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Han YF, Yan Y, Wang HY, Chu MY, Sun K, Feng ZW, Feng H. Effect of systemic lupus erythematosus on the ovarian reserve: A systematic review and meta-analysis. Joint Bone Spine 2024; 91:105728. [PMID: 38580102 DOI: 10.1016/j.jbspin.2024.105728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE Systemic Lupus Erythematosus (SLE) is an autoimmune disease that occurs at higher rates in young women. Evidence suggests that SLE may be associated with ovarian dysfunction. Therefore, it is crucial to investigate the possible effects of SLE on ovarian reserve function. METHODS PubMed, Embase, Web of Science, Scopus, Cochrane Library, and ClinicalTrials.gov databases were searched from inception to July 2023 to identify studies that compared ovarian reserve in patients with SLE to that of healthy individuals. The study examined anti-müllerian hormone (AMH), antral follicle count (AFC), and follicle-stimulating hormone (FSH) as outcomes. RESULTS Thirteen studies (n=1017) were eligible for meta-analysis. Females with SLE had significantly lower levels of AMH (weighted mean difference [WMD]: -1.07, 95% confidence interval [CI]: -1.37 to -0.76, P<0.001) and AFC (WMD: -3.46, 95% CI: -4.57 to -2.34, P<0.001). There was no significant difference in FSH levels. Subgroup analyses by age of onset revealed that SLE patients with adult-onset had significantly lower AMH levels (WMD: -1.44, 95% CI: -1.71 to -1.18, P<0.001), lower AFCs (WMD: -3.11, 95% CI: -3.60 to -2.61, P<0.001) and higher FSH levels (WMD: 0.60, 95% CI: 0.15 to 1.05, P<0.01). However, SLE patients with juvenile-onset did not exhibit significant differences in their AMH and FSH levels, except for AFCs (WMD: -7.27, 95% CI: -12.39 to -2.14, P<0.01). CONCLUSION The impact of SLE on ovarian reserve is significant, and the effect may be particularly severe in cases of adult-onset SLE.
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Affiliation(s)
- Yun-Fei Han
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 300381 Tianjin, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, 300381 Tianjin, China
| | - Ying Yan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 300381 Tianjin, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, 300381 Tianjin, China.
| | - Hong-Yu Wang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198 Jiangsu, China
| | - Meng-Yuan Chu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 300381 Tianjin, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, 300381 Tianjin, China
| | - Kai Sun
- Graduate School, Tianjin University of Traditional Chinese Medicine, 301617 Tianjin, China
| | - Zhi-Wang Feng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, 300381 Tianjin, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, 300381 Tianjin, China
| | - He Feng
- Graduate School, Tianjin University of Traditional Chinese Medicine, 301617 Tianjin, China
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Werner L, van der Schouw YT, de Kat AC. A systematic review of the association between modifiable lifestyle factors and circulating anti-Müllerian hormone. Hum Reprod Update 2024; 30:262-308. [PMID: 38402486 DOI: 10.1093/humupd/dmae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 01/21/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Levels of anti-Müllerian hormone (AMH) are known to be associated with lifestyle determinants such as smoking and oral contraception (OC) use. When measuring AMH in clinical practice, it is essential to know which factors may influence circulating levels or ovarian reserve in general. OBJECTIVE AND RATIONALE To date, there is no systematic review or summarizing consensus of the nature and magnitude of the relation between AMH and modifiable lifestyle factors. The purpose of this review was to systematically assess the evidence on association of lifestyle behaviors with circulating AMH levels. SEARCH METHODS We performed a pre-registered systematic review of publications in Embase and PubMed on the lifestyle factors BMI, smoking, OC use, alcohol consumption, caffeine consumption, physical activity, and waist-hip ratio (WHR) in relation to circulating AMH levels up to 1 November 2023. The search strategy included terms such as 'Anti-Mullerian hormone', 'lifestyle', and 'women'. Studies were considered eligible if the association between at least one of the lifestyle factors of interest and AMH was assessed in adult women. The quality of included studies was assessed using the Study Quality Assessment Tools of the National Heart, Lung, and Blood Institute. The results were presented as ranges of the most frequently used association measure for studies that found a significant association in the same direction. OUTCOMES A total of 15 072 records were identified, of which 65 studies were eligible for inclusion, and 66.2% of the studies used a cross-sectional design. The majority of studies investigating BMI, smoking, OC use, and physical activity reported significant inverse associations with AMH levels. For WHR, alcohol, and caffeine use, the majority of studies did not find an association with AMH. For all determinants, the effect measures of the reported associations were heterogeneous. The mean difference in AMH levels per unit increase in BMI ranged from -0.015 to -0.2 ng/ml in studies that found a significant inverse association. The mean difference in AMH levels for current smokers versus non-smokers ranged from -0.4 to -1.1 ng/ml, and -4% to -44%, respectively. For current OC use, results included a range in relative mean differences in AMH levels of -17% to -31.1%, in addition to a decrease of 11 age-standardized percentiles, and an average decrease of 1.97 ng/ml after 9 weeks of OC use. Exercise interventions led to a decrease in AMH levels of 2.8 pmol/l to 13.2 pmol/l after 12 weeks in women with polycystic ovary syndrome or a sedentary lifestyle. WIDER IMPLICATIONS Lifestyle factors are associated with differences in AMH levels and thus should be taken into account when interpreting individual AMH measurements. Furthermore, AMH levels can be influenced by the alteration of lifestyle behaviors. While this can be a helpful tool for clinical and lifestyle counseling, the nature of the relation between the observed differences in AMH and the true ovarian reserve remains to be assessed. REGISTRATION NUMBER PROSPERO registration ID: CRD42022322575.
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Affiliation(s)
- Lotte Werner
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annelien C de Kat
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
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Tandl V, Haudum C, Eberhard K, Hutz B, Foessl I, Kolesnik E, Zirlik A, von Lewinski D, Scherr D, Verheyen N, Pieber T, Obermayer-Pietsch B. AMH in Males: Effects of Body Size and Composition on Serum AMH Levels. J Clin Med 2023; 12:4478. [PMID: 37445513 DOI: 10.3390/jcm12134478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Serum concentrations of anti-Müllerian hormone (AMH) have been found to decrease with increasing body mass index (BMI) in many studies. It is not yet clear whether this stems from an adverse effect of adiposity on AMH production, or from dilution due to the greater blood volume that accompanies a larger body size. To investigate a possible hemodilution effect, we explored the relationships between serum AMH levels and different parameters of body composition using linear regression models in a cohort of adult males. Body weight, lean mass (LM), and body surface area (BSA) were found to be better predictors of AMH than measures of adiposity, such as BMI or fat mass. Since both LM and BSA correlate with plasma volume better than adipose tissue, we conclude that hemodilution of AMH does occur in adult males and should be considered for normalization in future studies.
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Affiliation(s)
- Veronika Tandl
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Christoph Haudum
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Katharina Eberhard
- Core Facility Computational Bioanalytics, Medical University Graz, 8036 Graz, Austria
| | - Barbara Hutz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Ines Foessl
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Ewald Kolesnik
- Division of Cardiology, Department of Internal Medicine and University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Andreas Zirlik
- Division of Cardiology, Department of Internal Medicine and University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Dirk von Lewinski
- Division of Cardiology, Department of Internal Medicine and University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine and University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Nicolas Verheyen
- Division of Cardiology, Department of Internal Medicine and University Heart Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Thomas Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
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Prieto-Huecas L, Piera-Jordán CÁ, Serrano De La Cruz-Delgado V, Zaragoza-Martí A, García-Velert MB, Tordera-Terrades C, Sánchez-Sansegundo M, Martín-Manchado L. Assessment of Nutritional Status and Its Influence on Ovarian Reserve: A Systematic Review. Nutrients 2023; 15:nu15102280. [PMID: 37242163 DOI: 10.3390/nu15102280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Nowadays, there is a growing interest in the relationship among lifestyle, reproductive health, and fertility. Recent investigations highlight the influence of environmental and lifestyle factors such as stress, diet, and nutritional status on reproductive health. The aim of this review was to determine the influence of nutritional status on ovarian reserve in order to improve the reproductive health of women of childbearing age. METHODS A systematic literature review was carried out following the PRISMA method. The quality of the studies was assessed using the Cochrane Collaboration Risk of Bias tool. Data were extracted, and the results were summarized into two blocks: according to the technique used to assess ovarian reserve and nutritional status; according to the results found in the relationship between ovarian reserve and nutritional status. RESULTS A total of 22 articles involving 5929 women were included. In 12 of the included articles (54.5%), a relationship between nutritional status and ovarian reserve was demonstrated. In seven publications (31.8%), the increased body mass index (BMI) led to a decrease in ovarian reserve, two of them (0.9%) in patients with polycystic ovary syndrome, showing a decrease only if BMI > 25. In two articles (0.9%), there was a negative relationship between ovarian reserve and waist-to-hip ratio, and in one (0.45%), a positive relationship was shown between ovarian reserve and testosterone levels, the latter being related to body mass index. In five articles (22.7%), body mass index was used as a confounder and was negatively related to ovarian reserve, and in another four (18%), no correlation was found. CONCLUSIONS Ovarian reserve appears to be influenced by nutritional status. A high body mass index has a negative impact on the ovary, decreasing antral follicle count and anti-Müllerian hormone. Oocyte quality is compromised, increasing the rate of reproductive problems and the demand for assisted reproductive techniques. Further studies are needed to understand which dietary factors have the greatest effect on ovarian reserve in order to promote reproductive health.
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Affiliation(s)
- Laura Prieto-Huecas
- Obstetrics and Gynaecology Service, Hospital Marina Salud, 03700 Denia, Spain
| | | | | | - Ana Zaragoza-Martí
- Department of Nursing, University of Alicante, 03690 Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), 03010 Alicante, Spain
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Komorowski AS, Walter JR, Martin CE, Bedrick BS, Riley JK, Jungheim ES. Neighborhood disadvantage is associated with decreased ovarian reserve in women with overweight and obesity. Fertil Steril 2023; 119:653-660. [PMID: 36565977 PMCID: PMC10079614 DOI: 10.1016/j.fertnstert.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 11/16/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE(S) To evaluate the association between neighborhood disadvantage and ovarian reserve stratified by body mass index (BMI). DESIGN Cross-sectional cohort study. SETTING Single academic medical center. PATIENT(S) A total of 193 healthy reproductive-age women with regular menstrual cycles in the St. Louis, Missouri metropolitan area. INTERVENTION(S) Residence in a disadvantaged neighborhood. MAIN OUTCOME MEASURE(S) Ovarian reserve as assessed by ovarian antral follicle count (AFC) and serum anti-Müllerian hormone (AMH) concentration. RESULT(S) Women (n = 193) ranged from 20 to 44 years. The majority had overweight or obesity (59%, n = 117) with mean BMI of 28±7 kg/m2. Forty-eight women lived in the most disadvantaged neighborhood quartile, of which 75% had overweight or obesity, compared with 54% of the 145 women living in the 3 less disadvantaged neighborhood quartiles. When controlling for age, race, and smoking status, women with overweight or obesity living in the most disadvantaged neighborhoods had significantly lower AMH compared with those living in the less disadvantaged neighborhoods. Antral follicle count did not differ among women with overweight or obesity by neighborhood of residence. Neighborhood disadvantage was not associated with ovarian reserve by AFC or AMH in women with normal weight or underweight status. CONCLUSION(S) Living in a socioeconomically deprived area is associated with lower markers of ovarian reserve among women with an elevated BMI.
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Affiliation(s)
- Allison S Komorowski
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri.
| | - Jessica R Walter
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Caitlin E Martin
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Bronwyn S Bedrick
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Joan K Riley
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Emily S Jungheim
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri
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Kataoka J, Larsson I, Lindgren E, Kindstrand LO, Schmidt J, Stener-Victorin E. Circulating Anti-Müllerian hormone in a cohort-study of women with severe obesity with and without polycystic ovary syndrome and the effect of a one-year weight loss intervention. Reprod Biol Endocrinol 2022; 20:153. [PMID: 36309748 PMCID: PMC9617381 DOI: 10.1186/s12958-022-01022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/25/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women with polycystic ovary syndrome (PCOS) have high circulating anti-Müllerian hormone (AMH) levels which is correlated with antral follicle count and polycystic ovarian morphology and negatively correlated with body mass index (BMI). Moreover, diet-induced weight loss in women with PCOS and overweight or obesity, reduce or normalize AMH-levels. There is, however, no previous study investigating the circulating AMH levels in women with severe obesity and how a structured diet-induced weight loss program affects circulating AMH levels in these women. Therefore, this study aims to investigate circulating AMH levels in a population of women with severe obesity (BMI ≥ 35 kg/m2) with and without PCOS, as diagnosed by the NIH-criteria, and to investigate the effect of a one-year weight loss program with a very low-energy diet (VLED) on circulating levels of AMH. METHODS In a prospective cohort-study, were 246 women with severe obesity were screened for PCOS diagnosis with the NIH-criteria, circulating AMH and anthropometry were measured at baseline and after a 12-month weight loss intervention with very low-energy diet (VLED). RESULTS Mean BMI was 39.9 ± 4.7 (PCOS), 39.6 ± 4.3 (non-PCOS) P = 0.960. Circulating AMH was higher in women with PCOS (5.47 ± 4.89 µg/L) compared with non-PCOS (2.66 ± 3.71 µg/L) P < 0.001 and was positively correlated with circulating total testosterone in both groups. Next, we performed ROC-analyses, and show that circulating AMH could not discriminate women with PCOS and severe obesity from non-PCOS women with severe obesity. Finally, a one-year weight reduction program does not affect circulating AMH levels despite significant weight loss neither in women with PCOS, nor without PCOS and severe obesity. CONCLUSION Women with severe obesity and PCOS have elevated levels of circulating AMH compared to women without the syndrome. AMH-levels could not discriminate women with PCOS from non-PCOS because of low sensitivity and specificity. Significant weight loss was not associated with changes in circulating AMH levels, neither in women with, nor without PCOS and severe obesity. These results imply that in women with severe obesity, a greater weight loss may be needed to improve reproductive features, independent of PCOS diagnosis. TRIAL REGISTRATION NUMBER Clinical trial.gov: NCT01319162.
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Affiliation(s)
- Josefin Kataoka
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Box 430, 405 30, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingrid Larsson
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 428, 405 30, Gothenburg, Sweden
| | - Eva Lindgren
- Department of Physiology and Pharmacology, Karolinska Institutet, Biomedicum, B5, 171 77, Stockholm, Sweden
| | - Li Oskarson Kindstrand
- Department of Physiology and Pharmacology, Karolinska Institutet, Biomedicum, B5, 171 77, Stockholm, Sweden
| | - Johanna Schmidt
- Institute of Clinical Sciences, Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, 416 85, Gothenburg, Sweden
| | - Elisabet Stener-Victorin
- Department of Physiology and Pharmacology, Karolinska Institutet, Biomedicum, B5, 171 77, Stockholm, Sweden.
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Bhattacharya K, Saha I, Sen D, Bose C, Chaudhuri GR, Dutta S, Sengupta P, Bhattacharya S, Barman SS, Syamal AK. Role of anti-Mullerian hormone in polycystic ovary syndrome. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2022. [DOI: 10.1186/s43043-022-00123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractPolycystic ovary syndrome (PCOS) is the most common gynecological endocrine disorders affecting up to 10% of all females in their reproductive age, and its cause of onset is still elusive. A spectrum of recent research reflected diverse associations between increased plasma level of anti-Mullerian hormone (AMH) and different clinical features of PCOS. Since AMH levels reflect the pool of growing follicles that potentially can ovulate, it can be stated that serum AMH levels can be used to assess the “functional ovarian reserve,” rather mentioning it as the “ovarian reserve.” AMH also appears to be a premier endocrine parameter for the assessment of atrophied ovarian follicular pool in response to age of individuals. AMH hinders the follicular development as well as the follicular recruitment and ultimately resulting in follicular arrest which is the key pathophysiologic condition for the onset of PCOS. Furthermore, FSH-induced aromatase activity remains inhibited by AMH that aids emergence of other associated clinical signs of PCOS, such as excess androgen, followed by insulin resistance among the PCOS individuals. Given the versatile association of AMH with PCOS and scarcity in literature explaining the underling mechanisms how AMH relates with PCOS, this review article will discuss the roles of AMH in the pathogenesis of PCOS which may introduce a new era in treatment approach of PCOS.
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8
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Kloos J. Letter to the Editor From Kloos: "Evaluation of Female Fertility-AMH and Ovarian Reserve Testing". J Clin Endocrinol Metab 2022; 107:e3963. [PMID: 35775478 DOI: 10.1210/clinem/dgac398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Jacqueline Kloos
- Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA
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9
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Grimes NP, Whitcomb BW, Reeves KW, Sievert LL, Purdue-Smithe A, Manson JE, Hankinson SE, Rosner BA, Bertone-Johnson ER. The association between anthropometric factors and anti-Müllerian hormone levels in premenopausal women. Women Health 2022; 62:580-592. [DOI: 10.1080/03630242.2022.2096747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Nydjie P. Grimes
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Brian W. Whitcomb
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Katherine W. Reeves
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Lynnette L. Sievert
- Department of Anthropology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Alexandra Purdue-Smithe
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - JoAnn E. Manson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Maryland, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Susan E. Hankinson
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Maryland, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Bernard A. Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Maryland, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth R. Bertone-Johnson
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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10
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Buyukkaba M, Turgut S, Ilhan MM, Ekinci I, Yaylım İ, Zeybek SU, Turan S, Tasan E, Karaman O. Anti-Mullerian Hormone Levels Increase After Bariatric Surgery in Obese Female Patients With and Without Polycystic Ovary Syndrome. Horm Metab Res 2022; 54:194-198. [PMID: 35276745 DOI: 10.1055/a-1756-4798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study was aimed to investigate the effect of weight loss by bariatric surgery on the level of anti-Mullerian hormone (AMH) in morbidly obese female patients with or without polycystic ovary syndrome (PCOS). This prospective study includes 70 females, obese, and fertile patients of reproductive age. All patients were evaluated to determine the changes in weight, body mass index (BMI), serum AMH, and other biochemical parameters at the end of six months. The mean levels of the preop and postop AMH were 1.66±0.87 ng/ml and 5.99±1.39 ng/ml in the PCOS group; 1.35±0.76 ng/ml and 6.23±1.47 ng/ml in the non-PCOS group, respectively. The postop AMH levels were significantly higher than the preop levels for both groups (p<0.001). There were significant differences in the level of glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, total cholesterol, hemoglobin A1c, HOMA-IR, insulin between preop and postop 6th month. A negative correlation was found between postop AMH and body weight in all patients (r=-0.337, p=0.031). Postop AMH levels were negatively correlated with postop BMI levels in the non-PCOS patient group (r=-0.408, p=0.043). No significant difference was observed between the PCOS and non-PCOS groups in terms of all the parameters examined. In conclusion, our study suggests that the significantly increased AMH levels by losing weight with bariatric surgery in patients with morbid obesity with and without PCOS may indicate the improvement of fertilization potential. It could be considered when evaluating fertility in patients with morbid obesity.
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Affiliation(s)
- Mitat Buyukkaba
- Department of Internal Medicine, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Seda Turgut
- Department of Internal Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mahmut Muzaffer Ilhan
- Department of Endocrinology and Metabolism Diseases, Medipol University, Istanbul, Turkey
| | - Iskender Ekinci
- Department of Internal Medicine, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - İlhan Yaylım
- Department of Molecular Medicine Istanbul University, Istanbul, Turkey
| | - Sakir Umit Zeybek
- Department of Molecular Medicine Istanbul University, Istanbul, Turkey
| | - Saime Turan
- Department of Molecular Medicine Istanbul University, Istanbul, Turkey
| | - Ertugrul Tasan
- Department of Internal Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Ozcan Karaman
- Department of Internal Medicine, Bezmialem Foundation University, Istanbul, Turkey
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Singla B, Banerjee K, Thind A, Bhatnagar N, Agria K, Bajaj P, Jindal A, Arora S, Goyal P, Mittal B, Malhotra K, Pai H, Malhotra J, Goel P, Jindal N. Effect of reproductive and lifestyle factors on anti-mullerian hormone levels in women of Indian origin. J Hum Reprod Sci 2022; 15:259-271. [PMID: 36341011 PMCID: PMC9635372 DOI: 10.4103/jhrs.jhrs_79_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Infertility is a world-wide problem and one third females. Over the years, anti-mullerian hormone (AMH) has emerged as a major marker of ovarian reserve. There is also increasing interest in determining the factors which can impact AMH levels. Aims: To correlate the association of reproductive and lifestyle factors on AMH levels in women of Indian origin. Settings and Design: Multicentric cross sectional study. Materials and Methods: The study was conducted using data extracted from the patient records of seven private fertility practices located in North India. Women who were attending these clinics for fertility treatment were requested to fill the questionnaire related to reproductive and lifestyle factors. Statistical Analysis used: Our outcome variable was level of AMH measured in the past 3 months, and was assessed as normal or low. All analyses were conducted using STATA 17. Results: We found a direct association of low AMH with increasing age, short cycles, amenorrhea and women with family history of premature menopause. We found a direct correlation of high AMH and women with polycystic ovary syndrome and those whose partners had Oligoasthenoteratozoospermia (OATS) or azoospermia. There was no correlation with smoking, sleep, diet, body mass index, cell phone or laptop use in our study. Conclusion: Reproductive and lifestyle factors may affect ovarian reserve and but there was a dearth of human studies in this area. To the best of our knowledge this is the first human study on the effect of AMH on Laptop and Cell phone use. We urgently need more studies to confirm or refute our findings so that we can counsel our patients well.
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Moolhuijsen LME, Louwers YV, McLuskey A, Broer L, Uitterlinden AG, Verdiesen RMG, Sisk RK, Dunaif A, Laven JSE, Visser JA. OUP accepted manuscript. Hum Reprod 2022; 37:1544-1556. [PMID: 35451015 PMCID: PMC9247424 DOI: 10.1093/humrep/deac082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/29/2022] [Indexed: 11/19/2022] Open
Abstract
STUDY QUESTION Do polymorphisms in the anti-Müllerian hormone (AMH) promoter have an effect on AMH levels in patients with polycystic ovary syndrome (PCOS)? SUMMARY ANSWER We have identified a novel AMH promoter polymorphism rs10406324 that is associated with lower serum AMH levels and is suggested to play a role in the mechanism of regulation of AMH gene expression in women. WHAT IS KNOWN ALREADY Follicle number is positively correlated with serum AMH levels, reflected by elevated AMH levels in women with PCOS. In addition, it is suggested that AMH production per follicle is higher in women with PCOS than in normo-ovulatory women, implying an altered regulation of AMH in PCOS. STUDY DESIGN, SIZE, DURATION A discovery cohort of 655 PCOS women of Northern European ancestry and both an internal and external validation PCOS cohort (n = 458 and n = 321, respectively) were included in this study. Summary-level data of an AMH genome-wide association study meta-analysis including 7049 normo-ovulatory women was included as a control cohort. A genetic approach was taken through association analysis and in silico analysis of the associated variants in the AMH promoter. In vitro analysis was performed to investigate the functional mechanisms. PARTICIPANTS/MATERIALS, SETTING, METHODS All common two-allelic single-nucleotide polymorphisms (SNPs) in the region Chr19:2 245 353–2 250 827 bp (Build 37) were selected for the analysis. Linear regression analyses were performed to determine the association between SNPs in the AMH promoter region and serum AMH levels. For the in silico analysis, the webtools ‘HaploReg’ v4.1 for ENCODE prediction weight matrices and ‘atSNP’ were used. In vitro analysis was performed using KK1 cells, a mouse granulosa cell line and COV434 cells, a human granulosa tumor cell line. Cells were transfected with the reference or the variant human AMH promoter reporter construct together with several transcription factors (TFs). Dual-Glo® Luciferase Assay was performed to measure the luciferase activity. MAIN RESULTS AND THE ROLE OF CHANCE Polymorphism rs10406324 was significantly associated with serum AMH levels in all three PCOS cohorts. Carriers of the minor allele G had significantly lower log-transformed serum AMH levels compared to non-carriers (P = 8.58 × 10−8, P = 1.35 × 10−3 and P = 1.24 × 10−3, respectively). This result was validated in a subsequent meta-analysis (P = 3.24 × 10−12). Interestingly, rs10406324 was not associated with follicle count, nor with other clinical traits. Also, in normo-ovulatory women, the minor allele of this variant was associated with lower serum AMH levels (P = 1.04 × 10−5). These findings suggest that polymorphism rs10406324 plays a role in the regulation of AMH expression, irrespective of clinical background. In silico analysis suggested a decreased binding affinity of the TFs steroidogenenic factor 1, estrogen-related receptor alpha and glucocorticoid receptor to the minor allele G variant, however in vitro analysis did not show a difference in promoter activity between the A and G allele. LIMITATIONS, REASONS FOR CAUTION Functional analyses were performed in a mouse and a human granulosa cell line using an AMH promoter reporter construct. This may have limited assessment of the impact of the polymorphism on higher order chromatin structures. Human granulosa cells generated from induced pluripotent stem cells, combined with gene editing, may provide a method to elucidate the exact mechanism behind the decrease in serum AMH levels in carriers of the −210 G allele. We acknowledge that the lack of follicle number in the external validation and the control cohort is a limitation of the paper. Although we observed that the association between rs10406324 and AMH levels was independent of follicle number in our discovery and internal validation PCOS cohorts, we cannot fully rule out that the observed effects on serum AMH levels are, in part, caused by differences in follicle number. WIDER IMPLICATIONS OF THE FINDINGS These results suggest that variations in serum AMH levels are not only caused by differences in follicle number but also by genetic factors. Therefore, the genetic context should be taken into consideration when assessing serum AMH levels in women. This may have clinical consequences when serum AMH levels are used as a marker for the polycystic ovarian morphology phenotype. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used. J.S.E.L. has received consultancy fees from the following companies: Ferring, Roche Diagnostics and Ansh Labs and has received travel reimbursement from Ferring. J.A.V. has received royalties from AMH assays, paid to the institute/lab with no personal financial gain. The other authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Loes M E Moolhuijsen
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Yvonne V Louwers
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Anke McLuskey
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Linda Broer
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Andre G Uitterlinden
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Renée M G Verdiesen
- Division of Molecular Pathology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ryan K Sisk
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrea Dunaif
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Wang Y, Wu L, Yang Z, Xu R, Duan Y, Lin J, Cui X, Fan C, Zhou Y, Bao W, Jin L, Liu Y. Association of body mass index with serum anti-Müllerian hormone and inhibin B levels among 8323 women attending a reproductive medical center: a cross-sectional study. Endocrine 2022; 75:284-292. [PMID: 34363585 DOI: 10.1007/s12020-021-02839-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the association of body mass index (BMI) with serum anti-Müllerian hormone (AMH) and inhibin B (InB) levels among women attending a reproductive medical center. METHODS We conducted a cross-sectional study of 8323 women (96.4% were Han race) without polycystic ovary syndrome (PCOS) from the reproductive medical center of Tongji Hospital in Wuhan, China for assisted reproductive technology treatment between January 2016 and May 2018. For each participant, BMI and levels of serum AMH and InB were measured at entry by trained clinical technicians. Multivariate linear regression models were used to quantitatively estimate the associations of continuous and categorical BMI with serum AMH and InB levels. RESULTS Each 1 kg/m2 increase in BMI was significantly associated with a 1.02% (95% CI: 0.40, 1.65%) and 3.59% (3.11, 4.06%) reduction in AMH and InB levels, respectively. No departure from linearity was observed for either AMH or InB (both P for nonlinear trend >0.05). Overweight and obesity were significantly associated with a 6.01% (0.70, 11.04%) and 18.64% (2.29, 32.26%) reduction in AMH level, and were significantly associated with a 18.80% (15.23, 22.23%) and a 35.44% (25.47, 44.08%) reduction in InB level, respectively. In addition, the association between BMI and AMH level was significantly stronger among women ≥32 years. CONCLUSIONS BMI was linearly and inversely associated with AMH and InB levels among women without PCOS. Both overweight and obesity were significantly associated with lower AMH and InB levels.
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Affiliation(s)
- Yaqi Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Second Road, Guangzhou, Guangdong, 510080, China
| | - Li Wu
- Reproductive Medical Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Zhengyu Yang
- Melbourne School of Population & Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria, 3010, Australia
| | - Ruijun Xu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Second Road, Guangzhou, Guangdong, 510080, China
| | - Yonggang Duan
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan First Road, Shenzhen, Guangdong, 518053, China
| | - Jiajia Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Second Road, Guangzhou, Guangdong, 510080, China
| | - Xiuqing Cui
- Hubei Provincial Key Laboratory for Applied Toxicology, Hubei Provincial Center for Disease Control and Prevention, 35 Zhuodaoquan North Road, Wuhan, Hubei, 430079, China
| | - Chuangang Fan
- Hubei Provincial Key Laboratory for Applied Toxicology, Hubei Provincial Center for Disease Control and Prevention, 35 Zhuodaoquan North Road, Wuhan, Hubei, 430079, China
| | - Yun Zhou
- State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, Guangdong, 510120, China
- School of Public Health, Guangzhou Medical University, 1 Xinzao Road, Guangzhou, Guangdong, 511436, China
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, 145 North Riverside Drive, Iowa City, Iowa, 52242, USA
| | - Lei Jin
- Reproductive Medical Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China.
| | - Yuewei Liu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Second Road, Guangzhou, Guangdong, 510080, China.
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di Clemente N, Racine C, Pierre A, Taieb J. Anti-Müllerian Hormone in Female Reproduction. Endocr Rev 2021; 42:753-782. [PMID: 33851994 DOI: 10.1210/endrev/bnab012] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 12/26/2022]
Abstract
Anti-Müllerian hormone (AMH), also called Müllerian inhibiting substance, was shown to be synthesized by the ovary in the 1980s. This article reviews the main findings of the past 20 years on the regulation of the expression of AMH and its specific receptor AMHR2 by granulosa cells, the mechanism of action of AMH, the different roles it plays in the reproductive organs, its clinical utility, and its involvement in the principal pathological conditions affecting women. The findings in respect of regulation tell us that AMH and AMHR2 expression is mainly regulated by bone morphogenetic proteins, gonadotropins, and estrogens. It has now been established that AMH regulates the different steps of folliculogenesis and that it has neuroendocrine effects. On the other hand, the importance of serum AMH as a reliable marker of ovarian reserve and as a useful tool in the prediction of the polycystic ovary syndrome (PCOS) and primary ovarian failure has also been acknowledged. Last but not least, a large body of evidence points to the involvement of AMH in the pathogenesis of PCOS.
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Affiliation(s)
- Nathalie di Clemente
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France.,Institut Hospitalo-Universitaire ICAN, Paris, France
| | - Chrystèle Racine
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France.,Institut Hospitalo-Universitaire ICAN, Paris, France.,Sorbonne Paris Cité, Paris-Diderot Université, Paris, France
| | - Alice Pierre
- Sorbonne Paris Cité, Université Paris-Diderot, CNRS, INSERM, Biologie Fonctionnelle et Adaptative UMR 8251, Physiologie de l'Axe Gonadotrope U1133, Paris, France
| | - Joëlle Taieb
- Sorbonne Paris Cité, Université Paris-Diderot, CNRS, INSERM, Biologie Fonctionnelle et Adaptative UMR 8251, Physiologie de l'Axe Gonadotrope U1133, Paris, France
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Lawal OI, Yusuff JDO. Demographic, lifestyle, and reproductive determinants of serum anti-Müllerian hormone levels in adult women of reproductive age in Ilorin, North-Central Nigeria. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2021. [DOI: 10.1186/s43043-021-00069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Abstract
Background
Anti-Müllerian hormone is a dimeric glycoprotein produced by the granulosa cells of preantral and small antral follicles of the ovaries. It is a reliable biomarker of ovarian reserve, ageing, and response in the management of women with infertility. However, there are few studies on the determinants of serum anti-Müllerian hormone in Nigerian women. This study aimed to investigate determinants of serum anti-Müllerian hormone among adult women of reproductive age. The study was a hospital-based cross-sectional study involving 161 women of reproductive age attending the gynaecology clinic and immunisation clinic of a Nigerian tertiary hospital. Baseline characteristics were collected using a semi-structured questionnaire. Serum anti-Müllerian hormone was quantified using enzyme-linked immunosorbent assay.
Results
In univariate analysis, age (B = − 0.035, P = 0.000), parity (B = − 0.080, P = 0.001), and infertility duration (B = − 0.050, P = 0.011) had a negative relationship with serum anti-Müllerian hormone, while ethnicity (B = 0.180, P = 0.040), body mass index (B = 0.015, P = 0.010), and cycle length (B = 0.042, P = 0.000) had a positive relationship with serum anti-Müllerian hormone. In multivariable analysis, all relationships except infertility duration persisted.
Conclusion
We found that age, ethnicity, parity, infertility duration, body mass index, and cycle length were associated with serum anti-Müllerian hormone. A large prospective population-based study is required to better understand factors that are associated with serum anti-Müllerian hormone in an ethnically diverse country like Nigeria.
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Lim S, Kim S, Kim O, Kim B, Jung H, Ko KP, Lee H. Correlations among anti-Müllerian hormone levels, body mass index and lipid profile in reproductive-aged women: The Korea Nurses' Health Study. Nurs Open 2021; 8:2996-3005. [PMID: 34342177 PMCID: PMC8510772 DOI: 10.1002/nop2.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 04/25/2021] [Accepted: 07/10/2021] [Indexed: 11/23/2022] Open
Abstract
Aim This study aimed to evaluate the correlations among anti‐Müllerian hormone levels, body mass index and lipid profile in female nurses of reproductive age. Design This is a descriptive cross‐sectional study that used data from the Korea Nurses' Health Study, based on Nurses' Health Study 3 in the United States. Methods Participants included 448 female nurses of reproductive age. They provided details about their work experience, shift work, body mass index and history of polycystic ovary syndrome. Serum anti‐Müllerian hormone levels and lipid profile were measured using blood samples. Statistical analysis included quantile regression analysis using STATA 13.0. Data were collected between November 2016 and March 2017 from Module 5 of the Korean Nurses' Health Study. Results Approximately 12% of the participants were underweight, and roughly one‐tenth were either overweight or obese. Although linear regression showed no relationship between anti‐Müllerian hormone levels and body mass index, quantile regression showed that body mass index, total cholesterol levels and low‐density lipoprotein levels were negatively correlated with anti‐Müllerian hormone levels at the lower tails of the dependent variable. Meanwhile, high‐density lipoprotein levels were positively correlated with anti‐Müllerian hormone at the higher percentiles of anti‐Müllerian hormone levels. Conclusion These findings suggest the possibility that changes in the lipid profile may influence anti‐Müllerian hormone levels in women with diminished ovarian function, rather than obesity itself.
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Affiliation(s)
- Sarah Lim
- College of Nursing, Yonsei University, Seoul, Korea
| | - Sue Kim
- College of Nursing, Yonsei University, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - Oksoo Kim
- College of Nursing, Ewha Womans University, Seoul, Korea.,Ewha Research Institute of Nursing Science, Seoul, Korea
| | - Bohye Kim
- College of Nursing, Ewha Womans University, Seoul, Korea
| | - Heeja Jung
- College of Nursing, Konyang University, Daejeon, Korea
| | - Kwang-Pil Ko
- Clinical Preventive Medicine Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyangkyu Lee
- College of Nursing, Yonsei University, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
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Adamska A, Popławska-Kita A, Siewko K, Łebkowska A, Krentowska A, Buczyńska A, Popławski Ł, Szumowski P, Szelachowska M, Krętowski AJ, Kowalska I. Body Composition and Serum Anti-Müllerian Hormone Levels in Euthyroid Caucasian Women With Hashimoto Thyroiditis. Front Endocrinol (Lausanne) 2021; 12:657752. [PMID: 34393994 PMCID: PMC8358788 DOI: 10.3389/fendo.2021.657752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 07/15/2021] [Indexed: 12/29/2022] Open
Abstract
Objective Women with Hashimoto thyroiditis (HT) are characterized by increased incidence of infertility and disturbances in body composition. Serum anti-Müllerian hormone (AMH), which reflects functional ovarian reserve, is decreased in women with HT and it be related to body mass. The aim of the present study was to investigate the relation between serum levels of AMH and body composition in HT compared to control group. Patients and Methods We examined 85 euthyroid women: 39 subjects with HT and 46 control women. Body composition was analysed by dual-energy X-ray absorptiometry and with bioimpedance method. Serum concentrations of AMH, leptin, TSH, thyroid hormones were assessed. Results We observed lower serum concentration of AMH in women with HT in comparison to the control group (p=0.01), but without differences in serum concentration of leptin between studied groups (p=0.28). Women with HT were characterized by higher %body fat (p=0.01) estimated with bioimpedance method without differences in BMI, android and gynoid fat mass and visceral adipose tissue (VAT) mass estimated with DXA method when compared to the control group (all p>0.05). We found a negative relationship between serum concentration of AMH and %body fat (r=-0.38,p=0.03) in women with HT. Additionally, in HT group, the relationship between serum levels of AMH and leptin was not statistically significant (r=0.01,p=0.96). We observed a relationship between serum concentration of leptin and BMI, %body fat mass, android, gynoid and VAT mass in HT and in the control group (all p<0.01). Conclusions Women with HT are characterized by lower levels of AMH and it is associated with higher fat mass, independently of serum levels of leptin.
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Affiliation(s)
- Agnieszka Adamska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland
| | - Anna Popławska-Kita
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland
| | - Katarzyna Siewko
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland
| | - Agnieszka Łebkowska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Białystok, Bialystok, Poland
| | - Anna Krentowska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Białystok, Bialystok, Poland
| | - Angelika Buczyńska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland
| | - Łukasz Popławski
- Department of Radiology, Medical University of Białystok, Bialystok, Poland
| | - Piotr Szumowski
- Department of Nuclear Medicine, Medical University of Białystok, Bialystok, Poland
| | - Małgorzata Szelachowska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland
| | - Adam Jacek Krętowski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland
- Clinical Research Centre, Medical University of Białystok, Bialystok, Poland
| | - Irina Kowalska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Białystok, Bialystok, Poland
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Oldfield AL, Kazemi M, Lujan ME. Impact of Obesity on Anti-Mullerian Hormone (AMH) Levels in Women of Reproductive Age. J Clin Med 2021; 10:3192. [PMID: 34300357 PMCID: PMC8306853 DOI: 10.3390/jcm10143192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/18/2021] [Indexed: 12/30/2022] Open
Abstract
Obesity negatively impacts reproductive health, including ovarian function. Obesity has been posited to alter Anti-Müllerian hormone (AMH) production. Understanding biological factors that could impact AMH levels is necessary given the increasing use of AMH for predicting reproductive health outcomes in response to controlled ovarian stimulation, diagnosing ovulatory disorders, onset of menopause, and natural conception. In this narrative review, we evaluated the impact of obesity on AMH levels in healthy, regularly cycling reproductive-age women (18-48 years). Thirteen studies (n = 1214 women; (811, non-obese (body mass index; BMI < 30 kg/m2); 403, obese (BMI > 30 kg/m2))) were included, of which five reported decreased AMH levels with obesity, whereas eight showed comparable AMH levels between groups. Inclusion of women with higher obesity classes (Class 3 versus Class 1) may have been a factor in studies reporting lower AMH levels. Together, studies reporting AMH levels in otherwise healthy women remain limited by small sample sizes, cross-sectional designs, and lack of representation across the entire adiposity spectrum. Ultimately, the degree to which obesity may negatively impact AMH levels, and possibly ovarian reserve, in otherwise healthy women with regular menstrual cycles should be deemed uncertain at this time. This conclusion is prudent considering that the biological basis for an impact of obesity on AMH production is unknown.
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Affiliation(s)
- Alexis L. Oldfield
- Biomedical and Biological Sciences, Cornell University, Ithaca, NY 14853, USA;
| | - Maryam Kazemi
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA;
| | - Marla E. Lujan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA;
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Abstract
IMPORTANCE In the US, approximately 12.7% of reproductive age women seek treatment for infertility each year. This review summarizes current evidence regarding diagnosis and treatment of infertility. OBSERVATIONS Infertility is defined as the failure to achieve pregnancy after 12 months of regular unprotected sexual intercourse. Approximately 85% of infertile couples have an identifiable cause. The most common causes of infertility are ovulatory dysfunction, male factor infertility, and tubal disease. The remaining 15% of infertile couples have "unexplained infertility." Lifestyle and environmental factors, such as smoking and obesity, can adversely affect fertility. Ovulatory disorders account for approximately 25% of infertility diagnoses; 70% of women with anovulation have polycystic ovary syndrome. Infertility can also be a marker of an underlying chronic disease associated with infertility. Clomiphene citrate, aromatase inhibitors such as letrozole, and gonadotropins are used to induce ovulation or for ovarian stimulation during in vitro fertilization (IVF) cycles. Adverse effects of gonadotropins include multiple pregnancy (up to 36% of cycles, depending on specific therapy) and ovarian hyperstimulation syndrome (1%-5% of cycles), consisting of ascites, electrolyte imbalance, and hypercoagulability. For individuals presenting with anovulation, ovulation induction with timed intercourse is often the appropriate initial treatment choice. For couples with unexplained infertility, endometriosis, or mild male factor infertility, an initial 3 to 4 cycles of ovarian stimulation may be pursued; IVF should be considered if these approaches do not result in pregnancy. Because female fecundity declines with age, this factor should guide decision-making. Immediate IVF may be considered as a first-line treatment strategy in women older than 38 to 40 years. IVF is also indicated in cases of severe male factor infertility or untreated bilateral tubal factor. CONCLUSIONS AND RELEVANCE Approximately 1 in 8 women aged 15 to 49 years receive infertility services. Although success rates vary by age and diagnosis, accurate diagnosis and effective therapy along with shared decision-making can facilitate achievement of fertility goals in many couples treated for infertility.
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Affiliation(s)
- Sandra Ann Carson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Amanda N Kallen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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Kalyanaraman R, Pal L. A Narrative Review of Current Understanding of the Pathophysiology of Polycystic Ovary Syndrome: Focus on Plausible Relevance of Vitamin D. Int J Mol Sci 2021; 22:ijms22094905. [PMID: 34063169 PMCID: PMC8124569 DOI: 10.3390/ijms22094905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 01/06/2023] Open
Abstract
Polycystic ovarian syndrome (PCOS) is the most prevalent endocrinopathy of reproductive years. Salient features in presentation of patients PCOS include menstrual dysfunction, hyperandrogenism and/or polycystic appearance of ovaries on ultrasound. While the diagnosis of PCOS depends on presence of specified criteria, misdiagnoses are common. Despite years of extensive research, the exact aetiology of PCOS remains largely unknown. In the past decade, apart from insulin resistance and hyperandrogenemia, anti-mullerian hormone (AMH), an important marker of ovarian reserve, and vascular endothelial growth factor (VEGF), a crucial factor in angiogenesis, have been examined as plausible players of causative relevance for PCOS. Vitamin D, a sex-steroid hormone that is universally known for its relevance for skeletal health, has received increasing attention due to growing evidence supporting its pivotal in reproductive physiology and in PCOS. In this review we summarize our current understanding of the mechanisms relevant to the pathophysiology of PCOS and examine the role of vitamin D signalling in this context.
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Affiliation(s)
- Rajeshwari Kalyanaraman
- Department of Obstetrics and Gynecology, St Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT 06105, USA
- Correspondence:
| | - Lubna Pal
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA;
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Zhou SJ, Sun TC, Song LL, Yang M, Sun XP, Tian L. The status and comparison of ovarian reserve between fertile and infertile healthy Chinese women of reproductive age. Medicine (Baltimore) 2021; 100:e25361. [PMID: 33907092 PMCID: PMC8084010 DOI: 10.1097/md.0000000000025361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/30/2022] Open
Abstract
ABSTRACT We aimed to investigate ovarian reserve status, and explore differences in ovarian reserve between fertile and infertile healthy Chinese women of reproductive age.We recruited 442 fertile women aged 23 to 49 years (mean: 35.22 ± 4.91 years) as subjects, and 196 infertile women aged 23 to 46 years (mean: 32.34 ± 4.34 years) as controls. For all participants, a number of parameters were tested on days 2 to 4 of a spontaneous cycle, including basal serum follicle-stimulating hormone (FSH), estradiol (E2), luteinizing hormone (LH), total testosterone, anti-Müllerian hormone (AMH), ovarian response prediction index (ORPI), and antral follicle count (AFC).There were significant differences in terms of AFC, serum AMH levels, and ORPI among subject subgroups (10.58 ± 5.80; 2.533 ± 2.146 ng/mL; 1.28 ± 1.87; respectively), and among control subgroups (12.44 ± 5.69; 3.189 ± 2.551 ng/mL; 1.88 ± 2.68; respectively) (P < .01 for all). For both subjects and controls, AFC, AMH levels, and ORPI decreased gradually with increasing age, and presented with similar age-related trends; there were positive correlations between AMH and AFC (P < .001), and negative correlations between age and AFC, AMH, ORPI (P < .05 for all). There was a significant difference in age (P < .001), serum E2 (P < .01), and AMH (P < .01) levels between subjects and controls; however, when controlling for confounding factors (age, body mass index, total testosterone, and LH), we found no differences between the 2 groups with regards to the serum levels of AMH, FSH, E2, and AFC (P > .05 for all). Moreover, receiver operating characteristic curve analysis indicated that the significant variables of subjects and controls for evaluating ovarian reserve included age, AMH and ORPI, and ORPI was more valuable than other variables.A diminished ovarian reserve was one of the manifestations caused by female aging. When confounding factors were controlled for, we found no differences in ovarian reserve when compared between fertile and infertile women, and no correlation with infertility.
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Affiliation(s)
- Shan-Jie Zhou
- Reproductive Medicine Center, Department of Gynecology and Obstetrics
| | - Tie-Cheng Sun
- Reproductive Medicine Center, Department of Gynecology and Obstetrics
| | - Ling-Li Song
- Reproductive Medicine Center, Department of Gynecology and Obstetrics
| | - Ming Yang
- Department of Clinical Laboratory, Peking University International Hospital, Beijing, China
| | - Xin-Ping Sun
- Department of Clinical Laboratory, Peking University International Hospital, Beijing, China
| | - Li Tian
- Reproductive Medicine Center, Department of Gynecology and Obstetrics
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22
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Akbari Sene A, Ashrafi M, Alaghmand-Fard N, Mohammadi N, Mortezapour Alisaraie M, Alizadeh A. Anti-Müllerian Hormone Predictive Levels to Determine The Likelihood of Ovarian Hyper-Response in Infertile Women with Polycystic Ovarian Morphology. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2021; 15:115-122. [PMID: 33687164 PMCID: PMC8052798 DOI: 10.22074/ijfs.2020.134614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 09/16/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The objective of this study was to investigate serum levels of anti-Müllerian hormone (AMH) in normal-ovulatory infertile women with polycystic ovarian morphology (PCOM) and their association with ovarian hyper-response. MATERIALS AND METHODS This prospective cohort study was carried out on 100 infertile women with PCOM who were treated with an antagonist/agonist triggered stimulation protocol at Shahid Akbar-Abadi Hospital IVF Centre, Tehran, Iran. Serum AMH levels were measured before starting the assisted reproductive technology (ART) cycle and the ovarian hyper-response was evaluated by retrieved oocyte numbers, ooestradiol levels on the triggering day, and the incidence of ovarian hyper-stimulation syndrome (OHSS) clinical signs and symptoms. Logistic regression and the area under the curve (AUC) were used to estimate the effects of AMH and the accuracy of the test. RESULTS Receiver operating characteristic (ROC) curve analysis showed that AMH could significantly predict ovarian hyper-response in PCOM patients (AUC=0.73). The estimated threshold value was 4.95 ng/ml, with a specificity of 74.58% (95% confidence interval [CI]: 50.85, 93.22) and sensitivity of 73.17% (95% CI: 48.78, 92.68). Logistic regression results showed a significant interaction between AMH and body mass index (BMI, P=0.008), which indicated that BMI had a moderation effect. CONCLUSION Individualized stimulation protocols for patients with isolated PCOM and AMH greater than 4.95 ng/ml may significantly reduce the chances of developing OHSS. However, the AMH cut-off values to predict ovarian hyperresponse differ for different BMI categories among PCOM patients; thus, it becomes a more precise predictive marker with increasing BMI.
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Affiliation(s)
- Azadeh Akbari Sene
- Shahid Akbar-Abadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mahnaz Ashrafi
- Shahid Akbar-Abadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Nasim Alaghmand-Fard
- Department of Obstetrics and Gynaecology, Shahid Akbar-Abadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Mohammadi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ahad Alizadeh
- Metabolic Diseases Research Centre, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
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Neubronner SA, Indran IR, Chan YH, Thu AWP, Yong EL. Effect of body mass index (BMI) on phenotypic features of polycystic ovary syndrome (PCOS) in Singapore women: a prospective cross-sectional study. BMC WOMENS HEALTH 2021; 21:135. [PMID: 33794861 PMCID: PMC8017849 DOI: 10.1186/s12905-021-01277-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 03/22/2021] [Indexed: 11/23/2022]
Abstract
Background A diagnosis of Polycystic Ovary Syndrome (PCOS) and its related phenotypic features including increased hair growth can affect a woman’s social and emotional well-being. We aim to determine firstly, if excess body weight affects menstrual cycle length, excessive hair growth and other phenotypic features in healthy women without PCOS and secondly, whether having PCOS exacerbates the effects of high body mass index (BMI). Methods A prospective cross-sectional study involving healthy women (21–45 years) recruited at an annual health screen for hospital staff and volunteers from the university community, and PCOS cases referred to tertiary gynecological clinics in Singapore. To dissect the independent and/or combinatorial effects of PCOS and BMI on the phenotypic features, subjects were divided into four categories: non-PCOS (normal BMI), non-PCOS (high BMI), PCOS (normal BMI), and PCOS (high BMI). General linear modelling was performed to compare clinical, ovarian, hormonal and metabolic parameters across these four categories. Results Of 389 participants, 134 (34.4%) were classified as PCOS and the remaining 255 (65.6%), as the non-PCOS population. Overall 45.2% of women had high BMI (≥ 23). Compared to non-PCOS subjects, women with PCOS had a higher BMI (mean (SD): 25.14 ± 6.46 vs 23.08 ± 4.36, p < 0.001). Women with PCOS and high BMI had increased hair growth with modified Ferriman-Gallwey (mFG) scores that were 2.96-fold higher versus healthy-normal BMI women (mean difference; 1.85, 95% CI 0.80–2.90). Compared to healthy-high BMI women, PCOS women with high BMI had significantly higher mean differences in mFG scores (1.79, 95% CI 0.64–2.93). In PCOS women, having high BMI also significantly increased mFG scores by 1.85-fold (mean difference; 1.82. 95% CI 0.52–3.12). This effect was mirrored by the additive effect of BMI and PCOS on free androgen index. No independent effect of high BMI on rates of oligomenorrhoea, antral follicle count, ovarian volume or serum androgens were observed. Conclusions We observed an additive effect of body weight to increase hair growth in women with PCOS. Maximum mFG scores were present in PCOS women with high BMI. Such increases in mFG score may affect the self-esteem of women with PCOS.
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Affiliation(s)
- Samantha A Neubronner
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 12, Singapore, Republic of Singapore, 119228
| | - Inthrani R Indran
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 12, Singapore, Republic of Singapore, 119228.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Angelica Win Pa Thu
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 12, Singapore, Republic of Singapore, 119228
| | - Eu-Leong Yong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 12, Singapore, Republic of Singapore, 119228.
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Permadi W, Wahyu Ferdian M, Tjahyadi D, Ardhana Iswari W, Djuwantono T. Correlation of Anti-Mullerian Hormone Level and Antral Follicle Count with Oocyte Number in A Fixed-Dose Controlled Ovarian Hyperstimulation of Patients of In Vitro Fertilization Program. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2021; 15:40-43. [PMID: 33497046 PMCID: PMC7838761 DOI: 10.22074/ijfs.2021.6238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/21/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study was conducted to determine the correlation of anti-Mullerian hormone (AMH) level and antral follicle count (AFC) with oocyte count in women who had received controlled ovarian hyperstimulation in an in vitro fertilization (IVF) program. MATERIALS AND METHODS We retrospectively gathered the data of 42 patients who underwent IVF during 2005-2017 at Aster Clinic in Dr. Hasan Sadikin Hospital and Bandung Fertility Center Limijati Hospital, Indonesia. Details of the subjects such as identity, characteristics, history of illness, history of previous therapy, levels of ovarian reserve markers examined (AFC and AMH), follicle-stimulating hormone (FSH) dose given, and number of oocytes produced were recorded. RESULTS A significant positive correlation between AMH (P≤0.001, r=0.530), AFC (P≤0.001, r=0.687), and AMHAFC combination (P≤0.001, r=0.652), and the number of oocytes was found at the FSH dose of 225 IU. CONCLUSION AFC and AMH are able to reliably predict ovarian response to FSH.
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Affiliation(s)
- Wiryawan Permadi
- Faculty of MedicineUniversitas Padjadjaran–Dr.
Hasan Sadikin HospitalJl. Pasteur No. 38Bandung 40161West JavaIndonesia
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Brouwer J, Dolhain RJEM, Hazes JMW, Erler NS, Visser JA, Laven JSE. Decline of ovarian function in patients with rheumatoid arthritis: serum anti-Müllerian hormone levels in a longitudinal cohort. RMD Open 2020; 6:rmdopen-2020-001307. [PMID: 33040022 PMCID: PMC7722280 DOI: 10.1136/rmdopen-2020-001307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/24/2020] [Accepted: 09/22/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) often affects women in their fertile age, and is known to compromise female fertility. Serum anti-Müllerian hormone (AMH) levels are a proxy for the total number of primordial follicles, and a reliable predictor of the age at menopause. Our objective was to study the longitudinal intra-individual decline of serum AMH levels in female RA patients. METHODS Female RA patients from a nationwide prospective cohort (2002-2008) were re-assessed in 2015-2016. Serum AMH levels were measured using the picoAMH assay and compared with healthy controls. A linear mixed model (LMM) was built to assess the effect of RA-related clinical factors on the decline of AMH levels. RESULTS A group of 128 women were re-assessed at an age of 42.6±4.4 years, with a median disease duration of 15.8 (IQR 12.7-21.5) years. The time between first and last AMH assessments was 10.7±1.8 (range 6.4-13.7) years. Participants represented a more fertile selection of the original cohort. At follow-up, 39% of patients had AMH levels below the 10th percentile of controls (95% CI 31% to 48%), compared with 16% (95% CI 9.3% to 22%) at baseline. The LMM showed a significant decline of AMH with increasing age, but no significant effect of RA-related factors on AMH. CONCLUSION AMH levels in RA patients showed a more pronounced decline over time than expected, supporting the idea that in chronic inflammatory conditions, reproductive function is compromised, resulting in a faster decline of ovarian function over time and probably an earlier age at menopause.
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Affiliation(s)
- Jenny Brouwer
- Rheumatology, Erasmus MC, Rotterdam, Netherlands.,Obstetrics and Gynaecology - Division of Reproductive Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | | | | | | | - Joop S E Laven
- Obstetrics and Gynaecology - Division of Reproductive Medicine, Erasmus MC, Rotterdam, Netherlands
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Zhou SJ, Zhao MJ, Li C, Su X. The comparison of evaluative effectiveness between antral follicle count/age ratio and ovarian response prediction index for the ovarian reserve and response functions in infertile women. Medicine (Baltimore) 2020; 99:e21979. [PMID: 32899038 PMCID: PMC7478524 DOI: 10.1097/md.0000000000021979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aim of the present study was to explore the evaluative effectiveness of age, ovarian volume (OV), antral follicle count (AFC), serum follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), AFC/Age ratio, AMH/Age ratio, FSH/luteinizing hormone (LH) ratio, and ovarian response prediction index (ORPI) to determine which could more advantageously assess ovarian reserve and response.This research enrolled 319 consecutive infertile women who had undergone in vitro fertilization-ET/intracytoplasmic sperm injection (IVF-ET/ICSI) treatments. Abovementioned variables were measured and calculated. Receiver operating characteristic (ROC) curve analysis was used to analyze the predictive accuracy of variables and to calculate cut-off values and corresponding sensitivity and specificity.Our study revealed that the significant variables for evaluating a decline in ovarian reserve include age, OV, FSH, AFC/Age ratio, AMH/Age ratio, and ORPI. Moreover, the area under the curve (AUC) of AFC/Age ratio was higher than other 5 variables (AUC = 1.000), and the cut-off value of AFC/Age ratio was 0.111 (sensitivity 100.00%, specificity 100.00%). The significant variables forecasting excessive ovarian response were age, AFC, AMH, FSH, AFC/Age ratio, AMH/Age ratio, FSH/LH ratio, and ORPI, and the significant variables forecasting poor ovarian response were AMH, LH, OV, AFC/Age ratio, AMH/Age ratio, and FSH/LH ratio. When ORPI was used to predict excessive response, the cut-off value of ORPI was 0.880 (sensitivity 84.72%, specificity 67.32%) and ORPI presented better effectiveness. When used to predict poor response, the evaluative effectiveness of 6 variables was almost similar, although the AUC of AFC/Age ratio presented the largest value.Regarding the infertile women, AFC/Age ratio performed better than did the other variables in evaluating ovarian reserve, and it offered excellent effectiveness in predicting poor ovarian response, however, ORPI presented better effectiveness in predicting excessive ovarian response.
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Affiliation(s)
- Shan-Jie Zhou
- Reproductive Medicine Center, Department of Gynecology and Obstetrics, Peking University International Hospital, Beijing
| | - Ming-Jia Zhao
- Department of Reproduction and Genetics, Tangshan Maternity and Child Healthcare Hospital, Tangshan, China
| | - Cui Li
- Department of Reproduction and Genetics, Tangshan Maternity and Child Healthcare Hospital, Tangshan, China
| | - Xing Su
- Department of Reproduction and Genetics, Tangshan Maternity and Child Healthcare Hospital, Tangshan, China
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Shin JJ, Choi YM, Jun JK, Lee KH, Kim TY, Han W, Im SA. Effect of Timing of Gonadotropin-Releasing Hormone Agonist Administration for Ovarian Protection in Patients with Breast Cancer. J Breast Cancer 2020; 23:268-278. [PMID: 32595989 PMCID: PMC7311369 DOI: 10.4048/jbc.2020.23.e33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/21/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose This study was performed to investigate the effect of the interval between the start of gonadotropin-releasing hormone agonist (GnRHa) and the start of chemotherapy on ovarian protection in patients with breast cancer. Methods This was a prospective observational cohort study that included 136 patients with breast cancer below 40 years who received GnRHa during chemotherapy for fertility preservation. Plasma anti-Müllerian hormone (AMH) levels were measured before chemotherapy (baseline) and after chemotherapy. Subjects were divided into 3 groups according to the interval between the start of GnRHa and the start of chemotherapy for analysis: 1–6 days, 7–13 days, and ≥ 14 days. The ratio of the post-chemotherapy AMH value to the baseline AMH (pcAMH) at each time point were compared among the 3 groups. Ranked analysis of covariance was used for statistical analysis, adjusted for age, body mass index (BMI), and the existence of polycystic ovaries (PCOs). In addition, recovery of ovarian function (AMH ≥ 1 ng/mL) at 12 months was evaluated. Results The median age of the patients was 32 years. There was no difference in the baseline AMH levels among the 3 groups (mean ± standard error: 5.0 ± 0.4 ng/mL [1–6 days], 5.3 ± 0.7 ng/mL [7–13 days], and 8.1 ± 1.3 ng/mL [≥ 14 days]; p = 0.250). The pcAMH at 3, 6, 12, 24, and 36 months were not significantly different among the 3 groups (p-values were 0.332, 0.732, 0.830, 0.148, and 0.393, respectively). In multivariate analysis, young age (p = 0.024), low BMI (p = 0.013), and the existence of PCO (p = 0.015) were predictors for AMH ≥ 1 ng/mL at 12 months. Conclusion There was no difference in the ovarian protective effect according to the difference in the timing of administration of GnRHa.
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Affiliation(s)
- Jae Jun Shin
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.,Fertility Center, Heryoojae Women's Hospital, Goyang, Korea
| | - Young Min Choi
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.,Medical Research Center, the Institute of Reproductive Medicine and Population, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Lawal OI, Akinyemi JO, Yusuff JDO, Okunlola MA. Perceived stress, psychological distress and serum anti-Müllerian hormone levels among infertile and fertile women in North-central Nigeria. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2020. [DOI: 10.1186/s43043-020-00029-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Previous studies reported that self-reported stress, stressful life events, and psychological distress influence ovarian ageing and response. However, there are limited, yet conflicting findings on the effect of stress and psychological distress on serum anti-Müllerian hormone (AMH) as a biomarker of ovarian reserve, response, and ageing. This case-control study aimed to determine if stress and psychological distress levels were associated with serum anti-Müllerian hormone levels among 81 infertile and 109 fertile women of reproductive age attending the gynaecology and immunization clinics of a tertiary hospital in North-central Nigeria, respectively. Stress and psychological distress were measured using the Perceived Stress scale-10 and Kessler Psychological Distress Scale-10, respectively. The serum concentration of AMH was determined using enzyme-linked immunosorbent assays.
Results
There was a significantly higher stress (p = 0.001) and psychological distress (p = 0.005) levels among infertile women; however, there was no difference in serum anti-Müllerian hormone levels between the two groups (p = 0.409). There was no significant correlation found between perceived stress and serum anti-Müllerian hormone in both infertile (r = 0.041, p = 0.719) and fertile (r = − 0.090, p = 0.353) women. There was also no correlation between psychological distress and serum anti-Müllerian hormone in the infertile (r = − 0.020, p = 0.860) and fertile (r = − 0.049, p = 0.636) groups. Controlling for age and body mass index in multivariate linear regression; stress and psychological distress were not significantly associated with serum anti-Müllerian hormone (B = − 0.005; p = 0.370 and B = − 0.001; p = 0.811).
Conclusion
Self-reported stress and psychological distress are not associated with serum anti-Müllerian hormone levels in infertile and fertile women of reproductive age. Also, ovarian ageing was accelerated in infertile women when compared to fertile women; however, this does not appear to be related to stress or psychological distress. More research is needed to understand factors that may contribute to this accelerated decline.
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Vlahoyiannis A, Nifli AP. Dietary restraint is associated with adiposity and repeated attempts of food avoidance since early adolescence. Physiol Behav 2020; 218:112826. [DOI: 10.1016/j.physbeh.2020.112826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 01/18/2020] [Accepted: 01/30/2020] [Indexed: 01/10/2023]
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30
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Palomaki GE, Kalra B, Kumar T, Patel AS, Savjani G, Torchen LC, Dunaif A, Morrison A, Lambert-Messerlian GM, Kumar A. Adjusting antimüllerian hormone levels for age and body mass index improves detection of polycystic ovary syndrome. Fertil Steril 2020; 113:876-884.e2. [PMID: 32147175 DOI: 10.1016/j.fertnstert.2019.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/08/2019] [Accepted: 12/05/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine whether accounting for a woman's age and body mass index (BMI) would improve the ability of antimüllerian hormone (AMH) to distinguish between women with (cases) and without (controls) polycystic ovarian syndrome (PCOS). DESIGN An opportunistic case-control dataset of reproductive age women having evaluations for PCOS as defined by National Institutes of Health criteria. SETTING Two medical centers in the United States enrolled women. Serum samples were analyzed for relevant analytes. PATIENTS Women were between 18 and 39 years of age when samples and clinical information were collected. Residual samples had been stored for 2-17 years. AMH was measured via immunoassay. INTERVENTIONS None; this was an observational study. MAIN OUTCOME MEASURES Detection and false-positive rates for PCOS were computed for AMH results expressed as multiples of the median (MoM) both before and after adjustment for the woman's age and BMI. RESULTS Using unadjusted AMH MoM results, 168 cases (78%) cases were at or beyond the 90th centile of controls (2.47 MoM). After accounting for each woman's age and BMI, 188 (87%) of those women were beyond the 90th centile of controls (2.20 MoM), a significant increase (P = .015). The adjusted AMH MoM levels fitted logarithmic normal distributions well (mean, standard deviation for controls and cases of 0.0000, 0.2765 and 0.6884, 0.2874, respectively) and this allowed for computation of patient-specific PCOS risks. CONCLUSIONS Accounting for the woman's age and BMI resulted in significantly higher AMH-based detection rates for PCOS at a 10% false-positive rate, and patient-specific PCOS risks could be computed.
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Affiliation(s)
- Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, Rhode Island; Savjani Institute for Health Research, Windham, Maine.
| | | | | | | | | | - Laura C Torchen
- Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrea Dunaif
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University, Chicago, Illinois
| | | | - Geralyn M Lambert-Messerlian
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, Rhode Island; Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Rhode Island
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Kotlyar AM, Seifer DB. Ethnicity/Race and Age-Specific Variations of Serum AMH in Women-A Review. Front Endocrinol (Lausanne) 2020; 11:593216. [PMID: 33633682 PMCID: PMC7900163 DOI: 10.3389/fendo.2020.593216] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/23/2020] [Indexed: 11/16/2022] Open
Abstract
PURPOSE OF REVIEW In this review, we summarize ethnic/race- and age-related variation in AMH and discuss the underpinnings behind these differences. RECENT FINDINGS Anti-mullerian hormone (AMH) has become a widely used method of ovarian reserve testing over the last 15 years. Numerous studies have shown substantial ethnic/race and age-related differences. When compared to age-matched Caucasian women, AMH levels tend to be lower in black and Hispanic women. Chinese women tend to have significantly greater AMH levels prior to age 25 than Caucasian women. When considering subpopulations within ethnicities, at least one study noted lower AMH levels among Maya women compared to other Hispanic women. Age exhibits a positive trend with AMH up until at least 25 years of age with a consistent decline after 34 years of age extending to menopause. SUMMARY AMH levels are highly variable among ethnicities and race with higher age-matched levels typically seen in Caucasian women. Age does not exhibit a consistent linear relationship with AMH, but a consistent decline is seen starting in the third decade of life and proceeding to menopause.
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Is ovarian reserve associated with body mass index and obesity in reproductive aged women? A meta-analysis. Menopause 2019; 25:1046-1055. [PMID: 29738413 DOI: 10.1097/gme.0000000000001116] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The associations of body mass index (BMI) and obesity with ovarian reserve are controversial. This systematic review and meta-analysis was conducted to investigate the associations in reproductive-aged women. METHODS PubMed and Scopus were searched up to December, 2016. Original studies on the association of BMI with ovarian reserve markers, anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), inhibin β, and antral follicle count (AFC), either according to BMI categories or a continuous variable, were selected. Analyses were stratified into three groups based on polycystic ovary syndrome (PCOS) and fertility status of women. RESULTS Of 4,055 records identified, 45 studies were eligible for inclusion. Comparing the obese with nonobese, the pooled mean differences (MDs) and 95% confidence intervals (CIs) were -1.08 (95% CIs -1.52, -0.63) ng/mL for AMH, -0.22 (95% CIs -0.39, -0.06) mIU/mL for FSH, -0.09 (95% CIs -0.60, 0.42) for AFC, and -21.06 (95% CIs -41.18, -0.85) pg/mL for inhibin β in overall populations. The MDs were significant for AMH in fertile non-PCOS and PCOS women, and for FSH only in PCOS women. Fisher's Z showed significant correlations of BMI with AMH in the overall populations (-0.15 [95% CIs -0.20, -0.11]) and in all subgroups, and with FSH in the fertile non-PCOS women (-0.16 [95% CIs -0.28, -0.04]). CONCLUSION Ovarian reserve markers of AMH and FSH are significantly lower in obese than in nonobese women, and BMI is negatively correlated with AMH in all study populations, and with FSH in fertile non-PCOS subgroups. PCOS and fertility status do not appear to affect the associations.
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Jamil Z, Shahid S, Baig E, Ahmad R, Subhani F, Fatima SS. Serum anti mullerian hormone and renalase levels in predicting the risk of preeclampsia. Taiwan J Obstet Gynecol 2019; 58:188-191. [PMID: 30910136 DOI: 10.1016/j.tjog.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of the study was to explore the association of serum AMH and Renalase with the risk of preeclampsia thereby assessing them as screening tools, reducing the risk of gravid consequences of preeclampsia. MATERIALS AND METHODS This cross-sectional study recruited n = 95 pregnant women between 14 and 32 gestational weeks. They were categorized as a) women with gestational hypertension (n = 45); b) women with pre-eclampsia (n = 20) and c) normotensive pregnant women (n = 30) according to the ACOG criteria. Anthropometrics data and blood and urine samples were collected. AMH and Renalase levels were measured by ELISA assay. RESULTS The mean age of study cohort was 27.3 ± 6.2 year and weight was 65.1 ± 14.1 kg. Blood pressures were significantly higher in pre-eclamptic patients versus both the gestational hypertensive females and controls (p < 0.05). AMH was found to be significantly higher in controls but no difference was observed between gestational hypertensive and pre-eclamptic patients. No difference was seen for serum Renalase among the three groups (p > 0.05). AMH showed a negative weak correlation with diastolic blood pressure (r = -0.272; p = 0.008) that remained significant even after adjustment (r = -0.236; p = 0.023) whereas Renalase did not show any difference (r = -0.051; p > 0.05). Females with low levels of AMH were 1.07 times at risk of developing hypertension even after adjustment for age and BMI (p < 0.05). CONCLUSION Low AMH levels may lead to hypertension in pregnancy suggesting a role in detecting vascular diseases as well as its effect on ovarian aging. However, further research is required to establish a causal relationship.
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Affiliation(s)
- Zehra Jamil
- Department of Biological & Biomedical Sciences, Aga Khan University, Pakistan
| | - Sana Shahid
- Department of Physiology, Sir Syed College of Medical Sciences for Girls, Pakistan
| | - Erum Baig
- Medical Students, Aga Khan University, Pakistan
| | - Rida Ahmad
- Medical Students, Aga Khan University, Pakistan
| | | | - Syeda Sadia Fatima
- Department of Biological & Biomedical Sciences, Aga Khan University, Pakistan.
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Gorkem U, Kucukler FK, Togrul C, Gulen Ş. Obesity Does not Compromise Ovarian Reserve Markers in Infertile Women. Geburtshilfe Frauenheilkd 2019; 79:79-85. [PMID: 30686837 PMCID: PMC6336460 DOI: 10.1055/a-0650-4723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 10/27/2022] Open
Abstract
Introduction In the literature, conflicting results from studies examining the relationship between obesity and ovarian reserve have been reported. The purpose of the study is to investigate whether obesity adversely affects serum concentrations of ovarian reserve markers in infertile women with different ovarian reserve status. Materials and Methods A total of 402 women were assigned to three groups according to body mass index (BMI; < 25 kg/m 2 : normal, n = 198; 25.0 - 29.9 kg/m 2 : overweight, n = 126; and ≥ 30 kg/m 2 : obese, n = 78). The women were also divided into two groups according to waist circumference (WC; < 80 cm: normal, n = 103; and ≥ 80 cm: obese, n = 299). Participants were also categorized into three types of ovarian reserve patterns: normal (n = 146), high (n = 112), and poor ovarian reserve (n = 144). The serum anti-Mullerian hormone (AMH), estradiol (E2), and follicle-stimulating hormone (FSH) levels were assayed and compared in all groups. Results There were no significant differences in BMI and WC in the three ovarian reserve groups. There were significant differences between all ovarian reserve groups for AMH, E2, and FSH (p < 0.001 for all). The comparisons of ovarian reserve parameters (AMH, E2, and FSH) and obesity parameters (BMI and WC) revealed no significant differences in women with all ovarian reserve patterns. Conclusion The parameters of ovarian reserve do not seem to be affected by increased BMI and WC. Thus, AMH may be considered as a reliable marker of ovarian reserve.
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Affiliation(s)
- Umit Gorkem
- Hitit University Faculty of Medicine, Department of Obstetrics and Gynecology, Corum, Turkey
| | | | - Cihan Togrul
- Hitit University Faculty of Medicine, Department of Obstetrics and Gynecology, Corum, Turkey
| | - Şebnem Gulen
- Ufuk University Faculty of Medicine, Department of Physiology, Ankara, Turkey
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Hardy TM, Garnier-Villarreal M, McCarthy DO, Anderson RA, Reynolds RM. Exploring the Ovarian Reserve Within Health Parameters: A Latent Class Analysis. West J Nurs Res 2018; 40:1903-1918. [PMID: 30089444 PMCID: PMC6218298 DOI: 10.1177/0193945918792303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The process of ovarian aging is influenced by a complex and poorly understood interplay of endocrine, metabolic, and environmental factors. The purpose of this study was to explore the feasibility of using latent class analysis to identify subgroups based on cardiometabolic, psychological, and reproductive parameters of health and to describe patterns of anti-Müllerian hormone levels, a biomarker of the ovarian reserve, within these subgroups. Sixty-nine lean (body mass index [BMI] ⩽ 25 kg/m2) and severely obese (BMI ⩾ 40 kg/m2) postpartum women in Edinburgh, Scotland, were included in this exploratory study. The best fitting model included three classes: Class 1, n = 23 (33.5%); Class 2, n = 30 (42.2%); Class 3, n = 16 (24.3%). Postpartum women with lower ovarian reserve had less favorable cardiometabolic and psychological profiles. Examining the ovarian reserve within distinct subgroups based on parameters of health that affect ovarian aging may facilitate risk stratification in the context of ovarian aging.
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Affiliation(s)
| | | | | | - Richard A Anderson
- Medical Research Council Centre for Reproductive Health, University of Edinburgh
| | - Rebecca M Reynolds
- University BHF Centre for Cardiovascular Sciences and Tommy’s Centre for Maternal and Fetal Health, Queen’s Medical Research Institute, University of Edinburgh
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Grigoryan OR, Mikheev RK, Andreeva EN, Dedov II. Comparative analysis of ovarian reserve in women with obesity in reproductive period. TERAPEVT ARKH 2018. [DOI: 10.26442/terarkh201890104-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective. To evaluate the ovarian reserve function in female patients with obesity in comparison with women without obesity. Materials and methods. This study evaluated 500 caucasian women, age 20-30 years, 250 with obesity (body mass index, BMI ≥30 kg/m2) and 250 without obesity (BMI
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Aydoğmuş H, Kelekçi S, Elmalı F, Aydoğmuş S. Can we use serum Anti-Mullerian hormone to differentiate the diagnosis between polycystic ovary syndrome patients and healthy women with polycystic ovarian morphology and regular menstrual cycles. Saudi Med J 2018; 39:1011-1016. [PMID: 30284584 PMCID: PMC6201027 DOI: 10.15537/smj.2018.10.23413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: To compare Anti-Mullerian hormone (AMH) concentrations between polycystic ovary syndrome (PCOS) patients and healthy women who have polycystic ovarian morphology (PCOM) with regular menstrual cycles, and to determine a diagnostic cutoff value for PCOS women during reproductive period. Methods: This study was carried out between February 2013 and October 2017 at the Department of Obstetrics and Gynecology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, Izmir, Turkey. Seventy PCOS patients and 70 PCOM women with normal menstrual cycles were included in the study. Blood samples of the subjects were obtained following an 8-hour fast for AMH and biochemical assessments, serum gonadotropin, and androgen measurements. Results: The mean serum AMH levels of PCOS patients were found to be higher than PCOM women with normal menstrual cycles (p<0.01). The optimal serum AMH cutoff value for PCOS diagnosis was determined as 3.51 ng/ml (sensitivity 72.8%, specificity 75.7%). Conclusion: Serum AMH concentrations are significantly higher in PCOS patients independent from the ovarian morphology and number of follicles per ovary. Positive and negative predictive values of AMH in PCOS diagnosis were found to be 75% and 73.6%, respectively, with a cutoff value of 3.51 ng/mL.
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Affiliation(s)
- Hüseyin Aydoğmuş
- Department of Gynecology and Obstetrics, İzmir Katip Çelebi University Atatürk Research and Training Hospital,İzmir, Turkey. E-mail.
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Heidar Z, Bakhtiyari M, Foroozanfard F, Mirzamoradi M. Age-specific reference values and cut-off points for anti-müllerian hormone in infertile women following a long agonist treatment protocol for IVF. J Endocrinol Invest 2018; 41:773-780. [PMID: 29235049 DOI: 10.1007/s40618-017-0802-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 11/23/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of this study were to determining the reference value of anti-müllerian hormone (AMH) in infertile women and effect of AMH on different ovarian responses in the stratum of BMI categories. METHODS Through a retrospective cohort study the information of 816 infertile patients referring to the referral infertility clinic of Mahdiyeh Hospital since the beginning of 2011 until the end of January 2016 were used. The normal-based method was undertaken to calculate age-specific AMH percentiles. To determine the effect of AMH on the outcomes of different ovarian responses following adjustment of associated variables, the multinomial regression model was used. RESULTS Estimated reference intervals for AMH corresponding to the 2.5 and 97.5th‰ in patients with normal ovarian response are from 0.096 to 6.2 ng/mL. These values for percentiles of 5, 10, 25, 50, 75, 90, and 95% are, respectively, 0.18, 0.33, 0.77, 1.68, 3.05, 4.45, and 5.36 ng/dL. Also the reference value for the 20-year-old participants has a maximum range (0.12-7.64), while for 43-year-old ones has the lowest range (0.08-5.3). Among participants under and above 35 years old, the optimal cut-off points for predicting normal ovarian response are, respectively, 1.5 and 1.2 ng/dL. With each unit increase in the log of AMH concentration, the odds of having excessive ovarian response in patients with normal weight compared to that of having normal ovarian response is 32% higher. CONCLUSIONS Determining AMH reference values in IVF candidates allows specialists to measure only AMH plasma levels in IVF candidates so as to find whether or not the ovarian response is normal before applying other therapeutic measures; accordingly, they can adjust a treatment plan for each individual separately.
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Affiliation(s)
- Z Heidar
- Infertility and Reproductive Health Research Center (IRHRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Bakhtiyari
- Non-communicable Disease Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - M Mirzamoradi
- Department of Obstetrics and Gynecology, Mahdiyeh Hospital, Shahid Beheshti University of Medical Sciences, Po.Box: 1185817311, Tehran, Iran.
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Goldsammler M, Merhi Z, Buyuk E. Role of hormonal and inflammatory alterations in obesity-related reproductive dysfunction at the level of the hypothalamic-pituitary-ovarian axis. Reprod Biol Endocrinol 2018; 16:45. [PMID: 29743077 PMCID: PMC5941782 DOI: 10.1186/s12958-018-0366-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/03/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Besides being a risk factor for multiple metabolic disorders, obesity could affect female reproduction. While increased adiposity is associated with hormonal changes that could disrupt the function of the hypothalamus and the pituitary, compelling data suggest that obesity-related hormonal and inflammatory changes could directly impact ovarian function. OBJECTIVE To review the available data related to the mechanisms by which obesity, and its associated hormonal and inflammatory changes, could affect the female reproductive function with a focus on the hypothalamic-pituitary-ovarian (HPO) axis. METHODS PubMed database search for publications in English language until October 2017 pertaining to obesity and female reproductive function was performed. RESULTS The obesity-related changes in hormone levels, in particular leptin, adiponectin, ghrelin, neuropeptide Y and agouti-related protein, are associated with reproductive dysfunction at both the hypothalamic-pituitary and the ovarian levels. The pro-inflammatory molecules advanced glycation end products (AGEs) and monocyte chemotactic protein-1 (MCP-1) are emerging as relatively new players in the pathophysiology of obesity-related ovarian dysfunction. CONCLUSION There is an intricate crosstalk between the adipose tissue and the inflammatory system with the HPO axis function. Understanding the mechanisms behind this crosstalk could lead to potential therapies for the common obesity-related reproductive dysfunction.
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Affiliation(s)
- Michelle Goldsammler
- Montefiore’s Institute for Reproductive Medicine and Health, Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Montefiore Medical Center, Hartsdale, NY USA
| | - Zaher Merhi
- 0000 0004 1936 8753grid.137628.9Department of Obstetrics and Gynecology, Division of Reproductive Biology, NYU School of Medicine, New York, NY USA
- 0000000121791997grid.251993.5Department of Biochemistry, Albert Einstein College of Medicine, Bronx, NY USA
| | - Erkan Buyuk
- Montefiore’s Institute for Reproductive Medicine and Health, Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Montefiore Medical Center, Hartsdale, NY USA
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Reproductive and metabolic determinants of granulosa cell dysfunction in normal-weight women with polycystic ovary syndrome. Fertil Steril 2018; 109:508-515. [PMID: 29428312 DOI: 10.1016/j.fertnstert.2017.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the degree to which E2 hyperresponsiveness to FSH and antimüllerian hormone (AMH) overproduction in normal-weight women with polycystic ovary syndrome (PCOS) correlate with increased antral follicle number (AFN), hyperandrogenism, and/or metabolic dysfunction. DESIGN Prospective cohort study. SETTING Academic medical center. PATIENT(S) Seven normal-weight women with PCOS (1990 National Institutes of Health criteria) ages 20-34 years and 13 age- and body mass index- (BMI-; 18.5-25 kg/m2) matched normoandrogenic ovulatory women were studied. INTERVENTION(S) All women underwent basal serum hormone and metabolic measurements, FSH stimulation testing with transvaginal ovarian sonography, frequently sampled IV glucose tolerance testing, and whole-body dual-energy x-ray absorptiometry. MAIN OUTCOME MEASURE(S) Serum hormone/metabolite levels, 24-hour serum E2 response to 150 IU recombinant human (rh) FSH infusion, AFN, insulin sensitivity, and body mass measurements. RESULT(S) Serum E2 responsiveness to rhFSH and AMH levels were greater in women with PCOS than in BMI- and age-matched control women, as were serum androgen levels, AFN, and abdominal fat mass. In all women combined, serum E2 responsiveness to rhFSH was associated with AFN. Serum AMH levels, however, positively correlated with AFN but remained positively correlated with serum LH and free T levels and negatively correlated with total body fat and percent body fat, adjusting for AFN. CONCLUSION(S) In normal-weight women with PCOS, serum E2 hyperresponsiveness to rhFSH represents increased AFN, while elevated serum AMH levels reflect opposing effects of stimulatory reproductive (hyperandrogenism and increased AFN) versus inhibitory metabolic (body fat) factors. Given the small number of subjects reported, additional follow-up studies are required to confirm these data.
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Spann RA, Lawson WJ, Bidwell GL, Zamarripa CA, Maranon RO, Bandyopadhyay S, Taylor ER, Reckelhoff JF, Garrett MR, Grayson BE. Rodent vertical sleeve gastrectomy alters maternal immune health and fetoplacental development. Clin Sci (Lond) 2018; 132:295-312. [PMID: 29167317 PMCID: PMC5989318 DOI: 10.1042/cs20171416] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/10/2017] [Accepted: 11/21/2017] [Indexed: 12/23/2022]
Abstract
Bariatric surgery is increasingly employed to improve fertility and reduce obesity-related co-morbidities in obese women. Surgical weight loss not only improves the chance of conception but reduces the risk of pregnancy complications including pre-eclampsia, gestational diabetes, and macrosomia. However, bariatric procedures increase the incidence of intrauterine growth restriction (IUGR), fetal demise, thromboembolism, and other gestational disorders. Using our rodent model of vertical sleeve gastrectomy (VSG), we tested the hypothesis that VSG in diet-induced, obese dams would cause immune and placental structural abnormalities that may be responsible for fetal demise during pregnancy. VSG dams studied on gestational day (G) 19 had reduced circulating T-cell (CD3+ and CD8+) populations compared with lean or obese controls. Further, local interleukin (IL) 1β and IL 1 receptor antagonist (il1rn) cmRNA were increased in placenta of VSG dams. Placental barrier function was also affected, with increased transplacental permeability to small molecules, increased matrix metalloproteinase 9 expression, and increased apoptosis in VSG. Furthermore, we identified increased placental mTOR signaling that may contribute to preserving the body weight of the fetuses during gestation. These changes occurred in the absence of a macronutrient deficit or gestational hypertension in the VSG dams. In summary, previous VSG in dams may contribute to fetal demise by affecting maternal immune system activity and compromise placental integrity.
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Affiliation(s)
- Redin A Spann
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - William J Lawson
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Gene L Bidwell
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - C Austin Zamarripa
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Rodrigo O Maranon
- Department of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Women's Health Research Center, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Sibali Bandyopadhyay
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Erin R Taylor
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Jane F Reckelhoff
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Women's Health Research Center, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Michael R Garrett
- Department of Pharmacology, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A.
- Women's Health Research Center, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Mississippi Center for Obesity Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Bernadette E Grayson
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A.
- Women's Health Research Center, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
- Mississippi Center for Obesity Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
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Tabbalat AM, Pereira N, Klauck D, Melhem C, Elias RT, Rosenwaks Z. Arabian Peninsula ethnicity is associated with lower ovarian reserve and ovarian response in women undergoing fresh ICSI cycles. J Assist Reprod Genet 2017; 35:331-337. [PMID: 29063502 DOI: 10.1007/s10815-017-1071-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/13/2017] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Recent studies have demonstrated that ethnicity can be an independent determinant of assisted reproductive technology (ART) outcomes. In this context, we investigate whether ART outcomes differ between Arabian Peninsula and Caucasian women. METHODS This is a retrospective cohort study of women undergoing fresh intracytoplasmic sperm injection (ICSI)-embryo transfer (ET) cycles for male factor infertility. The study cohort was divided into 2 groups based on ethnicity-Arabian Peninsula or Caucasian. Ovarian reserve, ovarian response, and pregnancy outcomes were compared between the groups. A sub-analysis was performed between individual Arabian Peninsula nationalities for the same outcomes. A multiple linear regression model was used to assess the independent effect of ethnicity on ovarian response. RESULTS Seven hundred sixty-three patients were included-217 (28.4%) Arabian Peninsula and 546 (71.6%) Caucasian. There was no difference in the mean age of the two groups; however, the former had a higher body mass index (28.5 ± 7.5 vs. 23.3 ± 5.7; P < 0.001). Although follicle stimulating hormone (FSH) levels and antral follicle counts (AFC) were within the normal range in both groups, Arabian Peninsula women had higher FSH levels (5.7 ± 2.5 vs. 4.9 ± 2.8; P = 0.001) and lower AFC (13.9 ± 4.7 vs. 16.5 ± 4.3; P < 0.001) when compared to Caucasian women. Women from the Arabian Peninsula also had a statistically lower number of mature oocytes retrieved (15.6 ± 6.8 vs. 14.1 ± 8.4; P = 0.01), despite requiring higher gonadotropin doses. Multiple linear regression reveled that Arabian Peninsula women had 2.5 (95% CI 2.1-3.9) less mature oocytes, even after controlling for confounders. A sub-analysis within the Arab cohort demonstrated that Qatari women had a higher yield of mature oocytes when compared to Emirati, Kuwaiti, and Saudi women. There was no difference in the rates of implantation, clinical pregnancy, or live birth when comparing individual Arabian Peninsula nationalities with each other or to Caucasians. CONCLUSIONS Arabian Peninsula ethnicity is associated with lower ovarian reserve and ovarian response parameters in women undergoing their first ICSI-ET cycle.
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Affiliation(s)
| | - Nigel Pereira
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Ave., New York, NY, 10021, USA.
| | - Devon Klauck
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Ave., New York, NY, 10021, USA
| | - Clara Melhem
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Ave., New York, NY, 10021, USA
| | - Rony T Elias
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Ave., New York, NY, 10021, USA
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Ave., New York, NY, 10021, USA
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Bastu E, Zeybek U, Gurel Gurevin E, Yüksel Ozgor B, Celik F, Okumus N, Demiral I, Dural O, Celik C, Bulut H, Ilkay Armutak E, Baysal B, Buyru F, Yeh J. Effects of Irisin and Exercise on Metabolic Parameters and Reproductive Hormone Levels in High-Fat Diet-Induced Obese Female Mice. Reprod Sci 2017; 25:281-291. [DOI: 10.1177/1933719117711264] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ercan Bastu
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Umit Zeybek
- Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Ebru Gurel Gurevin
- Department of Biology, Faculty of Science, Istanbul University, Istanbul, Turkey
| | - Bahar Yüksel Ozgor
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Faruk Celik
- Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Nazli Okumus
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Irem Demiral
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Ozlem Dural
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Cem Celik
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Huri Bulut
- Department of Biology, Faculty of Science, Istanbul University, Istanbul, Turkey
| | - Elif Ilkay Armutak
- Department of Histology and Embryology, Faculty of Veterinary, Istanbul University, Istanbul, Turkey
| | - Bulent Baysal
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Faruk Buyru
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - John Yeh
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Lefebvre T, Dumont A, Pigny P, Dewailly D. Effect of obesity and its related metabolic factors on serum anti-Müllerian hormone concentrations in women with and without polycystic ovaries. Reprod Biomed Online 2017. [PMID: 28624344 DOI: 10.1016/j.rbmo.2017.05.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The relationship between serum anti-Müllerian hormone (AMH) levels, body mass index (BMI) and related metabolic factors were investigated in women with polycystic ovary syndrome (PCOS). A total of 691 women aged between 18 and 35 years, referred to the Department of Gynaecological Endocrinology at the University Hospital of Lille between 2009 and 2014 were included: 137 controls and 554 women with PCOS. Mean serum AMH levels were slightly but significantly lower in women with PCOS who were overweight or obese (BMI ≥25) compared with women of normal weight (BMI <25) (P < 0.05). No such difference was found in the control group. After bivariate analysis, no significant correlation was found between BMI and AMH in controls. In the PCOS group, this relationship was significant (P = 0.0001) but weak (r = -0.177). Stepwise multiple regression analysis yielded a significant model, including five variables (follicle count, serum androstenedione, BMI, serum LH and FSH) explaining 38.6%, 3.4%, 1.4%, 0.7% and 1.4% of the total serum AMH variance, respectively. No effect of metabolic status was found on serum AMH levels in controls, but a significant, albeit weak, negative independent correlation was found between AMH and BMI in women with PCOS.
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Affiliation(s)
- Tiphaine Lefebvre
- Service de Biologie de la Reproduction, Centre Hospitalier Universitaire, Nantes, France.
| | - Agathe Dumont
- CHU Lille, Service de gynécologie endocrinienne et médecine de la reproduction, Hôpital Jeanne de Flandre, Lille, France
| | - Pascal Pigny
- CHU Lille, Laboratoire de biochimie et hormonologie, Lille, France
| | - Didier Dewailly
- CHU Lille, Service de gynécologie endocrinienne et médecine de la reproduction, Hôpital Jeanne de Flandre, Lille, France
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Tamirou F, Husson SN, Gruson D, Debiève F, Lauwerys BR, Houssiau FA. Brief Report: The Euro-Lupus Low-Dose Intravenous Cyclophosphamide Regimen Does Not Impact the Ovarian Reserve, as Measured by Serum Levels of Anti-Müllerian Hormone. Arthritis Rheumatol 2017; 69:1267-1271. [PMID: 28235250 DOI: 10.1002/art.40079] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/16/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The Euro-Lupus regimen of low-dose intravenous cyclophosphamide (IV CYC) (cumulative dose of 3 gm) was developed to reduce gonadal toxicity. To address the possibility of a marginal effect on the ovarian reserve, we measured serum titers of anti-Müllerian hormone (AMH) in patients with systemic lupus erythematosus (SLE) treated with the Euro-Lupus regimen and compared them with those measured in patients who were treated with higher doses of IV CYC or were never treated with IV CYC. METHODS Serum AMH levels were measured by enzyme-linked immunosorbent assay in a cohort of 155 premenopausal SLE patients; 30 of these patients had been treated with the Euro-Lupus regimen, and 24 had received higher doses of IV CYC. None had received oral CYC. AMH levels were age-adjusted using a slope computed from levels measured across the group of SLE patients who had not been treated with IV CYC. Demographic and clinical data were collected. RESULTS Serum titers of AMH measured in SLE patients treated with the Euro-Lupus IV CYC regimen (median dose 1.46 ng/ml) did not differ from those measured in patients never treated with the cytotoxic drug (median 1.85 ng/ml). As expected, patients given >6 gm of IV CYC had significantly lower serum titers of AMH (median 0.83 ng/ml) compared with those never treated with IV CYC (P = 0.047). Median serum AMH titers did not change before (1.24 ng/ml) and after (2.50 ng/ml) treatment with the Euro-Lupus IV CYC regimen in the subset of patients for whom paired samples could be tested (P = 0.43). CONCLUSION The Euro-Lupus regimen of low-dose IV CYC does not impact the ovarian reserve of SLE patients and can therefore be proposed as treatment in patients seeking to become pregnant.
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Affiliation(s)
- Farah Tamirou
- Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | | | - Damien Gruson
- Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Frédéric Debiève
- Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Bernard R Lauwerys
- Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Frédéric A Houssiau
- Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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McCredie S, Ledger W, Venetis CA. Anti-Müllerian hormone kinetics in pregnancy and post-partum: a systematic review. Reprod Biomed Online 2017; 34:522-533. [DOI: 10.1016/j.rbmo.2017.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
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Bernardi LA, Carnethon MR, de Chavez PJ, Ikhena DE, Neff LM, Baird DD, Marsh EE. Relationship between obesity and anti-Müllerian hormone in reproductive-aged African American women. Obesity (Silver Spring) 2017; 25:229-235. [PMID: 27925445 PMCID: PMC5182136 DOI: 10.1002/oby.21681] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/15/2016] [Accepted: 08/14/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine whether there is an association between obesity and anti-Müllerian hormone (AMH) among reproductive-aged African American women (AAW). METHODS From the women participating in an ongoing National Institute of Environmental Health Sciences study, 1,654 AAW aged 23 to 35 were included in this study. Anthropometric measurements, personal health information, and serum AMH and adipokine levels were analyzed. RESULTS The median body mass index (BMI) was 32.4 kg/m2 , and the median AMH was 3.18 ng/mL. Participants with obesity had AMH concentrations that were 23.7% lower than those with a BMI ≤25 kg/m2 (2.9 ng/mL vs. 3.8 ng/mL). In multivariable linear regression models, current BMI (β = -0.015; 95% CI -0.021 to -0.009), BMI at age 18 (β = -0.016; 95% CI -0.024 to -0.008), heaviest reported lifetime weight (β = -0.002; 95% CI -0.003 to -0.001), and leptin (β = -0.016; 95% CI -0.025 to -0.007) were inversely associated with AMH. There was no significant association between adiponectin and AMH. AMH was significantly lower (mean log = 0.91, SE = 0.11) in participants with obesity at age 18 and at enrollment when compared with those who were underweight or normal weight at age 18 but had obesity at enrollment (mean log = 1.16, SE = 0.12). CONCLUSIONS In reproductive-aged AAW there is a significant association between obesity and AMH, suggesting that excess adiposity may compromise ovarian reserve. Effects of obesity on AMH may be cumulative.
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Affiliation(s)
- Lia A. Bernardi
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois 60611, United States
| | - Peter J. de Chavez
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois 60611, United States
| | - Deborah E. Ikhena
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Lisa M. Neff
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Donna D. Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina 27709, United States
| | - Erica E. Marsh
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, United States
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Moini A, Hedayatshodeh M, Hosseini R, Rastad H. Association between parity and ovarian reserve in reproductive age women. Eur J Obstet Gynecol Reprod Biol 2016; 207:184-187. [DOI: 10.1016/j.ejogrb.2016.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 09/23/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
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Longitudinal changes in maternal serum concentrations of antimüllerian hormone in individual women during conception cycles and early pregnancy. Fertil Steril 2016; 106:1407-1413.e2. [DOI: 10.1016/j.fertnstert.2016.07.1113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/01/2016] [Accepted: 07/22/2016] [Indexed: 11/21/2022]
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Abstract
Poor ovarian reserve (POR) is an important limiting factor for the success of any treatment modality for infertility. It indicates a reduction in quantity and quality of oocytes in women of reproductive age group. It may be age related as seen in advanced years of reproductive life or may occur in young women due to diverse etiological factors. Evaluating ovarian reserve and individualizing the therapeutic strategies are very important for optimizing the success rate. Majority or women with POR need to undergo in vitro fertilization to achieve pregnancy. However, pregnancy rate remains low despite a plethora of interventions and is associated with high pregnancy loss. Early detection and active management are essential to minimize the need for egg donation in these women.
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