
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Wang K, Guan Y, Zhang Y, Jia R, Wu S, Yao Z, Zhang M, Li Z. Analysis of cumulative outcomes and influencing factors of patients with discrepancies between age and AMH levels in the early follicular phase prolonged protocol. Front Endocrinol (Lausanne) 2023; 14:1098131. [PMID: 36967754 PMCID: PMC10031014 DOI: 10.3389/fendo.2023.1098131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To explore the cumulative outcomes and influencing factors of patients with discrepancies between age and Anti-Müllerian hormone (AMH) levels in the early follicular phase prolonged protocol. METHODS A total of 1282 cycles of in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) assisted pregnancy with the early follicular phase prolonged protocol in the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University from September 2015 to December 2020 were retrospectively analyzed. They were divided into the young low-AMH group (n=1076) and the older high-AMH group (n=206). The primary outcomes included cumulative clinical pregnancy rate (CCPR) and cumulative live birth rate (CLBR). Secondary outcomes included the number of oocytes retrieved, number of available embryos, clinical pregnancy rate (CPR), live birth rate (LBR), miscarriage rate (MR), pregnancy complications, and neonatal outcomes. RESULTS The CPR (68.7% vs. 59.4%) and the LBR (60.7% vs. 43.1%) in the young low-AMH group were higher than those in the older high-AMH group. In contrast, the number of oocytes retrieved (11 vs. 17), number of available embryos (5 vs. 8), and MR (10.6% vs. 18.3%) in the young low-AMH group were lower. There was no significant difference between the two groups in the CCPR, CLBR, pregnancy complications, and neonatal outcomes. Logistic regression analysis showed that infertility duration, basal follicle-stimulating hormone (FSH), and antral follicle count (AFC) correlated with CCPR, while maternal age, type of infertility, basal FSH, AFC, and infertility duration correlated with CLBR. The area under the receiver operating characteristic curves (ROC) curve for the combined model of infertility duration, AFC, and basal FSH to predict cumulative pregnancy was 0.629 (95%CI:0.592-0.666), while the combined model of maternal age, AFC, basal FSH, infertility duration, and type of infertility to predict cumulative live birth was 0.649 (95%CI:0.615-0.682). CONCLUSION Although AMH levels are low by contrast, young patients have a favorable outcome after IVF/ICSI. In patients with discrepancies between age and AMH levels in the early follicular phase prolonged protocol, maternal age correlates better with cumulative live birth. The model that combines maternal age and other factors can help predict cumulative live birth, but its value is limited.
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Kristensen SG, Kumar A, Mamsen LS, Kalra B, Pors SE, Bøtkjær JA, Macklon KT, Fedder J, Ernst E, Hardy K, Franks S, Andersen CY. Intrafollicular Concentrations of the Oocyte-secreted Factors GDF9 and BMP15 Vary Inversely in Polycystic Ovaries. J Clin Endocrinol Metab 2022; 107:e3374-e3383. [PMID: 35511085 PMCID: PMC9282257 DOI: 10.1210/clinem/dgac272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT The oocyte-secreted factors growth differentiation factor 9 (GDF9) and bone morphogenetic protein 15 (BMP15) play essential roles in follicle development and oocyte maturation, and aberrant regulation might contribute to the pathogenesis of polycystic ovary syndrome. OBJECTIVE Are there measurable differences in concentrations of GDF9, BMP15, and the GDF9/BMP15 heterodimer in small antral follicle fluids from women with and without polycystic ovaries (PCO)? DESIGN AND SETTING Follicle fluids (n = 356) were collected from 4- to 11-mm follicles in unstimulated ovaries of 87 women undergoing ovarian tissue cryopreservation for fertility preservation. PATIENTS Twenty-seven women with PCO were identified and 60 women without PCO-like characteristics (non-PCO women) were matched according to age and follicle size. MAIN OUTCOME MEASURES Intrafollicular concentrations of GDF9, BMP15, GDF9/BMP15 heterodimer, anti-Mullerian hormone (AMH), inhibin-A and -B, total inhibin, activin-B and -AB, and follistatin were measured using enzyme-linked immunosorbent assays. RESULTS The detectability of GDF9, BMP15, and the GDF9/BMP15 heterodimer were 100%, 94.4%, and 91.5%, respectively, and concentrations were significantly negatively correlated with increasing follicle size (P < 0.0001). GDF9 was significantly higher in women with PCO (PCO: 4230 ± 189 pg/mL [mean ± SEM], n = 188; non-PCO: 3498 ± 199 pg/mL, n = 168; P < 0.03), whereas BMP15 was lower in women with PCO (PCO: 431 ± 40 pg/mL, n = 125; non-PCO: 573 ± 55 pg/mL, n = 109; P = 0.10), leading to a significantly higher GDF9:BMP15 ratio in women with PCO (P < 0.01). Significant positive associations between BMP15 and AMH, activins, and inhibins in non-PCO women switched to negative associations in women with PCO. CONCLUSIONS Intrafollicular concentrations of GDF9 and BMP15 varied inversely in women with PCO reflecting an aberrant endocrine environment. An increased GDF9:BMP15 ratio may be a new biomarker for PCO.
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Affiliation(s)
- Stine Gry Kristensen
- Correspondence: Stine Gry Kristensen, PhD, Laboratory of Reproductive Biology, Section 5701, Copenhagen University Hospital – Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
| | | | - Linn Salto Mamsen
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | | | - Susanne Elisabeth Pors
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | - Jane Alrø Bøtkjær
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | - Kirsten Tryde Macklon
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Jens Fedder
- Centre of Andrology & Fertility Clinic, Odense University Hospital, 5000 Odense, Denmark
| | - Erik Ernst
- Department of Gynecology and Obstetrics, Horsens Regional Hospital, 8700 Horsens, Denmark
| | - Kate Hardy
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London W12 0NN, United Kingdom
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London W12 0NN, United Kingdom
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
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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.
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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
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Skowrońska P, Kunicki M, Pastuszek E, Konieczna L, Bączek T, Męczekalski B, Smolarczyk R, Łukaszuk K. Vitamin D and anti-Müllerian hormone concentration in human follicular fluid individually aspirated from all patient follicles. Gynecol Endocrinol 2022; 38:28-32. [PMID: 34044669 DOI: 10.1080/09513590.2021.1933934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The main aim of this prospective study was to investigate the relationship between intrafollicular vitamin D and anti-Müllerian hormone (AMH) concentration and its impact on oocyte quality and developmental competence. METHODS The analysis was performed on 208 follicular fluid (FF) samples obtained from 33 patients undergoing ovarian stimulation as part of in vitro fertilization (IVF) treatment that included intracytoplasmic sperm injection. RESULTS Our study shows that vitamin D concentration in FF varies according to the developmental stage of the oocyte and corelates with embryo development status on day 3, while AMH concentration in FF is not correlated with the developmental potential of an oocyte. We demonstrated that the levels of vitamin D and AMH were higher in FF than in serum. Moreover we showed that AMH and vitamin D levels were positively correlated in FF but not in serum. CONCLUSION FF-AMH levels do not appear to be a suitable as noninvasive test of the developmental potential of an oocyte, while FF-vitamin D level can be used to evaluate whether embryos obtained from particular oocytes have potential of reaching the third day of culture. However, our results encourage further research to be carried out on a larger number of patients and testing additional components found in FF such as androgens.
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Affiliation(s)
| | - Michał Kunicki
- INVICTA Fertility and Reproductive Center, Warsaw, Poland
- Department of Gynecological Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Pastuszek
- INVICTA Fertility and Reproductive Center, Gdansk, Poland
| | - Lucyna Konieczna
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Bączek
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, Gdansk, Poland
| | - Błażej Męczekalski
- Department of Gynaecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Roman Smolarczyk
- Department of Gynecological Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Łukaszuk
- INVICTA Fertility and Reproductive Center, Warsaw, Poland
- INVICTA Fertility and Reproductive Center, Gdansk, Poland
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
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Affiliation(s)
- C Tamer Erel
- Cerrahpasa Faculty of Medicine, Department of Obstetrics and Gynecology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ipek B Ozcivit
- Cerrahpasa Faculty of Medicine, Department of Obstetrics and Gynecology, Istanbul University-Cerrahpaşa, Istanbul 34098, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Zhao D, Fan J, Wang P, Jiang X, Yao J, Li X. Age-specific definition of low anti-Mullerian hormone and associated pregnancy outcome in women undergoing IVF treatment. BMC Pregnancy Childbirth 2021; 21:186. [PMID: 33673814 PMCID: PMC7936413 DOI: 10.1186/s12884-021-03649-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 02/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The age-specific definition of low anti-müllerian hormone (AMH) is lacking. This study aims to define an age-specific reference for low AMH and to evaluate the associated outcome in women undergoing IVF treatment. METHODS A retrospective study was performed in women receiving IVF treatment at the Shenzhen maternity and child healthcare hospital between September 2016 and September 2018. We excluded cases without AMH concentration. Polynomial least-squares regression was used to estimate the age-specific reference ranges for AMH after log-transformed. The age-specific 10th centile was defined as the threshold of low AMH concentration. RESULTS A total of 909 patients were analyzed in this study. The age-specific reference ranges for AMH were established using linear regression model and resulted in an age-specific equation for mean: mean of LnAMH = (- 0.085 × age) + 3.722 (ng/ml, in unit). Women with AMH level higher than 10th centile had favorable outcomes in ovarian stimulation compared to those with low AMH level. In patients younger than 35 years, the rates of clinical pregnancy per transfer and ongoing pregnancy per transfer in the subgroup with AMH level higher than 10th centile were significantly higher than that in the subgroup of low AMH level, 57% versus 31.3% p = 0.003 and 51.9% versus 21.9% p = 0.001, respectively. CONCLUSION Women with AMH lower than age-specific 10th centile had significantly unfavorable outcomes after IVF treatment. The age-specific 10th centile of AMH concentration may be useful to predict the outcome of IVF treatment.
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Affiliation(s)
- Depeng Zhao
- Department of Reproductive Medicine, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Jing Fan
- Department of Reproductive Medicine, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Ping Wang
- Department of Reproductive Medicine, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Xuan Jiang
- Department of Reproductive Medicine, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Jilong Yao
- Department of Reproductive Medicine, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Xuemei Li
- Department of Reproductive Medicine, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China.
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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.
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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
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12
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Lam MT, Li HWR, Wong CYG, Yeung WSB, Ho PC, Ng EHY. Women's age and total motile normal morphology sperm count predict fecundability: a prospective cohort study. BMJ Sex Reprod Health 2020; 46:279-286. [PMID: 32718983 DOI: 10.1136/bmjsrh-2020-200639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study investigated the role of women's age, serum anti-Müllerian hormone (AMH) level and semen parameters in predicting fecundability. METHODS This was a prospective cohort study on couples attending for preconceptional health check. Occurrence of conception at 1 year after ceasing contraception and time to pregnancy were noted by telephone follow-up. The women's age, serum AMH level and total motile normal morphology sperm count (TMNC) were compared between those who conceived and those who did not after 1 year; their independent predictive value on conception at 1 year was analysed by logistic regression. Among those conceiving within 1 year, Spearman's correlations between time to pregnancy and the clinical parameters were studied. RESULTS Of the 100 couples analysed, we found younger age of the women (p=0.008), higher serum AMH level (p=0.038) and higher TMNC (p=0.015) in those that conceived within 1 year. Multivariate logistic regression found that women's age (OR 0.867, 95% CI 0.761 to 0.988, p=0.032) and TMNC (OR 1.089, 95% 1.001-1.185, p=0.047), but not serum AMH level, significantly predicted conception within 1 year. Among those that conceived within 1 year, none of the parameters analysed were correlated with time to pregnancy within 1 year. CONCLUSIONS Women's age and TNMC are significant independent predictors of conception within 1 year. No parameter was shown to predict the time to pregnancy within 1 year. This finding can aid preconceptional counselling of couples who are planning for pregnancy.
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Affiliation(s)
- Mei Ting Lam
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
| | - Hang Wun Raymond Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
- The Family Planning Association of Hong Kong, Wan Chai, Hong Kong
| | - Ching Yin Grace Wong
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
- The Family Planning Association of Hong Kong, Wan Chai, Hong Kong
| | - William Shu Biu Yeung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Pak Chung Ho
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Ernest Hung Yu Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
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13
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Abstract
BACKGROUND There is a need for a reference material to support the development and ensure the quality of immunoassays for human AMH. A batch of ampoules, coded 16/190, containing lyophilised recombinant AMH was evaluated in a WHO Collaborative Study. The aims of the study were to determine the AMH content in terms of the calibration of each immunoassay method, to predict long-term stability and to assess the suitability of the preparation to calibrate AMH immunoassays. METHODS Study participants were asked to report the AMH content of specific dilutions of coded ampoules of 16/190 and a comparator preparation containing approximately half the AMH content. In each assay, participants also reported the AMH content of 22 patient samples to assess commutability. A robust all-laboratory geometric mean of the content estimates was determined using the laboratory geometric mean estimates. Commutability was assessed using a difference in bias approach. Stability was predicted by the measurement of thermally accelerated degradation samples. RESULTS Seven laboratories performed twenty-one immunoassay method-platform combinations, sixteen of which provided data which met the validity criteria, giving a consensus geometric mean estimate of AMH content of 511 ng/ampoule (95% CI, 426-612, n = 16, GCV 42%) and a robust geometric mean of 489 ng/ampoule. By contrast, the GCV% for the all-laboratory geometric mean of the relative content estimates for the comparator sample to 16/190 was 12%. Commutability was assessed using 20 of the 22 representative patient samples. Of the valid assays, 16/190 was within the limits of acceptable commutability for 6 methods, partially commutable for a further 3 methods and non-commutable when measured by 7 methods. The preparation was predicted to be highly stable when stored at - 20 °C. CONCLUSION The majority of methods met the validity criteria. Content estimates showed a high between-method variability, yet assays exhibited a similar proportionality of response as demonstrated using the comparator sample. 16/190 was commutable in some but not all methods. On the basis of these results, it was agreed by the WHO Expert Committee on Biological Standardization to establish 16/190 as a WHO Reference Reagent for AMH with a content defined by consensus immunoassay of 489 ng/ampoule.
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Affiliation(s)
- Jackie Ferguson
- Biotherapeutics Division, National Institute for Biological Standards and Control, South Mimms, Potters Bar, Hertfordshire, UK
| | - Jason Hockley
- Biostatistics Group, National Institute for Biological Standards and Control, South Mimms, Potters Bar, Hertfordshire, UK
| | - Peter Rigsby
- Biostatistics Group, National Institute for Biological Standards and Control, South Mimms, Potters Bar, Hertfordshire, UK
| | - Chris Burns
- Biotherapeutics Division, National Institute for Biological Standards and Control, South Mimms, Potters Bar, Hertfordshire, UK.
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Fauser BCJM, Nelson SM. Next Steps Toward AMH as a Robust Biomarker for Assessing Ovarian Aging in Individual Women. J Clin Endocrinol Metab 2020; 105:5823271. [PMID: 32315387 PMCID: PMC7450215 DOI: 10.1210/clinem/dgaa220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/19/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Bart C J M Fauser
- University of Utrecht, Utrecht, The Netherlands
- Corresponding Author and Reprint Requests: Bart CJM Fauser, Burg LF Montignylaan 28 3055 LG Rotterdam, The Netherlands. E-mail:
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Van Saen D, Vloeberghs V, Gies I, De Schepper J, Tournaye H, Goossens E. Characterization of the stem cell niche components within the seminiferous tubules in testicular biopsies of Klinefelter patients. Fertil Steril 2020; 113:1183-1195.e3. [PMID: 32418646 DOI: 10.1016/j.fertnstert.2020.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To characterize the tubular environment in testicular biopsy tissues from patients with Klinefelter syndrome (KS). DESIGN Observational immunohistochemical study. SETTING Academic research unit. PATIENT(S) Males with KS and controls at different developmental time points: fetal, prepubertal, peripubertal, and adult. INTERVENTION(S) Immunohistochemical analysis of testicular biopsies samples to characterize maturation of Sertoli cells and tubular wall components-peritubular myoid cells (PTMC) and extracellular matrix (ECM) proteins. MAIN OUTCOME MEASURE(S) Intensity of antimüllerian hormone staining; proportion of Sertoli cells expressing androgen receptor (AR); and expression of tubular wall markers as characterized by identifying abnormal staining patterns. RESULT(S) Decreased expression for alpha smooth muscle actin 2 (ACTA2) was observed in peripubertal and adult KS as well as in Sertoli cell only (SCO) patients. Altered expression patterns for all ECM proteins were observed in SCO and KS biopsy tissues compared with controls. Only for collagen I and IV were altered expression patterns observed between KS and SCO patients. In peripubertal samples, no statistically significant differences were observed in the maturation markers, but altered ECM patterns were already present in some samples. CONCLUSION(S) The role of loss of ACTA2 expression in PTMC in the disintegration of tubules in KS patients should be further investigated. Future research is necessary to identify the causes of testicular fibrosis in KS patients. If the mechanism behind this fibrotic process could be identified, this process might be altered toward increasing the chances of fertility in KS patients.
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Affiliation(s)
- Dorien Van Saen
- Biology of the Testis, Laboratory for Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Veerle Vloeberghs
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Inge Gies
- Department of Pediatrics, Division of Pediatric Endocrinology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jean De Schepper
- Biology of the Testis, Laboratory for Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Pediatrics, Division of Pediatric Endocrinology, Universitair Ziekenhuis Brussel, Brussels, Belgium; Pediatric Endocrinology, Universitair Ziekenhuis Gent, Gent, Belgium
| | - Herman Tournaye
- Biology of the Testis, Laboratory for Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium; Department of Surgical and Clinical Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ellen Goossens
- Biology of the Testis, Laboratory for Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Ramezani Tehrani F, Bidhendi Yarandi R, Solaymani-Dodaran M, Tohidi M, Firouzi F, Azizi F. Improving Prediction of Age at Menopause Using Multiple Anti-Müllerian Hormone Measurements: the Tehran Lipid-Glucose Study. J Clin Endocrinol Metab 2020; 105:5766353. [PMID: 32109280 DOI: 10.1210/clinem/dgaa083] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/26/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Several statistical models were introduced for the prediction of age at menopause using a single measurement of anti-müllerian hormone (AMH); however, individual prediction is challenging and needs to be improved. OBJECTIVE The objective of this study was to determine whether multiple AMH measurements can improve the prediction of age at menopause. DESIGN All eligible reproductive-age women (n = 959) were selected from the Tehran Lipid and Glucose Study. The serum concentration of AMH was measured at the time of recruitment and twice after that at an average of 6-year intervals. An accelerated failure-time model with Weibull distribution was used to predict age at menopause, using a single AMH value vs a model that included the annual AMH decline rate. The adequacy of these models was assessed using C statistics. RESULTS The median follow-up period was 14 years, and 529 women reached menopause. Adding the annual decline rate to the model that included single AMH improved the model's discrimination adequacy from 70% (95% CI: 67% to 71%) to 78% (95% CI: 75% to 80%) in terms of C statistics. The median of differences between actual and predicted age at menopause for the first model was -0.48 years and decreased to -0.21 in the model that included the decline rate. The predicted age at menopause for women with the same amount of age-specific AMH but an annual AMH decline rate of 95 percentiles was about one decade lower than in those with a decline rate of 5 percentiles. CONCLUSION Prediction of age at menopause could be improved by multiple AMH measurements; it will be useful in identifying women at risk of early menopause.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Razieh Bidhendi Yarandi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Solaymani-Dodaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faezeh Firouzi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Romito A, Bardhi E, Errazuriz J, Blockeel C, Santos-Ribeiro S, Vos MD, Racca A, Mackens S, Kelen AVD, Panici PB, Vaiarelli A, Tournaye H, Drakopoulos P. Heterogeneity Among Poor Ovarian Responders According to Bologna Criteria Results in Diverging Cumulative Live Birth Rates. Front Endocrinol (Lausanne) 2020; 11:208. [PMID: 32373068 PMCID: PMC7179754 DOI: 10.3389/fendo.2020.00208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/24/2020] [Indexed: 02/03/2023] Open
Abstract
Research Question: Does reproductive outcome differ among the various subgroups of poor ovarian responders according to the Bologna criteria? Design: This was a retrospective, cohort study including poor ovarian responders according to Bologna criteria, undergoing an ICSI cycle from January 2011 until December 2017. Patients were divided into four groups: (1) age ≥ 40 years and abnormal ovarian response test, (2) age ≥ 40 years, abnormal ovarian reserve test and one previous poor response to stimulation, (3) age ≥ 40 years and one previous poor response, (4) abnormal ovarian reserve test and one previous poor response. Result(s): Overall, 846 cycles in 706 Bologna poor ovarian responders were included: 310 cycles in group 1, 169 in group 2, 52 in group 3, and 315 in group 4. There were significant differences in age, antral follicle count, antimüllerian hormone, cycle cancellation rates, and number of retrieved oocytes between the four groups. Live birth and cumulative live birth rate differed significantly between groups and were highest in Group 4 [Live birth rate: 7.4% (1) vs. 4.1% (2) vs. 5.8% (3) vs. 13.4% (4), p = 0.001 and Cumulative live birth rate: 8.3% (1) vs. 4.1 % (2) vs. 9.6% (3) vs. 16.8% (4) p < 0.001]. The multivariate GEE analysis revealed that the number of MIIs and the Bologna criteria pattern were the variables which were significantly associated with cumulative live birth rate. Conclusion(s): Poor ovarian responders represent a heterogeneous population. The young subpopulation has a better clinical prognosis in terms of fresh and cumulative live birth rate.
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Affiliation(s)
- Alessia Romito
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Erlisa Bardhi
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Joaquin Errazuriz
- Departamento de Ginecologia y Obstetricia Clinica Alemana, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Christophe Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Obstetrics and Gynaecology, University of Zagreb, Zagreb, Croatia
| | | | - Michel De Vos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Annalisa Racca
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Shari Mackens
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alberto Vaiarelli
- Clinica Valle Giulia, G.E.N.E.R.A. Centre for Reproductive Medicine, Rome, Italy
| | - Herman Tournaye
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Panagiotis Drakopoulos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- *Correspondence: Panagiotis Drakopoulos
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18
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Abstract
Anti-Müllerian hormone reflects the continuum of the functional ovarian reserve, and as such can predict ovarian response to gonadotropin stimulation and be used to individualize treatment pathways to improve efficacy and safety. However, consistent with other biomarkers and age-based prediction models it has limited ability to predict live birth and should not be used to refuse treatment, but rather to inform counselling and shared decision making. The use of absolute clinical thresholds to stratify patient phenotypes, assess discordance and individualize treatment protocols in non-validated algorithms combined with the lack of standardization of assays may result in inappropriate classification and sub-optimal clinical decision making. We propose that holistic baseline phenotyping, incorporating antral follicle count and other patient characteristics is critical. Treatment decisions driven by validated algorithms that use ovarian reserve biomarkers as continuous measures, reducing the risk of misclassification, are likely to improve overall outcomes for our patients.
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Affiliation(s)
- Hang Wun Raymond Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pokfulam, Hong Kong
- *Correspondence: Hang Wun Raymond Li,
| | - Scott M. Nelson
- School of Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom
- NIHR Bristol Biomedical Research Centre, Bristol, United Kingdom
- The Fertility Partnership, Oxford, United Kingdom
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19
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Jing J, Xia F, Ding Z, Chen L, Shao Y, Ge YF, Pan P, Tian T, Lan XP, Yao B. A single-center performance evaluation of the fully automated iFlash anti-Müllerian hormone immunoassay. Clin Chem Lab Med 2019; 57:e19-e22. [PMID: 30020884 DOI: 10.1515/cclm-2018-0371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/20/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Jun Jing
- Jinling Hospital, Nanjing University School of Medicine, Reproductive Medical Center, Nanjing, Jiangsu, P.R. China
| | - Fuzhen Xia
- Jinling Hospital, Nanjing University School of Medicine, Reproductive Medical Center, Nanjing, Jiangsu, P.R. China
| | - Zheng Ding
- Nanjing Jiangning Hospital, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Li Chen
- Jinling Hospital, Nanjing University School of Medicine, Reproductive Medical Center, Nanjing, Jiangsu, P.R. China
| | - Yong Shao
- Jinling Hospital, Nanjing University School of Medicine, Reproductive Medical Center, Nanjing, Jiangsu, P.R. China
| | - Yi-Feng Ge
- Jinling Hospital, Nanjing University School of Medicine, Reproductive Medical Center, Nanjing, Jiangsu, P.R. China
| | - Peng Pan
- Jinling Hospital, Nanjing University School of Medicine, Reproductive Medical Center, Nanjing, Jiangsu, P.R. China
| | - Tian Tian
- Jinling Hospital, Nanjing University School of Medicine, Reproductive Medical Center, Nanjing, Jiangsu, P.R. China
| | - Xiao-Peng Lan
- Fuzhou General Hospital of Nanjing Military Command Area, Department Laboratory, Fuzhou, Fujian, P.R. China
| | - Bing Yao
- Jinling Hospital, Nanjing University School of Medicine, Reproductive Medical Center, No. 305 Zhongshan East Road, Nanjing, 210002 Jiangsu, P.R. China
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Fushimi Y, Monniaux D, Takagi M. Efficacy of a single measurement of plasma anti-Müllerian hormone concentration for ovum pick-up donor selection of Japanese Black heifers in herd breeding programs. J Reprod Dev 2019; 65:369-374. [PMID: 30930424 PMCID: PMC6708858 DOI: 10.1262/jrd.2019-003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 03/18/2019] [Indexed: 02/05/2023] Open
Abstract
In this study, we evaluated the efficiency of a single measurement of plasma anti-Müllerian hormone (AMH) concentration in heifers in determining the number of oocytes recoverable by ovum pick-up (OPU), and compared AMH concentrations among sister heifers from the same parents. For this, blood samples from 50 embryo-transfer-derived female Japanese Black (JB) heifers (mean: 8.7 age in months) were collected and plasma AMH concentration was measured. At 13-15 months of age, both the number of follicles (2-9 mm) and the number of collected oocytes after OPU were counted and compared. Results indicated that the heifers with the highest AMH concentration had the highest number of follicles in their ovaries and gave the highest number of collected oocytes with OPU, thereby indicating that a single measurement of plasma AMH concentration is informative for the selection of OPU-donor heifers in herd breeding programs. The practice of performing a single AMH measurement may accelerate the intensive breeding of JB herds.
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Affiliation(s)
| | - Danielle Monniaux
- Physiologie de la Reproduction, Centre INRA Val de Loire, 37380 Nouzilly, France
| | - Mitsuhiro Takagi
- Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi 753-8515, Japan
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Altutunji AZ, Liu L, Cai J, Wang Z, Gao Y. The effect of acupuncture on anti-mullerian hormone and assisted reproduction outcome in Polycystic Ovary Syndrome patients undergoing in vitro fertilization. J PAK MED ASSOC 2019; 69(Suppl 3):S4-S8. [PMID: 31603867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the effect of acupuncture at follicular phase of menstrual cycle on anti-mullerian hormone levels in patients with polycystic ovary syndrome undergoing in-vitro fertilisation and to see its impact on assisted reproduction outcome. METHODS The prospective, randomised, controlled trial was conducted from March 2011 to July 2012 at the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. In the center, the patients randomly chose odd or pair number, the patients with odd numbers classified as an interventional group and the patients with paired numbers as non-interventional group. Infertile polycystic ovary syndrome patients aged 20-40 years were enrolled from the hospital's Assisted Reproduction Centre from March 2011 to July 2012. The patients were randomised into two groups, with one receiving follicular phase acupuncture for 30-40 minutes according to the principles of traditional Chinese medicine, and the other group not getting subjected to acupuncture. Serum and follicular anti-mullerian hormone concentration were determined. RESULTS Of the 102 patients, 33(32.4%) were in the intervention group, while 69(67.6%) were in the control group. There was no significant effect of acupuncture on serum and follicular fluid anti-mullerian hormone levels in the intervention group compared to the control group (p>0.05). Serum progesterone and estradiol levels on the day of giving human chorionic gonadotrophin, as well as serum progesterone and estradiol levels on the day of oocytes pick-up were significantly lower in the intervention group (p<0.05). Number of embryos transferred, clinical and ongoing pregnancy rates were significantly higher in the intervention group (p<0.05) with a significant decrease of ovarian hyper-stimulation syndrome rate in the intervention group (p<0.05). CONCLUSIONS Follicular phase acupuncture was found to have a positive effect for polycystic ovary syndrome patients undergoing in-vitro fertilisation, but it had no effect on anti mullerian hormone concentrations.
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Affiliation(s)
- Amina Zakaria Altutunji
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Liu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Cai
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zehua Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Gao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Gowkielewicz M, Lipka A, Piotrowska A, Szadurska-Noga M, Nowakowski JJ, Dzięgiel P, Majewski MK, Jozwik M, Majewska M. Anti-Müllerian Hormone Expression in Endometrial Cancer Tissue. Int J Mol Sci 2019; 20:ijms20061325. [PMID: 30884769 PMCID: PMC6471522 DOI: 10.3390/ijms20061325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 12/29/2022] Open
Abstract
Anti-Müllerian hormone (AMH) is a commonly known factor secreted by Sertoli cells, responsible for regression of the Müllerian ducts in male fetuses. AMH has also other functions in humans. In vivo and in vitro studies have shown that AMH inhibits cell cycle and induces apoptosis in cancers with AMH receptors. The aim of the study was to assess whether the tissue of pre-cancerous states of endometrium (PCS) and various histopathologic types of endometrial cancer (EC) exhibit the presence of AMH. We aimed to investigate whether the potential presence of the protein concerns menopausal women or those regularly menstruating, and whether is related to cancers with a good or a bad prognosis, as well as what other factors may influence AMH expression. The undertaken analysis was carried out on tissues retrieved from 232 women who underwent surgical treatment for PCS and EC. Tissues were prepared for immunohistochemical assessment with the use of a tissue microarrays method. AMH expression was confirmed in 23 patients with well differentiated endometrioid adenocarcinoma (G1), moderately differentiated endometrioid adenocarcinoma (G2), clear cell carcinoma (CCA) and nonatypical hyperplasia. AMH was not found in EC tissues in regularly menstruating women. An appropriately long mean period of breastfeeding in line with a prolonged period of hormonal activity had a positive effect on AMH expression. Our results may suggest that AMH is a factor which protects the organism against cancer, and should be further investigated as a potential prognosis marker and a therapeutic agent.
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Affiliation(s)
- Marek Gowkielewicz
- Department of Gynecology and Obstetrics, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-045 Olsztyn, Poland.
| | - Aleksandra Lipka
- Department of Gynecology and Obstetrics, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-045 Olsztyn, Poland.
| | - Aleksandra Piotrowska
- Division of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, 50-368 Wroclaw, Poland.
| | - Marta Szadurska-Noga
- Department of Pathomorphology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland.
| | - Jacek J Nowakowski
- Department of Ecology & Environmental Protection, University of Warmia and Mazury in Olsztyn, 10⁻727 Olsztyn, Poland.
| | - Piotr Dzięgiel
- Division of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, 50-368 Wroclaw, Poland.
- Department of Physiotherapy, Wroclaw University School of Physical Education, 51-612 Wroclaw, Poland.
| | - Mariusz Krzysztof Majewski
- Department of Human Physiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland.
| | - Marcin Jozwik
- Department of Gynecology and Obstetrics, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-045 Olsztyn, Poland.
| | - Marta Majewska
- Department of Human Physiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland.
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Villarroel C, Salinas A, López P, Kohen P, Rencoret G, Devoto L, Codner E. Anti-Müllerian hormone in type 2 and gestational diabetes during the second half of pregnancy: relationship with sexual steroid levels and metabolic parameters. Gynecol Endocrinol 2018; 34:120-124. [PMID: 28758808 DOI: 10.1080/09513590.2017.1359824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Hyperandrogenemia and hyperinsulinemia are observed in women with diabetes during pregnancy. The effect of diabetes on anti-Müllerian hormone (AMH) levels during pregnancy is unclear. The aim of this study was to determine the AMH levels in women with type 2 diabetes (T2D) and gestational diabetes (GD) compared to healthy (C) pregnant women during the second half of gestation. A prospective study of 69 pregnant women with T2D (N: 21), GD (N: 24) and C (N: 24) were followed up during the second half of pregnancy. Clinical assessments and blood samples were collected at 26.7 (25-27.8); 34 (32-34.9) and 37.5 (37-40) weeks of gestation. AMH, sexual steroids, insulin, homeostatic model assessment of insulin resistance, HbA1c levels were measured. AMH levels were similar between T2D, GD and C (p = .07). A decline of AMH levels during the second half of gestation was observed in the three groups (p < .0001). AMH levels were negatively associated with age (p < .001). A positive association between AMH and testosterone (p < .05) was found in all groups. A progressive decline of AMH levels is observed in diabetic and healthy women during the second half of pregnancy. Testosterone levels are an independent factor that influences AMH levels during pregnancy. However, AMH levels are not affected by the presence of diabetes during gestation.
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Affiliation(s)
- Claudio Villarroel
- a Institute for Mother and Child Research , University of Chile , Santiago , Chile
| | - Abril Salinas
- a Institute for Mother and Child Research , University of Chile , Santiago , Chile
| | - Patricia López
- a Institute for Mother and Child Research , University of Chile , Santiago , Chile
- b Servicio de Salud Centro, Ministerio de Salud , Hospital Clínico San Borja Arriarán , Santiago , Chile
| | - Paulina Kohen
- a Institute for Mother and Child Research , University of Chile , Santiago , Chile
| | - Gustavo Rencoret
- a Institute for Mother and Child Research , University of Chile , Santiago , Chile
- c School of Medicine , University of Chile , Santiago , Chile
| | - Luigi Devoto
- a Institute for Mother and Child Research , University of Chile , Santiago , Chile
| | - Ethel Codner
- a Institute for Mother and Child Research , University of Chile , Santiago , Chile
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Alvaro Mercadal B, Rodríguez I, Arroyo G, Martínez F, Barri PN, Coroleu B. Characterization of a suboptimal IVF population and clinical outcome after two IVF cycles. Gynecol Endocrinol 2018; 34:125-128. [PMID: 28868939 DOI: 10.1080/09513590.2017.1369515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The number of oocytes retrieved in in vitro fertilization (IVF) cycles is an independent factor influencing pregnancy rate (PR), and optimal number of oocytes would be between 10 and 15. This has led to the hypothesis that the identification of a suboptimal group of responders beforehand (4-9 oocytes retrieved) would allow physicians to optimize their PR. A retrospective observational study counting on 735 women doing an IVF treatment in our center was performed. Multivariable logistic regression was used to analyze the relationship between anti-Mullerian hormone (AMH) and antral follicle count (AFC), within suboptimal and optimal responders. We also analyzed the outcome of those patients with an estimated high probability of having an optimal response and the second cycles of those who did not get pregnant in the first cycle to observe the main significant traits that made them change from one group of responders to the other. Main results are that suboptimal responders account for almost half of our patients. Ovarian reserve markers (AMH and AFC) are significantly different in optimal and suboptimal responders, even when adjusted by age. There is a significant difference in the cumulative PR between both groups. Interestingly, 18.9% shifted from suboptimal to optimal response, and 36.9% from optimal to suboptimal.
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Affiliation(s)
- Beatriz Alvaro Mercadal
- a Department of Gynecology, Obstetrics and Reproductive Medicine , Hospital Universitari Dexeus , Barcelona , Spain
| | - Ignacio Rodríguez
- b Statistics Department , Hospital Universitari Dexeus , Barcelona , Spain
| | - Gemma Arroyo
- a Department of Gynecology, Obstetrics and Reproductive Medicine , Hospital Universitari Dexeus , Barcelona , Spain
| | - Francisca Martínez
- a Department of Gynecology, Obstetrics and Reproductive Medicine , Hospital Universitari Dexeus , Barcelona , Spain
| | - Pedro Nolasco Barri
- a Department of Gynecology, Obstetrics and Reproductive Medicine , Hospital Universitari Dexeus , Barcelona , Spain
| | - Buenaventura Coroleu
- a Department of Gynecology, Obstetrics and Reproductive Medicine , Hospital Universitari Dexeus , Barcelona , Spain
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Lensen SF, Wilkinson J, Leijdekkers JA, La Marca A, Mol BWJ, Marjoribanks J, Torrance H, Broekmans FJ. Individualised gonadotropin dose selection using markers of ovarian reserve for women undergoing in vitro fertilisation plus intracytoplasmic sperm injection (IVF/ICSI). Cochrane Database Syst Rev 2018; 2:CD012693. [PMID: 29388198 PMCID: PMC6491064 DOI: 10.1002/14651858.cd012693.pub2] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND During a cycle of in vitro fertilisation plus intracytoplasmic sperm injection (IVF/ICSI), women receive daily doses of gonadotropin follicle-stimulating hormone (FSH) to induce multifollicular development in the ovaries. Generally, the dose of FSH is associated with the number of eggs retrieved. A normal response to stimulation is often considered desirable, for example the retrieval of 5 to 15 oocytes. Both poor and hyper-response are associated with increased chance of cycle cancellation. Hyper-response is also associated with increased risk of ovarian hyperstimulation syndrome (OHSS). Clinicians often individualise the FSH dose using patient characteristics predictive of ovarian response such as age. More recently, clinicians have begun using ovarian reserve tests (ORTs) to predict ovarian response based on the measurement of various biomarkers, including basal FSH (bFSH), antral follicle count (AFC), and anti-Müllerian hormone (AMH). It is unclear whether individualising FSH dose based on these markers improves clinical outcomes. OBJECTIVES To assess the effects of individualised gonadotropin dose selection using markers of ovarian reserve in women undergoing IVF/ICSI. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Specialised Register, Cochrane Central Register of Studies Online, MEDLINE, Embase, CINAHL, LILACS, DARE, ISI Web of Knowledge, ClinicalTrials.gov, and the World Health Organisation International Trials Registry Platform search portal from inception to 27th July 2017. We checked the reference lists of relevant reviews and included studies. SELECTION CRITERIA We included trials that compared different doses of FSH in women with a defined ORT profile (i.e. predicted low, normal or high responders based on AMH, AFC, and/or bFSH) and trials that compared an individualised dosing strategy (based on at least one ORT measure) versus uniform dosing or a different individualised dosing algorithm. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Primary outcomes were live birth/ongoing pregnancy and severe OHSS. Secondary outcomes included clinical pregnancy, moderate or severe OHSS, multiple pregnancy, oocyte yield, cycle cancellations, and total dose and duration of FSH administration. MAIN RESULTS We included 20 trials (N = 6088); however, we treated those trials with multiple comparisons as separate trials for the purpose of this review. Meta-analysis was limited due to clinical heterogeneity. Evidence quality ranged from very low to moderate. The main limitations were imprecision and risk of bias associated with lack of blinding.Direct dose comparisons in women according to predicted responseAll evidence was low or very low quality.Due to differences in dose comparisons, caution is warranted in interpreting the findings of five small trials assessing predicted low responders. The effect estimates were very imprecise, and increased FSH dosing may or may not have an impact on rates of live birth/ongoing pregnancy, OHSS, and clinical pregnancy.Similarly, in predicted normal responders (nine studies, three comparisons), higher doses may or may not impact the probability of live birth/ongoing pregnancy (e.g. 200 versus 100 international units: OR 0.88, 95% CI 0.57 to 1.36; N = 522; 2 studies; I2 = 0%) or clinical pregnancy. Results were imprecise, and a small benefit or harm remains possible. There were too few events for the outcome of OHSS to enable any inferences.In predicted high responders, lower doses may or may not have an impact on rates of live birth/ongoing pregnancy (OR 0.98, 95% CI 0.66 to 1.46; N = 521; 1 study), OHSS, and clinical pregnancy. However, lower doses probably reduce the likelihood of moderate or severe OHSS (Peto OR 2.31, 95% CI 0.80 to 6.67; N = 521; 1 study).ORT-algorithm studiesFour trials compared an ORT-based algorithm to a non-ORT control group. Rates of live birth/ongoing pregnancy and clinical pregnancy did not appear to differ by more than a few percentage points (respectively: OR 1.04, 95% CI 0.88 to 1.23; N = 2823, 4 studies; I2 = 34%; OR 0.96, 95% CI 0.82 to 1.13, 4 studies, I2=0%, moderate-quality evidence). However, ORT algorithms probably reduce the likelihood of moderate or severe OHSS (Peto OR 0.58, 95% CI 0.34 to 1.00; N = 2823; 4 studies; I2 = 0%, low quality evidence). There was insufficient evidence to determine whether the groups differed in rates of severe OHSS (Peto OR 0.54, 95% CI 0.14 to 1.99; N = 1494; 3 studies; I2 = 0%, low quality evidence). Our findings suggest that if the chance of live birth with a standard dose is 26%, the chance with ORT-based dosing would be between 24% and 30%. If the chance of moderate or severe OHSS with a standard dose is 2.5%, the chance with ORT-based dosing would be between 0.8% and 2.5%. These results should be treated cautiously due to heterogeneity in the study designs. AUTHORS' CONCLUSIONS We did not find that tailoring the FSH dose in any particular ORT population (low, normal, high ORT), influenced rates of live birth/ongoing pregnancy but we could not rule out differences, due to sample size limitations. In predicted high responders, lower doses of FSH seemed to reduce the overall incidence of moderate and severe OHSS. Moderate-quality evidence suggests that ORT-based individualisation produces similar live birth/ongoing pregnancy rates to a policy of giving all women 150 IU. However, in all cases the confidence intervals are consistent with an increase or decrease in the rate of around five percentage points with ORT-based dosing (e.g. from 25% to 20% or 30%). Although small, a difference of this magnitude could be important to many women. Further, ORT algorithms reduced the incidence of OHSS compared to standard dosing of 150 IU, probably by facilitating dose reductions in women with a predicted high response. However, the size of the effect is unclear. The included studies were heterogeneous in design, which limited the interpretation of pooled estimates, and many of the included studies had a serious risk of bias.Current evidence does not provide a clear justification for adjusting the standard dose of 150 IU in the case of poor or normal responders, especially as increased dose is generally associated with greater total FSH dose and therefore greater cost. However, a decreased dose in predicted high responders may reduce OHSS.
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Affiliation(s)
- Sarah F Lensen
- University of AucklandDepartment of Obstetrics and GynaecologyPark RdGraftonAucklandNew Zealand1142
| | - Jack Wilkinson
- Manchester Academic Health Science Centre (MAHSC), University of ManchesterCentre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and HealthClinical Sciences Building Salford Royal NHS Foundation Trust HospitalRoom 1.315, Jean McFarlane Building University Place Oxford RoadManchesterUKM13 9PL
| | - Jori A Leijdekkers
- University Medical CenterDepartment of Reproductive Medicine and GynecologyOudegracht 150 bisUtrechtNetherlands3511 AZ
| | - Antonio La Marca
- University of Modena and Reggio Emilia, Clinica EuginMother‐Infant DepartmentVia Universit� 4ModenaItaly41121
| | - Ben Willem J Mol
- The University of AdelaideDiscipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research InstituteLevel 3, Medical School South BuildingFrome RoadAdelaideSouth AustraliaAustraliaSA 5005
| | - Jane Marjoribanks
- University of AucklandDepartment of Obstetrics and GynaecologyPark RdGraftonAucklandNew Zealand1142
| | - Helen Torrance
- University Medical CenterDepartment of Reproductive Medicine and GynecologyOudegracht 150 bisUtrechtNetherlands3511 AZ
| | - Frank J Broekmans
- University Medical CenterDepartment of Reproductive Medicine and GynecologyOudegracht 150 bisUtrechtNetherlands3511 AZ
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Wang YF, Wu X, Hu R, Wang FM, Jia ST, Pei LG, Wang H, Ouyang XE, Hu T, Fu YX. [Seminal plasma anti-Müllerian hormone and inhibin B and serum inhibin B in predicting the outcome of routine IVF fertilization]. Zhonghua Nan Ke Xue 2017; 23:991-996. [PMID: 29738164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To analyze the correlations of seminal plasma (sp) anti-Müllerian hormone (spAMH) and inhibin B (spINHB) and serum INHB (serINHB) with semen parameters in oligoasthenospermia patients and explore their value in predicting the outcome of routine in vitro fertilization (IVF). METHODS We obtained the levels of spAMH, spINHB and serINHB as well as semen parameters from 88 infertile males undergoing IVF due to oligoasthenospermia or female uterine tubal factors from August 2016 to February 2017. Using the ROC curve and Pearson's correlation analysis, we examined the effects of the obtained parameters on the fertilization rate and assessed the correlation of the levels of spAMH, spINHB and serINHB with the semen parameters of the patients. RESULTS Concerning the predictive value for the outcome of IVF, Pearson's correlation analysis showed that the area under the ROC curve (AUC) of spAMH was 0.807 (sensitivity = 84.6%, specificity = 76%, cut-off point = 3.529, P <0.001) and that of spINHB was 0.768 (sensitivity = 84.6%, specificity = 88.7%, cut-off point = 31.117, P = 0.002). The serINHB level was found positively correlated with sperm concentration (r = 0.346, P = 0.001), total sperm count (r = 0.378, P <0.001), sperm motility (r = 0.521, P <0.001), and the percentage of progressively motile sperm (r = 0.343, P = 0.001). CONCLUSIONS The levels of spAMH and spINHB can be used as laboratory indexes to predict the fertilization rate of routine IVF and are correlated with semen parameters in oligoasthenospermia patients, while that of serINHB has a positive correlation with the semen parameters of the patients.
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Affiliation(s)
- Yan-Fei Wang
- Department of Gynecology and Obstetrics, Graduate School, General Hospital, Ningxia Medical University, Yinchuan, Ningxia 750001, China
| | - Xin Wu
- Key Laboratory of the Ministry of Education for Fertility Preservation and Maintenance, General Hospital, Ningxia Medical University, Yinchuan, Ningxia 750001, China
| | - Rong Hu
- Key Laboratory of the Ministry of Education for Fertility Preservation and Maintenance, General Hospital, Ningxia Medical University, Yinchuan, Ningxia 750001, China
| | - Fei-Miao Wang
- Key Laboratory of the Ministry of Education for Fertility Preservation and Maintenance, General Hospital, Ningxia Medical University, Yinchuan, Ningxia 750001, China
| | - Shao-Tong Jia
- Key Laboratory of the Ministry of Education for Fertility Preservation and Maintenance, General Hospital, Ningxia Medical University, Yinchuan, Ningxia 750001, China
| | - Li-Guo Pei
- Key Laboratory of the Ministry of Education for Fertility Preservation and Maintenance, General Hospital, Ningxia Medical University, Yinchuan, Ningxia 750001, China
| | - Hui Wang
- Department of Gynecology and Obstetrics, Graduate School, General Hospital, Ningxia Medical University, Yinchuan, Ningxia 750001, China
| | - Xiao-E Ouyang
- Department of Gynecology and Obstetrics, Graduate School, General Hospital, Ningxia Medical University, Yinchuan, Ningxia 750001, China
| | - Ting Hu
- Department of Gynecology and Obstetrics, Graduate School, General Hospital, Ningxia Medical University, Yinchuan, Ningxia 750001, China
| | - Yun-Xing Fu
- Department of Gynecology and Obstetrics, Graduate School, General Hospital, Ningxia Medical University, Yinchuan, Ningxia 750001, China
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Innocenti F, Cerquetti L, Pezzilli S, Bucci B, Toscano V, Canipari R, Stigliano A. Effect of mitotane on mouse ovarian follicle development and fertility. J Endocrinol 2017; 234:29-39. [PMID: 28450646 DOI: 10.1530/joe-17-0203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 04/27/2017] [Indexed: 11/08/2022]
Abstract
Mitotane (MTT) is an adrenolytic drug used in advanced and adjuvant treatment of adrenocortical carcinoma, in Cushing's disease and in ectopic syndrome. However, knowledge about its effects on the ovary is still scarce. The purpose of this study is to investigate the effect of MTT on the ovary using in vivo and in vitro models. The study was performed in CD1 mice and in the COV-434 human ovarian granulosa cell line. We examined ovarian morphology, follicle development, steroidogenesis and procreative function in mice and the effect of MTT on cell growth in vitro Our results revealed that treatment of CD1 mice with MTT induces a decrease in early antral follicles with a subsequent increase in the secondary follicles, measured by the increased levels of anti-Mullerian Hormone (P < 0.05) and decreased levels of FSH receptor (P < 0.05). Moreover, we observed a significant decrease in Cyp11a1 (P < 0.01) and Cyp17a1 (P < 0.001) mRNA level in MTT-treated animals. Ovulation, induced by PMSG/hCG stimulation, was also significantly impaired, with a reduction in the number of ovulated oocytes (P < 0.01) and fewer corpora lutea in treated animals. Likewise, the mating experiment demonstrated a delay in the time of conception as well as fewer pups per litter in MTT-treated mice (P < 0.05). Experiments performed on the COV-434 cell line showed a significant inhibition of growth followed by apoptosis (P < 0.01). In conclusion, our study highlights the key points of ovarian folliculogenesis affected by MTT and demonstrates impairment of the ovulation process with a negative impact on conception, which is nevertheless preserved.
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Affiliation(s)
- Federica Innocenti
- DAHFMOUnit of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Lidia Cerquetti
- EndocrinologyDepartment of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Serena Pezzilli
- EndocrinologyDepartment of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Vincenzo Toscano
- EndocrinologyDepartment of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Rita Canipari
- DAHFMOUnit of Histology and Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Antonio Stigliano
- EndocrinologyDepartment of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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28
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Lee JY, Ahn S, Lee JR, Jee BC, Kim CH, Seo S, Suh CS, Kim SH. Reference Values for the Revised Anti-Müllerian Hormone Generation II Assay: Infertile Population-based Study. J Korean Med Sci 2017; 32:825-829. [PMID: 28378557 PMCID: PMC5383616 DOI: 10.3346/jkms.2017.32.5.825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/30/2017] [Indexed: 11/20/2022] Open
Abstract
Anti-Müllerian hormone (AMH) is now accepted as an important clinical marker of ovarian reserve and is increasingly measured as an initial evaluation at infertility clinics. The aim of this study was to establish reference values for the revised second generation (Gen II) assay using population-based data. In this population-based cohort study, AMH data from unselected infertile women aged 25-45 years from June 2013 to June 2014 (n = 15,801) were collected. The AMH values were measured using the revised Gen II assay. We established and validated 5 AMH-age regression models. Based on the optimal AMH-age model, reference values and centile charts were obtained. The quadratic model (log AMH = 0.410 × age -0.008 × age² -3.791) was the most appropriate for describing the age-dependent decrease in AMH measured using the revised Gen II assay. This is the largest population-based study to establish age-specific reference values of AMH using the revised Gen II assay. These reference values may provide more specific information regarding the ovarian reserve estimation of infertile women.
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Affiliation(s)
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | - Soyeon Seo
- Samkwang Medical Laboratories, Seoul, Korea
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
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Łebkowska A, Adamska A, Karczewska-Kupczewska M, Nikołajuk A, Otziomek E, Milewski R, Górska M, Wołczyński S, Kowalska I. Serum anti-Müllerian hormone concentration in women with polycystic ovary syndrome and type 1 diabetes mellitus. Metabolism 2016; 65:804-811. [PMID: 26961579 DOI: 10.1016/j.metabol.2016.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/28/2016] [Accepted: 02/09/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE A single prior study conducted in Chilean women has shown that women with type 1 diabetes mellitus (T1DM) and polycystic ovary syndrome (PCOS) have a normal serum anti-Müllerian hormone (AMH) concentrations despite polycystic ovarian morphology. As it is not clear why women with PCOS+T1DM would not have an elevated concentrations of AMH, we hypothesize that women with T1DM and PCOS have a similar hormonal profile and serum AMH levels as is observed in classic PCOS. METHODS We studied 89 women: 37 with T1DM (16 with PCOS+T1DM, 21 with T1DM/no-PCOS), 36 with PCOS (PCOS) and 16 healthy women (control group) matched for age and body mass index (BMI). A clinical examination, determination of serum AMH and sex hormones, and an ultrasonographic evaluation of the ovaries were performed for all study participants. RESULTS Serum AMH concentrations were significantly higher in women with PCOS+T1DM than in those with T1DM/no-PCOS (p<0.001) and was not different between both PCOS groups (PCOS vs PCOS+T1DM). Ovarian volume and ovarian follicle count did not differ between women with PCOS+T1DM and PCOS. The number of ovarian follicles was higher in patients with PCOS+T1DM and PCOS versus the control (p=0.007, p<0.001) and versus cases of T1DM/no-PCOS (p<0.001, p<0.001, respectively). Cross-sectionally, AMH concentrations correlated positively with luteinizing hormone (LH) (r=0.4; p<0.001), testosterone (r=0.2, p=0.02), ovarian volume (r=0.4, p<0.001) and follicle count (r=0.7, p<0.001). In both groups, PCOS+T1DM and PCOS, AMH was related to LH (r=0.5; p=0.036; r=0.3; p=0.031) and to ovarian follicle number (r=0.7; p<0.001; r=0.4; p=0.006). In multivariate logistic regression analysis, serum AMH was the only predictor of PCOS in T1DM women (OR=1.73; 95% CI 1.07-2.79, p=0.023). CONCLUSIONS Women with T1DM and PCOS have a similar hormonal profile and serum AMH concentrations as observed in classic PCOS.
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Affiliation(s)
- Agnieszka Łebkowska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, M.C. Sklodowskiej 24a, 15-276 Bialystok, Poland
| | - Agnieszka Adamska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, M.C. Sklodowskiej 24a, 15-276 Bialystok, Poland
| | - Monika Karczewska-Kupczewska
- Department of Metabolic Diseases, Medical University of Bialystok, M.C. Sklodowskiej 24a, 15-276 Bialystok, Poland; Department of Prophylaxis of Metabolic Diseases, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Tuwima 10, 10-748 Olsztyn, Poland
| | - Agnieszka Nikołajuk
- Department of Metabolic Diseases, Medical University of Bialystok, M.C. Sklodowskiej 24a, 15-276 Bialystok, Poland; Department of Prophylaxis of Metabolic Diseases, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Tuwima 10, 10-748 Olsztyn, Poland
| | - Elżbieta Otziomek
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, M.C. Sklodowskiej 24a, 15-276 Bialystok, Poland
| | - Robert Milewski
- Department of Statistics and Medical Informatics, Medical University of Bialystok, Szpitalna 37, 15-295 Bialystok, Poland
| | - Maria Górska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, M.C. Sklodowskiej 24a, 15-276 Bialystok, Poland
| | - Sławomir Wołczyński
- Department of Reproduction and Gynecological Endocrinology, Medical University of Bialystok, M.C. Sklodowskiej 24a, 15-276 Bialystok, Poland
| | - Irina Kowalska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, M.C. Sklodowskiej 24a, 15-276 Bialystok, Poland.
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Novembri R, Funghi L, Voltolini C, Belmonte G, Vannuccini S, Torricelli M, Petraglia F. Placenta expresses anti-Müllerian hormone and its receptor: Sex-related difference in fetal membranes. Placenta 2015; 36:731-7. [PMID: 25972076 DOI: 10.1016/j.placenta.2015.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 04/16/2015] [Accepted: 04/21/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Anti-Müllerian hormone (AMH) is a member of the transforming growth factor-β superfamily, playing a role in sexual differentiation and recruitment. Since a correlation exists between AMH serum levels in cord blood and fetal sex, the present study aimed to identify mRNA and protein expression of AMH and AMHRII in placenta and fetal membranes according to fetal sex. METHODS Placenta and fetal membranes samples (n = 40) were collected from women with singleton uncomplicated pregnancies at term. Identification of AMH protein in placenta and fetal membranes was carried out by immunohistochemistry and AMH and AMHRII protein localization by immunofluorescence, while mRNA expression was assessed by quantitative real-time PCR. RESULT AMH and AMHRII mRNAs were expressed by placenta and fetal membranes at term, without any significant difference between males and females. Placental immunostaining showed a syncytial localization of AMH without sex-related differences; while fetal membranes immunostaining was significantly more intense in male than in female fetuses (p < 0,01). Immunofluorescence showed an intense co-localization of AMH and AMHRII in placenta and fetal membranes. DISCUSSION The present study for the first time demonstrated that human placenta and fetal membranes expresses and co-localizes AMH and AMHRII. Although no sex-related difference was found for the mRNA expression both in placenta and fetal membranes, a most intense staining for AMH in male fetal membranes supports AMH as a gender specific hormone.
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Affiliation(s)
- R Novembri
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - L Funghi
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - C Voltolini
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - G Belmonte
- Department of Biomedical Sciences, Applied Biology, University of Siena, Siena, Italy
| | - S Vannuccini
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - M Torricelli
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - F Petraglia
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
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Lukaszuk K, Kuczynski W, Kunicki M, Ludwikowska B, Liss J, Malinowska I, Lukaszuk A, Bednarowska A, Kuczynska A, Kuc P, Pastuszek E. Comparison of the second-generation Beckman Coulter IVD and first-generation AnshLabs ELISA assays for anti-Müllerian hormone in patients undergoing IVF treatment. Ginekol Pol 2014; 85:778-783. [PMID: 25546930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES Ovarian reserve is the main factor influencing the efficacy of infertility treatment. Currently the anti- Müllerian hormone is the main indicator of the ovarian reserve and has a wide spectrum of clinical importance. It achieved a high clinical value right after the introduction of the first commercial AMH assays in 2005. Lack further research and development of the tests and monopoly on their production have led to a significant reduction of their quality resulting in lowered veracity and usefulness. Therefore, we searched for an alternative to the Beckman Coulter assay. The objective of the study was to draw a comparison between the commonly used second-generation assay by Beckman Coulter and the ultra-sensitive first-generation assay by AnshLabs. MATERIALS AND METHODS Serum samples (n=520) were collected from female patients undergoing routine AMH evaluation before entering an IVF program. We chose samples of patients with the lowest correlation between the AMH serum level and response to stimulation. The AMH serum levels of the patients were examined using two AMH tests, the second-generation assay by Beckman Coulter and the first-generation assay by AnshLabs. Precision and accuracy of both methods were determined and the results of AMH serum levels of 130 patients were correlated with the number of: antral follicles (AFC), follicles after stimulation, and the obtained cumulus cells. RESULTS Both precision and accuracy of the compared methods were highly satisfactory. The coefficients of variation obtained in the study conducted on two different levels of control material were lower than 12% and the load did not exceed 9%. The study proved that both of the methods yielded comparable results. The coefficient of variation between the first-generation and the second-generation AMH assays was 0.871. CONCLUSION Both methods might be applied in the evaluation of the ovarian reserve. The first- and second-generation assays show comparable correlation with the clinical effects of stimulation, however it seems that first-generation assays are a better alternative to the unstable second-generation kits. The results from the first-generation assays are distributed on a wider range, which facilitates clinical interpretation.
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Tramišak Milaković T, Panić Horvat L, Čavlović K, Smiljan Severinski N, Vlašić H, Vlastelić I, Ljiljak D, Radojčić Badovinac A. Follicular fluid anti-Müllerian hormone: a predictive marker of fertilization capacity of MII oocytes. Arch Gynecol Obstet 2014; 291:681-7. [PMID: 25205183 DOI: 10.1007/s00404-014-3460-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/29/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The present study aimed to correlate anti-Müllerian hormone (AMH) levels in follicular fluid (FF) with oocyte maturity stages, morphological quality of metaphase II (MII) oocyte and fertilization capacity of MII oocytes. METHODS A total of 92 infertile women undergoing controlled ovarian stimulation and intracytoplasmic sperm injection were analyzed. Patients were divided into two groups according to age: <35 years (n = 43) and ≥35 years (n = 49). An FF sample was obtained from a single dominant follicle in each patient for a total of 92 follicular fluid samples analyzed. AMH levels in serum and follicular fluid were measured by enzyme-linked immunosorbent assay. Mature MII oocytes, zygotes, and embryos were assessed for morphological quality. RESULTS Serum AMH levels were significantly higher in patients aged <35 years. No correlation was observed between FF AMH level and oocyte maturation stages or morphological quality of MII oocyte. Significantly lower FF AMH levels were observed in fertilized MII oocytes than in non-fertilized MII oocytes in patients aged <35 years (2.56 ± 2.0 ng/ml vs. 4.81 ± 4.14 ng/ml; p = 0.032). CONCLUSIONS The present study revealed no correlation between FF AMH and oocyte maturity stage or morphological quality of MII oocyte. However, FF AMH might be a predictive marker for fertilization capacity of MII oocytes.
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Affiliation(s)
- Tamara Tramišak Milaković
- Department of Obstetrics and Gynecology, Clinical Hospital Center Rijeka, University of Rijeka, Cambierieva 17/5, 51 000, Rijeka, Croatia,
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Kim JH, Lee JR, Chang HJ, Jee BC, Suh CS, Kim SH. Anti-Müllerian hormone levels in the follicular fluid of the preovulatory follicle: a predictor for oocyte fertilization and quality of embryo. J Korean Med Sci 2014; 29:1266-70. [PMID: 25246746 PMCID: PMC4168181 DOI: 10.3346/jkms.2014.29.9.1266] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/28/2014] [Indexed: 11/20/2022] Open
Abstract
This prospective study investigated the relationship between anti-Müllerian hormone (AMH) level in the follicular fluid (FF) and the quality of the oocyte and embryo. A total of 65 FF samples from 54 women were included in this study. FF was collected from the largest preovulatory follicle sized≥20 mm of mean diameter from each ovary. Samples were divided into 3 groups according to the FF AMH levels: below the 33th percentile (low group, FF AMH<2.1 ng/mL, n=21), between the 33th and the 67th percentile (intermediate group, FF AMH=2.1-3.6 ng/mL, n=22), and above the 67th percentile (high group, FF AMH>3.6 ng/mL, n=22). The quality of the ensuing oocytes and embryos was evaluated by fertilization rate and embryo score. FF AMH levels correlated positively with the matched embryo score on day 3 after fertilization (r=0.331, P=0.015). The normal fertilization rate was significantly lower in the low group than in the intermediate group (61.9% vs. 95.5% vs. 77.3%, respectively, P=0.028). Our results suggest that the FF AMH level could be a predictor of the ensuing oocyte and embryo quality.
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Affiliation(s)
- Jee Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Jin Chang
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Health Promotion Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Chai J, Howie AF, Cameron DA, Anderson RA. A highly-sensitive anti-Müllerian hormone assay improves analysis of ovarian function following chemotherapy for early breast cancer. Eur J Cancer 2014; 50:2367-74. [PMID: 25027307 PMCID: PMC4166459 DOI: 10.1016/j.ejca.2014.06.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/11/2014] [Accepted: 06/13/2014] [Indexed: 11/18/2022]
Abstract
Aim Anti-Müllerian hormone (AMH) shows promise as a biomarker of the ovarian reserve but current assays are insufficiently sensitive to allow assessment of this post-chemotherapy in most women. We have assessed a new highly sensitive AMH assay (Ansh picoAMH) in the evaluation of ovarian activity in women with very low ovarian reserve after chemotherapy. Methods A prospective cohort and an independent validation cohort of premenopausal women with early breast cancer (eBC) were recruited at the time of diagnosis (combined n = 98), and ovarian reserve markers 2–5 years later following chemotherapy were assessed in relation to menstrual activity. Results The picoAMH assay had a limit of detection of 7.5 pg/ml. AMH clearly distinguished women with ongoing menses from those with amenorrhoea at 2 years after diagnosis (mean 522 ± 169 versus 8.9 ± 1.3 pg/ml, P < 0.0001) with high predictive value for continuing menses or amenorrhoea for the subsequent 3 years. AMH was detectable in more women than using a previous assay (P = 0.004). Other markers of the ovarian reserve (follicle-stimulating hormone (FSH), inhibin B) were also of discriminatory value but to lesser extents. This finding was validated in a second, independent cohort of women treated for eBC. Conclusion The 10-fold increased assay sensitivity showed very clear distinction between groups based on ovarian activity with excellent prediction of future menses or amenorrhoea. This will improve assessment of post-chemotherapy ovarian function in women and may aid treatment decisions.
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Affiliation(s)
- Joyce Chai
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - A Forbes Howie
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - David A Cameron
- Edinburgh Breast Unit and Edinburgh University Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK.
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Shahed A, Young KA. Anti-Müllerian hormone (AMH), inhibin-α, growth differentiation factor 9 (GDF9), and bone morphogenic protein-15 (BMP15) mRNA and protein are influenced by photoperiod-induced ovarian regression and recrudescence in Siberian hamster ovaries. Mol Reprod Dev 2013; 80:895-907. [PMID: 23877969 PMCID: PMC3835454 DOI: 10.1002/mrd.22215] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 07/12/2013] [Indexed: 11/07/2022]
Abstract
Exposure of Siberian hamsters to short photoperiod (SD) inhibits ovarian function, including folliculogenesis, whereas function is restored with their transfer to long photoperiods (LD). To investigate the mechanism of photo-stimulated recrudescence, we assessed key folliculogenic factors-anti-Müllerian hormone (AMH), inhibin-α, growth differentiation factor-9 (GDF9), and bone morphogenic protein-15 (BMP15)-across the estrus cycle and in photo-regressed and recrudescing ovaries. Adult hamsters were exposed to either LD or SD for 14 weeks, which respectively represent functional and regressed ovaries. Select regressed hamsters were transferred back to LD for 2 (post-transfer week 2; PTw2) or 8 weeks (PTw8). Ovaries were collected and fixed in formalin for immunohistochemistry or frozen in liquid nitrogen for real-time PCR. AMH, inhibin-α, GDF9, and BMP15 mRNA and protein were detected in all stages of the estrus cycle. Fourteen weeks of SD exposure increased (P < 0.05) ovarian AMH, GDF9, and BMP15, but not inhibin-α mRNA levels as compared to LD. Transfer of regressed hamsters to stimulatory long photoperiod for 8 weeks returned AMH and GDF9 mRNA levels to LD-treated levels, and further increased mRNA levels for inhibin-α and BMP15. Immunostaining for AMH, inhibin-α, GDF9, and BMP15 proteins was most intense in preantral/antral follicles and oocytes. The overall immunostaining extent for AMH and inhibin-α generally mirrored the mRNA data, though no changes were observed for GDF9 or BMP15 immunostaining. Shifts in mRNA and protein levels across photoperiod conditions suggest possible syncretic roles for these folliculogenic factors in photo-stimulated recrudescence via potential regulation of follicle recruitment, preservation, and development.
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Affiliation(s)
- Asha Shahed
- Department of Biological Sciences, California State University Long Beach, Long Beach, California
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Di Paola R, Costantini C, Tecchio C, Salvagno GL, Montemezzi R, Perandini A, Pizzolo G, Zaffagnini S, Franchi M. Anti-Müllerian hormone and antral follicle count reveal a late impairment of ovarian reserve in patients undergoing low-gonadotoxic regimens for hematological malignancies. Oncologist 2013; 18:1307-14. [PMID: 24149138 DOI: 10.1634/theoncologist.2013-0138] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The impact of cancer therapy on the reproductive potential of patients is increasingly recognized because survival rates of patients have clearly improved in recent years. Different fertility preservation methods, either generally accepted or still experimental, are currently available, and counseling of patients requires a delicate balance between the efficacy and side effects of the proposed method and the characteristics of both the tumor and the therapy. Deeper knowledge of the effects of cancer therapy on the reproductive potential of patients over time is required to identify the most appropriate fertility preservation method. In this paper, we report a case-control study in which female patients who were diagnosed with hematological malignancies and treated with chemotherapy and/or radiotherapy were compared with age-matched controls in terms of ovarian reserve, as measured by ultrasound examination and hormonal status. By stratifying patients for gonadotoxicity of the therapy received and time elapsed from the end of the therapy, we report that patients treated with low gonadotoxic therapies, while being similar to age-matched controls in their ovarian reserve when evaluated within a few years from the end of the therapy, show a clear impairment over longer times. We also report that anti-Müllerian hormone is the most sensitive hormonal parameter in detecting changes in ovarian reserve when compared with follicle-stimulating hormone or inhibin-B. This study stresses the importance of accurate counseling at the time of diagnosis of cancer and emphasizes the risks of infertility with low gonadotoxic therapies that may reduce the reproductive window of survivors.
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Affiliation(s)
- Rossana Di Paola
- Department of Life and Reproduction Sciences, Section of Obstetrics and Gynecology and
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Kučera R, Topolčan O, Rumpíková T, Rumpík D, Dostál J. [Determination of anti-Müllerian hormone in women]. Ceska Gynekol 2013; 78:282-288. [PMID: 23869836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Anti-Müllerian hormone (AMH) is a glycoprotein and belongs to the TGF-β growth factors family. Our review describes the method of AMH determination in serum and follicular fluid. The reference values and changes in AMH levels during a womans life are also discussed. In addition, it is also presented the relationship between AMH, obesity, smoking and use of hormonal contraceptives. The focus of the work is the importance of the determination of AMH in clinical practice. In assisted reproduction has become its determination one of the tools to detect ovarian reserve. It helps not only predict reduced response to stimulation with gonadotropins but also the risk of the ovarian hyperstimulation syndrome. Benefits of the ovarian reserve detection using AMH serum levels are discussed in comparison with the antral follicle count (AFC) determined by ultrasound. Several clinical indications of AMH determination are mentioned in the next section. These are primarily the polycystic ovary syndrome (PCOS), which is a great challenge not only for the AMH testing, but there is an open space for further interdisciplinary cooperation. Endometriosis has no direct effect on ovarian reserve and AMH levels in serum. AMH is very sensitive tumor marker in the diagnostics and monitoring of ovarian granulosa cells tumors. Treatment of cancer disease burdens entire body, including healthy cells. Ovarian follicles are very sensitive to chemotherapy and radiation. AMH is a good predictor of ovarian reserve damage during radio- and chemotherapy.
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Affiliation(s)
- R Kučera
- Imunoanalytická laboratoř ONM Fakultní nemocnice, Plzeň.
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Lie Fong S, Visser JA, Welt CK, de Rijke YB, Eijkemans MJC, Broekmans FJ, Roes EM, Peters WHM, Hokken-Koelega ACS, Fauser BCJM, Themmen APN, de Jong FH, Schipper I, Laven JSE. Serum anti-müllerian hormone levels in healthy females: a nomogram ranging from infancy to adulthood. J Clin Endocrinol Metab 2012; 97:4650-5. [PMID: 22993032 PMCID: PMC3683801 DOI: 10.1210/jc.2012-1440] [Citation(s) in RCA: 170] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Anti-müllerian hormone (AMH) is an accurate marker of ovarian reserve. However, sufficiently large sets of normative data from infancy to the end of reproductive life are scarce. OBJECTIVE This study was an assessment of serum AMH levels in healthy females. SUBJECTS In 804 healthy females ranging from infancy until the end of the reproductive period, serum AMH levels were measured with an enzyme-linked immunometric assay. All adults had regular menstrual cycles. The majority was proven fertile and none of them had used oral contraceptive pills prior to study inclusion. RESULTS In the total cohort, AMH was inversely correlated with age (r = -0.24; P < 0.001). The age at which the maximum AMH value was attained was at 15.8 yr. In girls younger than 15.8 yr, serum AMH and age were positively correlated (r = +0.18; P = 0.007). Thereafter AMH levels remained stable (r = -0.33; P = 0.66), whereas from the age of 25.0 yr onward, an inverse correlation between AMH and age (r = -0.47; P < 0.001) was observed. At any given age, considerable interindividual differences in serum AMH levels were observed. CONCLUSION During infancy AMH levels increase, whereas during adolescence, a plateau until the age of 25 yr was observed. From the age of 25 yr onward, serum AMH levels correlate inversely with age, implying that AMH is applicable as a marker of ovarian reserve only in women of 25 yr old and older. Our nomogram may facilitate counseling women on their reproductive potential.
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Affiliation(s)
- S Lie Fong
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands.
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Zysling DA, Park SU, McMillan EL, Place NJ. Photoperiod-gonadotropin mismatches induced by treatment with acyline or FSH in Siberian hamsters: impacts on ovarian structure and function. Reproduction 2012; 144:603-16. [PMID: 22936286 DOI: 10.1530/rep-12-0155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Many seasonal breeders time their reproductive efforts to specific times of the year to ensure adequate resources for the production and care of young. For long-day (LD) breeders, females born before the summer solstice (LDs) reach sexual maturity quickly and often breed that same year, whereas females born after the summer solstice (short days (SDs)) may delay reproductive development to the following spring when environmental conditions are favorable for reproduction. In Siberian hamsters, development in SD is associated with structural and functional differences in the ovary compared with females held in LD, including a greater number of primordial follicles and an abundance of hypertrophied granulosa cells (HGCs), which are immunoreactive for anti-Müllerian hormone. The goal of this study was to determine whether SD-induced gonadotropin suppression is responsible for these phenotypic differences. Gonadotropin levels were suppressed in LD hamsters using the GNRH antagonist acyline. Conversely, to determine whether the SD ovarian phenotype is completely reversed by gonadotropin stimulation, recombinant human FSH (rhFSH) was administered. Our treatments were successful in mimicking FSH concentrations of the opposite photoperiod, but they did not produce a comparable change in the ovarian phenotype. Most notable was the lack of HGCs in the ovaries of acyline-treated LD females. Similarly, HGCs were maintained in the ovaries of SD females treated with rhFSH. Our data suggest that gonadotropins alone do not account for the SD ovarian phenotype. Future studies will determine whether SD-induced changes in other factors underlie these phenotypic changes.
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Affiliation(s)
- D A Zysling
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, S2-072 Schurman Hall, Ithaca, New York 14853, USA.
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Hossein G, Arabzadeh S, Hossein-Rashidi B, Hosseini MA. Relations between steroids and AMH: impact of basal and intrafollicular steroids to AMH ratios on oocyte yield and maturation rate in women with or without polycystic ovary undergoing in vitro fertilization. Gynecol Endocrinol 2012; 28:413-7. [PMID: 21992510 DOI: 10.3109/09513590.2011.613964] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study sought to determine the relationships between serum or intrafollicular ovarian steroids and anti-mullerian hormone (AMH) and to predict impact of steroids to AMH ratios on oocyte quantity and metaphase II (MII) oocyte rate in normo-ovulatory (control) and polycystic ovary syndrome (PCOS) patients. DESIGN Prospective study. SETTING University hospital and research center. PATIENTS Thirty-two patients with PCOS and 37 controls undergoing IVF-ET. METHODS Serum (day 3) and follicular fluid (FF) from more than one follicle ≥ 17 mm on the day of oocyte retrieval were collected from each patients. MAIN OUTCOME MEASURES Serum or follicular fluid steroids, AMH, retrieved oocytes number and maturation rate. RESULTS In control group, intrafollicular AMH levels were positively related to P4 and T levels (p = .002, p = .011, respectively). Multiple linear regression analysis showed serum basal AMH and T levels as independent positive predictors while T/AMH ratio and intrafollicular AMH were negative predictors for both retrieved and MII oocyte number. The presence of PCOS and intrafollicular P4/AMH ratio revealed as important negative factors influencing oocyte maturation rate. CONCLUSIONS Serum basal T, AMH as well as their ratio and intrafollicular P4/AMH ratio may be used as predictors for retrieved oocyte number and their nuclear maturation rate, respectively.
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Affiliation(s)
- Ghamartaj Hossein
- Department of Developmental Biology, School of Biology, University College of Science, University of Tehran, Tehran, Iran.
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Yilmaz N, Uygur D, Dogan M, Ozgu E, Salman B, Mollamahmutoglu L. The effect of follicular antimullerian hormone levels of non-obese, non-hyperandrogenemic polycystic ovary syndrome patients on assisted reproduction outcome. Gynecol Endocrinol 2012; 28:162-5. [PMID: 22103791 DOI: 10.3109/09513590.2011.593667] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Our aim is to investigate the follicular fluid concentrations of antimullerian hormone and its effect on assisted reproductive technology (ART) outcome in non-obese, non-hyperandrogenemic polycystic ovary syndrome patients. Subjects were categorized according to in vitro fertilization (IVF) indications: Group 1 PCOS (n:16), Group 2 male factor infertility (n:19) and Group 3 unexplained infertiliy patients (n:19). Follicular fluid antimullerian hormone levels (FF AMH) on the day of oocyte retrieval were analysed and ART outcome was studied. FF AMH levels in group 1, 2 and 3 were 35.70 ng/ml (median); 17.90 ng/ml (median); 17.90 ng/ml (median), respectively (p = 0.18). There were correlations between the FF AMH levels and follicle, oocyte, 2PN and embryo numbers in pathophysiology of polycystic ovary syndrome (PCOS) patients (p = 0.012; 0.024; 0.027; 0.013 respectively). There were no correlations between the FF AMHand ART outcome parameters in group 2 and 3. FF AMH levels were not different between the groups who were pregnant or not (p = 0.06). In conclusion there were no significant differences in terms of FF AMH levels in the three groups. FF AMH levels can predict the recovery of oocytes but not oocyte quality, embryo quality or pregnancy in non-obese non-hyperandrogenemic PCOS patient.
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Affiliation(s)
- Nafiye Yilmaz
- Department of Infertility, Dr Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey.
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Hagen CP, Aksglaede L, Sørensen K, Mouritsen A, Juul A. Clinical use of anti-Müllerian hormone (AMH) determinations in patients with disorders of sex development: importance of sex- and age-specific reference ranges. Pediatr Endocrinol Rev 2011; 9 Suppl 1:525-528. [PMID: 22423510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Determination of postnatal AMH levels in circulation has been used for decades when evaluating a child with ambiguous genitalia. We describe the age- and gender-specific changes of postnatal AMH serum levels to enable an appropriate clinical use of AMH assessment in pediatric endocrinology. In males, cord blood AMH is measurable at high levels (mean 148 (53-340) pmol/L), whereas AMH is undetectable (54%) or very low (95% CI: < 2-16 pmol/L) in female infants. AMH is constant through childhood in both sexes, boys having approximately 35 times higher levels than girls with no overlapping between the sexes until puberty. Ambiguous genitalia due to impaired androgen secretion or action may be a result of various conditions with low, normal or high AMH. Furthermore, low AMH is a marker of premature ovarian failure in Turner Syndrome girls. Measurement of AMH is an important tool in assessing gonadal function in children. In this context, detailed normative data are essential.
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Affiliation(s)
- Casper P Hagen
- Department of Growth and Reproduction, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Denmark
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Wetzka B, Textor W, Ochsner A, Geisthövel F. Anti-Mullerian hormone confirms the novel classification of female functional androgenization including polycystic ovary syndrome. Eur J Endocrinol 2011; 165:323-30. [PMID: 21602314 DOI: 10.1530/eje-10-1179] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Functional androgenization (FA) can be divided into five groups corresponding to the predominant organ pathology as recently shown by our group: functional cutaneous androgenization (FCA, skin) and FA syndrome (FAS) I (ovary, lean individual), II (adrenal gland), III (ovary, fat tissue, pancreas, and hyperinsulinemia), and IV (residual FA dysfunctions). Group-specific clusters are based on primary variables such as LH, testosterone, DHEAS, sex hormone-binding globulin (SHBG), body mass index (BMI), glucose, insulin, and enlarged polyfollicular ovaries. Because anti-Müllerian hormone (AMH) positively correlates with the antral follicle count, its relevance as an additional primary variable for classifying FA was investigated. DESIGN In this study, 178 patients with FA were consecutively enrolled and classified into the five FA groups as described earlier and 30 women with regular menstrual cycles served as control. METHODS Primary variables and serum AMH were analyzed in the early follicular phase. RESULTS FA patients showed significantly elevated AMH levels (11.1±6.7 ng/ml) versus control (3.0±2.0 ng/ml; P<.0001). AMH was significantly increased in groups FAS I (15.6±5.8 ng/ml) and FAS III (11.6±6.6 ng/ml) compared with groups FCA (7.0±3.8 ng/ml), FAS II (5.05±3.0 ng/ml), and FAS IV (6.9±4.6 ng/ml) and correlated positively (P<.0001) with LH (r=0.538) and testosterone (r=0.368). In regression and multivariate analyses, AMH was not dependent on SHBG, DHEAS, BMI, glucose, or insulin. In receiver operating characteristic analysis, 9.21 ng/ml AMH showed 90% specificity with 71.2% sensitivity for the diagnosis of the two ovarian FA groups, FAS I and III. CONCLUSION AMH confirms the novel stratification system and constitutes a useful primary variable in the algorithm of FA classification.
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Affiliation(s)
- B Wetzka
- Centre for Endocrinology and Reproductive Medicine Freiburg (CERF), Bismarckalle 7f, D-79098 Freiburg im Breisgau, Germany.
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Janse F, Donnez J, Anckaert E, de Jong FH, Fauser BCJM, Dolmans MM. Limited value of ovarian function markers following orthotopic transplantation of ovarian tissue after gonadotoxic treatment. J Clin Endocrinol Metab 2011; 96:1136-44. [PMID: 21289248 DOI: 10.1210/jc.2010-2188] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In young women, some treatments for cancer or other conditions (such as sickle cell anemia) may give rise to primary ovarian insufficiency. Ovarian transplantation is one of the available options for fertility preservation, with highly variable pregnancy rates. OBJECTIVE The objective of the study was to investigate markers of ovarian reserve and ovarian function in women up to 7 yr after orthotopic ovarian transplantation. Secondary objectives were to assess the relationship between markers of ovarian reserve and pregnancy rate along with the duration of ovarian function. DESIGN This was a prospective cohort study in 10 women, with a mean follow-up of 2.5 yr. SETTING The study was conducted at a university hospital in Brussels, Belgium. PATIENTS Patients included 10 women who were about to receive or had previously received gonadotoxic treatment. In seven women cryopreservation of ovarian tissue was performed before starting treatment. Subsequently autografts were orthotopically transplanted in these women. Three women, who had already developed primary ovarian insufficiency due to treatment, underwent orthotopic transplantation of ovarian allograft tissue originating from their human leukocyte antigen-compatible sisters. MAIN OUTCOME MEASURES Serum concentrations of FSH, LH, estradiol, inhibin B, and anti-Müllerian hormone (AMH) were measured. RESULTS On average, first menses took place after 4.7 months. Duration of graft functioning varied from 2 to more than 60 months. FSH concentrations remained elevated, whereas estradiol levels normalized and AMH was low to undetectable. Inhibin B varied among women and was not associated with the duration of ovarian function (hazard ratio 0.966, 95% confidence interval 0.881-1.059). Two spontaneous pregnancies occurred. Endocrine characteristics were not significantly different in these women. CONCLUSIONS Low AMH and inhibin B concentrations may suggest decreased ovarian reserve in women after ovarian transplantation. AMH and inhibin B levels may not be associated with the duration of ovarian graft function or probability to achieve a pregnancy.
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Affiliation(s)
- Femi Janse
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Cabrol S, Ross JL, Fennoy I, Bouvattier C, Roger M, Lahlou N. Assessment of Leydig and Sertoli cell functions in infants with nonmosaic Klinefelter syndrome: insulin-like peptide 3 levels are normal and positively correlated with LH levels. J Clin Endocrinol Metab 2011; 96:E746-53. [PMID: 21307139 PMCID: PMC5393421 DOI: 10.1210/jc.2010-2103] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Klinefelter syndrome (KS) is the most common sex chromosome disorder and a major cause of male infertility. In adult patients, serum inhibin B and anti-Mullerian-hormone (AMH) are undetectable, testosterone secretion is often impaired, and the tubules are depleted of germ cells. Before puberty, inhibin B, AMH, and testosterone levels are within the normal range. OBJECTIVE Sertoli and Leydig cell secretions, including insulin-like peptide-3 (INSL3), were evaluated in infants with nonmosaic XXY karyotype to assess testicular function soon after birth. DESIGN The study was conducted in four University Pediatric Departments from the United States and France. SUBJECTS Sixty-eight prenatally diagnosed infants aged 2-750 d were enrolled. MAIN OUTCOME MEASURES Serum FSH, LH, inhibin B, AMH, and INSL3 were measured by immunoassay, and testosterone was measured by tandem mass-spectrometry. RESULTS In infants with KS, INSL3 levels transiently increased at 2-3 months of age and were significantly correlated with testosterone (Spearman r = 0.57) and LH (Spearman r = 0.73) levels. They did not differ from controls. Testosterone levels were within the normal range, but most of them were below the median of controls. Inhibin B and AMH levels were also within normal range. Inhibin B was correlated with FSH (Spearman r = 0.49). AMH was not correlated with FSH or testosterone. FSH levels were above normal in 25% of patients, despite normal inhibin B levels. CONCLUSIONS In infants with KS, Leydig cells are normally sensitive to the LH proliferative effect. In contrast, the Sertoli cell sensitivity to FSH is questionable, which may be prophetic of the postpubertal Sertoli cell resistance to FSH.
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Affiliation(s)
- Sylvie Cabrol
- Department of Pediatric Endocrinology, Hôpital Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie University, 75012 Paris, France
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Abstract
Development of novel antibodies directed against anti-Müllerian hormone (AMH) has allowed measurement in serum and immunohistochemical assessment in tissues. AMH is secreted by granulosa cells in late preantral and small antral follicles and appears in serum in detectable and stable amounts throughout the menstrual cycle. AMH measurement allows an assessment of ovarian reserve with several advantages over other biochemical and biophysical markers. Recent research has highlighted utility in cases of premature ovarian failure, either iatrogenic after treatment for cancer, or naturally occurring, in polycystic ovary syndrome and in the management of superovulation in assisted reproduction. A surge in research activity has taken place over the last 5 yr, and the true place of AMH in reproductive medicine remains to be fully elucidated, but the rapid and widespread adoption of AMH assay into clinical practice demonstrates the degree of interest in this new marker amongst reproductive endocrinologists.
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Affiliation(s)
- William L Ledger
- University of Sheffield, Academic Unit of Reproductive and Developmental Medicine, Jessop Wing, Royal Hallamshire Hospital, Sheffield S10 2SF, United Kingdom.
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Mark-Kappeler CJ, Sen N, Keating AF, Sipes IG, Hoyer PB. Distribution and responsiveness of rat anti-Müllerian hormone during ovarian development and VCD-induced ovotoxicity. Toxicol Appl Pharmacol 2010; 249:1-7. [PMID: 20816688 PMCID: PMC2956858 DOI: 10.1016/j.taap.2010.08.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 08/23/2010] [Accepted: 08/24/2010] [Indexed: 10/19/2022]
Abstract
Anti-Müllerian hormone (AMH) is produced by granulosa cells in primary to small antral follicles of the adult ovary and helps maintain primordial follicles in a dormant state. The industrial chemical, 4-vinylcyclohexene diepoxide (VCD) causes specific ovotoxicity in primordial and small primary follicles of mice and rats. Previous studies suggest that this ovotoxicity involves acceleration of primordial to primary follicle recruitment via interactions with the Kit/Kit ligand signaling pathway. Because of its accepted role in inhibiting primordial follicle recruitment, the present study was designed to investigate a possible interaction between AMH and VCD-induced ovotoxicity. Protein distribution of AMH was compared in neonatal and adult F344 rat ovaries. AMH protein was visualized by immunofluorescence microscopy in large primary and secondary follicles of the adult ovary, but in small primary follicles in neonatal rat ovaries. In cultured postnatal day (PND) 4 F344 rat ovaries, VCD exposure (30 μM, 2-8 days) decreased (P<0.05) AMH mRNA (d4-8) and protein (d6-8). Recombinant AMH (100-400 mg/ml) in PND4 ovaries cultured 8 days±VCD (30 μM) caused an increase (P<0.05) in primordial, and a decrease (P<0.05) in small primary follicles, supporting that AMH retarded primordial follicle recruitment. However, no concentration of AMH had an effect on VCD-induced ovotoxicity. Whereas, VCD caused a reduction in expression of AMH (d4-d8), it followed previously reported initial disruptions in Kit signaling induced by VCD (d2). Thus, collectively, these results do not support a mechanism whereby VCD causes ovotoxicity via generalized activation of primordial follicle recruitment, but instead provide further support for the specificity of other intracellular mechanisms involved in VCD-induced ovotoxicity.
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Affiliation(s)
| | - Nivedita Sen
- Department of Physiology, University of Arizona, Tucson, Arizona, 85724-5051, USA
| | - Aileen F. Keating
- Department of Physiology, University of Arizona, Tucson, Arizona, 85724-5051, USA
| | - I. Glenn Sipes
- Department of Pharmacology, University of Arizona, Tucson, Arizona, 85724, USA
| | - Patricia B. Hoyer
- Department of Physiology, University of Arizona, Tucson, Arizona, 85724-5051, USA
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Bukulmez O, Li Q, Carr BR, Leader B, Doody KM, Doody KJ. Repetitive oocyte donation does not decrease serum anti-Müllerian hormone levels. Fertil Steril 2009; 94:905-12. [PMID: 19631321 DOI: 10.1016/j.fertnstert.2009.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 05/06/2009] [Accepted: 05/07/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine if the anti-Müllerian hormone (AMH), a proposed marker of ovarian aging, decreases with repetitive oocyte donation. DESIGN Retrospective cohort. SETTING Academic. PATIENT(S) Thirty-six young women who underwent three to seven oocyte donation cycles. INTERVENTION(S) Assessor blind determination of AMH levels from serum samples collected during each treatment cycle. MAIN OUTCOME MEASURE(S) Cycle trends of serum AMH levels. RESULT(S) The AMH was the only predictor of oocyte yield in the first cycles. The AMH was negatively associated with donor age and follicle stimulating hormone (FSH) dose used. Serum AMH levels did not show any decrease per treatment cycle basis and per maximum number of oocyte donation cycles performed per woman. Whereas donors who underwent six cycles showed increasing AMH levels when controlled for studied covariates, the slopes of the multiple regression curves were not significantly different from donors who underwent three, four, and five cycles. Clinical outcome assessed by FSH dose/number of oocytes ratio did not show significant change over repetitive cycles. Intercycle variation of AMH in all patients over three cycles was found to be 12.5%, which was within the reported intermenstrual range. CONCLUSION(S) Serum AMH levels do not decrease over repetitive oocyte donation cycles, which may imply that accelerated ovarian aging may not occur in oocyte donors.
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Affiliation(s)
- Orhan Bukulmez
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida 32610-0294, USA.
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Yding Andersen C, Rosendahl M, Byskov AG. Concentration of anti-Müllerian hormone and inhibin-B in relation to steroids and age in follicular fluid from small antral human follicles. J Clin Endocrinol Metab 2008; 93:2344-9. [PMID: 18381582 DOI: 10.1210/jc.2007-2342] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Ovaries surgically removed for fertility preservation served as a source of follicle fluid from human small antral follicles. OBJECTIVE The objective of the study was to measure intrafollicular concentrations of anti-Müllerian Hormone (AMH), inhibin-B, progesterone, androstenedione, testosterone, estradiol, and IGF binding protein-4. SETTING The study was conducted at a university hospital. PATIENTS Patients included 43 women having one ovary removed prior to receiving gonadotoxic treatment due to malignant disease. INTERVENTIONS Fluid from 100 follicles (diameter of 3-9 mm) were included. MAIN OUTCOME MEASURES Intrafollicular concentrations of the measured hormones, their possible intercorrelation, and correlation with age were measured. RESULTS Concentrations of AMH were unrelated to follicular fluid concentrations of androstenedione and testosterone. There was a significant negative correlation between estradiol, inhibin-B, progesterone, and AMH. In four age groups spanning 11-37 yr, levels of AMH, estradiol, androstenedione, testosterone and inhibin-B remained constant, whereas progesterone showed significant variations. IGF binding protein-4 was unrelated to any other measured hormone. CONCLUSIONS This study was unable to confirm a stimulatory effect of androgens on AMH secretion but did enforce a close intimate correlation between AMH and estradiol expressions in the developing human follicle. The insignificant variation of the AMH concentration with age, even in prepubertal girls, suggests that AMH expression is unrelated to menstrual cycle FSH cyclicity.
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Affiliation(s)
- Claus Yding Andersen
- Laboratory of Reproductive Biology, University Hospital of Copenhagen, Blegdamsvej 9, Rigshospitalet, Copenhagen, Denmark.
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Duvilla E, Lejeune H, Trombert-Paviot B, Gentil-Perret A, Tostain J, Levy R. Significance of inhibin B and anti-Müllerian hormone in seminal plasma: a preliminary study. Fertil Steril 2008; 89:444-8. [PMID: 17681330 DOI: 10.1016/j.fertnstert.2007.03.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 03/06/2007] [Accepted: 03/07/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the predictive value of seminal inhibin B and anti-Müllerian hormone (AMH) on the outcome of testicular sperm extraction (TESE) in patients with nonobstructive azoospermia. DESIGN Prospective study. SETTING Reproductive biology department. PATIENT(S) Forty-seven normospermic, 28 oligozoospermic, and 68 azoospermic patients. INTERVENTION(S) Testicular sperm extraction. MAIN OUTCOME MEASURE(S) Seminal inhibin B and AMH measure. RESULT(S) The seminal values of inhibin B and AMH are widely dispersed. Both inhibin B and AMH seminal values are significantly different between the three groups. The average rates of seminal AMH (not inhibin B) differ significantly according to the etiology of the azoospermia. Both seminal markers are correlated. A significant positive correlation could be observed between the seminal inhibin B and the sperm count, but not for AMH. A significant correlation also exists between seminal and serum inhibin B. The predictive value for TESE outcome of each parameter is rather low. Conversely, a logistic regression combining serum FSH, seminal inhibin B, and AMH produced a satisfying area under the curve of 0.985. CONCLUSION(S) Seminal inhibin B and AMH values are proposed. Separately, seminal markers are poor predictors of TESE outcome. A logistic regression model led to a satisfying area under the curve of 0.985.
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Affiliation(s)
- Emma Duvilla
- Laboratoire de Biologie de la Reproduction, Hôpital Nord, CHU de Saint Etienne, Saint Etienne, France
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