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Robin G, Gallo C, Catteau-Jonard S, Lefebvre-Maunoury C, Pigny P, Duhamel A, Dewailly D. Polycystic Ovary-Like Abnormalities (PCO-L) in women with functional hypothalamic amenorrhea. J Clin Endocrinol Metab 2012; 97:4236-43. [PMID: 22948766 DOI: 10.1210/jc.2012-1836] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT In the general population, about 30% of asymptomatic women have polycystic ovary-like abnormalities (PCO-L), i.e. polycystic ovarian morphology (PCOM) at ultrasound and/or increased anti-Müllerian hormone (AMH) serum level. PCOM has also been reported in 30-50% of women with functional hypothalamic amenorrhea (FHA). OBJECTIVE The aim of this study was to verify whether both PCOM and excessive AMH level indicate PCO-L in FHA and to elucidate its significance. DESIGN We conducted a retrospective analysis using a database and comparison with a control population. SETTING Subjects received ambulatory care in an academic hospital. PATIENTS Fifty-eight patients with FHA were compared to 217 control women with nonendocrine infertility and body mass index of less than 25 kg/m(2). INTERVENTIONS There were no interventions. MAIN OUTCOME MEASURES We measured serum testosterone, androstenedione, FSH, LH, AMH, and ovarian area values. The antral follicle count (AFC) was used as a binary variable (i.e. negative or positive) because of the evolution of its sensitivity over the time of this study. The ability of these variables (except AFC) to detect PCO-L in both populations was tested by cluster analysis. RESULTS One cluster (cluster 2) suggesting PCO-L was detected in the control population (n = 52; 24%), whereas two such clusters were observed in the FHA population (n = 22 and n = 6; 38 and 10%; clusters 2 and 3, respectively). Cluster 2 in FHA had similar features of PCO-L as cluster 2 in controls, with higher prevalence of positive AFC (70%) and PCOM (70%), higher values of ovarian area and higher serum AMH (P < 0.0001 for all), and testosterone levels (P < 0.01) than in cluster 1. Cluster 3 in FHA was peculiar, with frankly elevated AMH levels. In the whole population (controls + FHA), PCO-L was significantly associated with lower FSH values (P < 0.0001). CONCLUSION PCO-L in FHA is a frequent and usually incidental finding of unclear significance, as in controls. The association of PCO-L with hypothalamic amenorrhea should not lead to a mistaken diagnosis of PCOS.
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Affiliation(s)
- G Robin
- Department of Endocrine Gynaecology and Reproductive Medicine, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire, 59037 Lille, France
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102
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Carmina E, Campagna AM, Mansuet P, Vitale G, Kort D, Lobo R. Does the level of serum antimüllerian hormone predict ovulatory function in women with polycystic ovary syndrome with aging? Fertil Steril 2012; 98:1043-6. [DOI: 10.1016/j.fertnstert.2012.06.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/15/2012] [Accepted: 06/07/2012] [Indexed: 12/01/2022]
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103
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Campbell BK, Clinton M, Webb R. The role of anti-Müllerian hormone (AMH) during follicle development in a monovulatory species (sheep). Endocrinology 2012; 153:4533-43. [PMID: 22778215 DOI: 10.1210/en.2012-1158] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Knockout studies in mice have suggested that anti-Müllerian hormone (AMH) modulates primordial follicle recruitment and the response of growing follicles to FSH. Little is known of the physiology of AMH in monovular species, despite intense clinical interest in this factor. Using sheep as a model, we sought to investigate the functional role of AMH in modulating follicle development in monovular species. In contrast to the rodent, the results indicate that AMH does not affect the rate of primordial follicle recruitment but appears to regulate the rate at which follicles progress through the gonadotropin-responsive phase, during which it is maximally expressed. Thus, knockdown of AMH bioactivity by active immunization lead to a decline in the population of gonadotropin-responsive preantral and small antral follicles (P < 0.01) and increases in both the number of gonadotropin-dependent antral follicles (P < 0.01) and ovulation rate (P < 0.05). These in vivo findings were consistent with the results of other studies examining the pattern of expression of AMH, which was negatively correlated with aromatase (P < 0.001), and in vitro supplementation experiments, which supported an inhibitory role for AMH in modulating the response of both theca and granulosa cells to LH and FSH, respectively. The elucidation of a functional relationship between AMH and LH-stimulated thecal androgen production may be significant in terms of the etiology of common forms of anovulatory infertility in women. Furthermore, the observed increase in both the number of recruitable antral follicles and ovulatory quota in response to AMH knockdown may have therapeutic value in women who respond poorly to ovarian stimulation.
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Affiliation(s)
- Bruce K Campbell
- Division of Clinical Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom.
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104
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Different diagnostic power of anti-Mullerian hormone in evaluating women with polycystic ovaries with and without hyperandrogenism. J Assist Reprod Genet 2012; 29:1147-51. [PMID: 22886405 DOI: 10.1007/s10815-012-9839-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 07/25/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The aim of this study is to compare the secretory profiles and diagnostic power of anti-Mullerian hormone (AMH) for the PCOS patient with and without hyperandrogenism. METHODS One hundred and thirty-one PCOS patients with oligomenorrhea or amenorrhea were recruited into the study. Sixty-two and sixty-nine patients had and did not have hyperandrogenism (HA+) hyperandrogenism (HA-), respectively. Sera were collected for determining the levels of AMH, basal sexual hormones, glucose and lipid metabolic indicators. RESULTS The AMH serum levels of PCOS patients were significantly higher than the control group, with the highest AMH serum level in the HA+ group. The cut-off value for predicting PCOS patients of all types was 3.92 ng/mL, with a sensitivity of 65 %, and specificity of 62 %. The cut-off value for predicting PCOS patients in the HA+ group was 4.23 ng/mL, with a sensitivity of 82 %, and specificity of 64 %. The cut-off value for predicting PCOS patients in the HA- group was 3.76 ng/mL, with a sensitivity of 64 %, and specificity of 62 %. In the HA+ group, AMH was negatively associated with FSH and positively associated with LH. In the HA- group, AMH was negatively associated with HDL and positively associated with BMI, fasting glucose and LDL. CONCLUSIONS AMH is only suitable for predicting the PCOS patients with hyperandrogenism. The diagnostic power of AMH is limited when used to predict patients without hyperandrogenism. It reflects the differences in pathophysiology and severity of disrupted folliculogenesis between the two subtypes.
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105
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Eilertsen TB, Vanky E, Carlsen SM. Anti-Mullerian hormone in the diagnosis of polycystic ovary syndrome: can morphologic description be replaced? Hum Reprod 2012; 27:2494-502. [DOI: 10.1093/humrep/des213] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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106
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Yilmaz N, Uygur D, Dogan M, Ozgu E, Salman B, Mollamahmutoglu L. The effect of follicular antimullerian hormone levels of non-obese, non-hyperandrogenemic polycystic ovary syndrome patients on assisted reproduction outcome. Gynecol Endocrinol 2012; 28:162-5. [PMID: 22103791 DOI: 10.3109/09513590.2011.593667] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Our aim is to investigate the follicular fluid concentrations of antimullerian hormone and its effect on assisted reproductive technology (ART) outcome in non-obese, non-hyperandrogenemic polycystic ovary syndrome patients. Subjects were categorized according to in vitro fertilization (IVF) indications: Group 1 PCOS (n:16), Group 2 male factor infertility (n:19) and Group 3 unexplained infertiliy patients (n:19). Follicular fluid antimullerian hormone levels (FF AMH) on the day of oocyte retrieval were analysed and ART outcome was studied. FF AMH levels in group 1, 2 and 3 were 35.70 ng/ml (median); 17.90 ng/ml (median); 17.90 ng/ml (median), respectively (p = 0.18). There were correlations between the FF AMH levels and follicle, oocyte, 2PN and embryo numbers in pathophysiology of polycystic ovary syndrome (PCOS) patients (p = 0.012; 0.024; 0.027; 0.013 respectively). There were no correlations between the FF AMHand ART outcome parameters in group 2 and 3. FF AMH levels were not different between the groups who were pregnant or not (p = 0.06). In conclusion there were no significant differences in terms of FF AMH levels in the three groups. FF AMH levels can predict the recovery of oocytes but not oocyte quality, embryo quality or pregnancy in non-obese non-hyperandrogenemic PCOS patient.
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Affiliation(s)
- Nafiye Yilmaz
- Department of Infertility, Dr Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey.
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107
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Sonntag B. Anti-Müller-Hormon und Follikelzahl als diagnostische Marker des polyzystischen Ovarsyndroms. GYNAKOLOGISCHE ENDOKRINOLOGIE 2012. [DOI: 10.1007/s10304-011-0460-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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108
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Woo HY, Kim KH, Rhee EJ, Park H, Lee MK. Differences of the association of anti-Müllerian hormone with clinical or biochemical characteristics between women with and without polycystic ovary syndrome. Endocr J 2012; 59:781-90. [PMID: 22673409 DOI: 10.1507/endocrj.ej12-0055] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of the present study was to compare the associations of anti-Müllerian hormone (AMH) with clinical or biochemical characteristics between women with and without polycystic ovary syndrome (PCOS). We also explored the optimal cutoff point of AMH to diagnose PCOS. A cross-sectional study was performed in 87 women diagnosed with PCOS and 53 healthy control subjects. Body mass index (BMI), indices of insulin resistance, metabolic syndrome-related variables, reproductive hormones and serum AMH were measured in all subjects. We conducted receiver operating characteristic (ROC) curve analysis to determine the cutoff of AMH for diagnosis of PCOS. Serum AMH levels were significantly (p <0.001) higher in women with PCOS after adjustment for age and BMI. AMH levels were not significantly related with obesity, indices of insulin resistance, and metabolic syndrome-related variables in both PCOS and control groups. In the control group, AMH levels showed positive correlations with total testosterone (p <0.001), free testosterone (p=0.024), and adiponectin (p=0.002), and showed negative correlations with age (p=0.010) and estradiol (E2) (p=0.012). However, only total (p=0.044) and free testosterone (p=0.012) levels showed significant positive correlations with serum AMH level in PCOS group. ROC curve analysis showed a cutoff point for AMH of 7.82 ng/mL (sensitivity 75.9%, specificity 86.8%) for diagnosis of PCOS. Differences of the association of AMH with clinical or biochemical characteristics between women with PCOS and control groups were observed. This might contribute to the pathogenesis of PCOS, although further investigation is necessary to elucidate the detailed mechanism.
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Affiliation(s)
- Hee-Yeon Woo
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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109
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Pawelczak M, Kenigsberg L, Milla S, Liu YH, Shah B. Elevated serum anti-Müllerian hormone in adolescents with polycystic ovary syndrome: relationship to ultrasound features. J Pediatr Endocrinol Metab 2012; 25:983-9. [PMID: 23426830 PMCID: PMC3763943 DOI: 10.1515/jpem-2012-0013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 07/11/2012] [Indexed: 11/15/2022]
Abstract
CONTEXT Serum anti-Müllerian hormone (AMH) is linked to the ovarian follicle pool. Little is known about the relationship between serum AMH and ovarian ultrasound (US) features in adolescents with polycystic ovary syndrome (PCOS). OBJECTIVES To confirm that serum AMH is elevated in adolescents with PCOS and to correlate serum AMH with ovarian US features in this population are the objectives of this study. DESIGN A retrospective chart review of clinical, biochemical, and ultrasonographic data in adolescents with PCOS and normal controls is the design of the study. Serum AMH was measured and compared between groups and correlated with ovarian US findings. SETTING The study was done in two urban tertiary academic medical centers. PARTICIPANTS Study groups included 23 adolescent females with PCOS and 12 age and BMI-matched female controls. MAIN OUTCOME MEASURES We hypothesized that serum AMH would be elevated in the PCOS group compared with the controls and would positively correlate with the follicle number, distribution, and ovarian volume. RESULTS Serum AMH was 6.78±3.55 ng/mL in the PCOS group vs. 3.38±1.48 ng/mL in the controls (p=0.0004). AMH positively correlated with ovarian volume (left ovary r=0.65, p=0.0007, right ovary r=0.55, p=0.0065) and peripheral follicle distribution (p=0.0027). Ten or more follicles were observed in 83% of USs. CONCLUSIONS There is a positive relationship between serum AMH and ovarian volume as well as peripheral follicular distribution in adolescents with PCOS. Our findings support the use of serum AMH as a useful marker to reflect ovarian US features typical of PCOS in cases where accurate USs are not available and for follow-up.
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Affiliation(s)
- Melissa Pawelczak
- Department of Pediatrics, Division of Pediatric Endocrinology, New York University School of Medicine, New York, New York 10016
| | - Lisa Kenigsberg
- Department of Pediatrics, Division of Pediatric Endocrinology, New York University School of Medicine, New York, New York 10016
| | - Sarah Milla
- Department of Radiology, New York University School of Medicine, New York, New York 10016
| | - Ying-Hua Liu
- Department of Pediatrics, New York University School of Medicine, New York, New York 10016
| | - Bina Shah
- Department of Pediatrics, Division of Pediatric Endocrinology, New York University School of Medicine, New York, New York 10016
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110
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Tyndall V, Broyde M, Sharpe R, Welsh M, Drake AJ, McNeilly AS. Effect of androgen treatment during foetal and/or neonatal life on ovarian function in prepubertal and adult rats. Reproduction 2012; 143:21-33. [PMID: 22016380 PMCID: PMC3245827 DOI: 10.1530/rep-11-0239] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 10/19/2011] [Indexed: 11/08/2022]
Abstract
We investigated the effects of different windows of testosterone propionate (TP) treatment during foetal and neonatal life in female rats to determine whether and when excess androgen exposure would cause disruption of adult reproductive function. Animals were killed prepubertally at d25 and as adults at d90. Plasma samples were taken for hormone analysis and ovaries serial sectioned for morphometric analyses. In prepubertal animals, only foetal+postnatal and late postnatal TP resulted in increased body weights, and an increase in transitory, but reduced antral follicle numbers without affecting total follicle populations. Treatment with TP during both foetal+postnatal life resulted in the development of streak ovaries with activated follicles containing oocytes that only progressed to a small antral (smA) stage and inactive uteri. TP exposure during foetal or late postnatal life had no effect upon adult reproductive function or the total follicle population, although there was a reduction in the primordial follicle pool. In contrast, TP treatment during full postnatal life (d1-25) resulted in anovulation in adults (d90). These animals were heavier, had a greater ovarian stromal compartment, no differences in follicle thecal cell area, but reduced numbers of anti-Mullerian hormone-positive smA follicles when compared with controls. Significantly reduced uterine weights lead reduced follicle oestradiol production. These results support the concept that androgen programming of adult female reproductive function occurs only during specific time windows in foetal and neonatal life with implications for the development of polycystic ovary syndrome in women.
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Affiliation(s)
- Victoria Tyndall
- MRC Human Reproductive Sciences UnitUniversity/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute47 Little France Crescent, Edinburgh, EH16 4TJUK
| | - Marie Broyde
- MRC Human Reproductive Sciences UnitUniversity/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute47 Little France Crescent, Edinburgh, EH16 4TJUK
| | - Richard Sharpe
- MRC Human Reproductive Sciences UnitUniversity/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute47 Little France Crescent, Edinburgh, EH16 4TJUK
| | - Michelle Welsh
- MRC Human Reproductive Sciences UnitUniversity/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute47 Little France Crescent, Edinburgh, EH16 4TJUK
| | - Amanda J Drake
- Endocrinology Unit University/BHF Centre for Cardiovascular ScienceThe Queens Medical Research Institute47 Little France Crescent, Edinburgh, EH16 4TJUK
| | - Alan S McNeilly
- MRC Human Reproductive Sciences UnitUniversity/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute47 Little France Crescent, Edinburgh, EH16 4TJUK
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111
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Selim MF. The Optimal Number of Ovarian Punctures to Be Applied During Laparoscopic Ovarian Diathermy in Women with Polycystic Ovarian Syndrome. J Gynecol Surg 2011. [DOI: 10.1089/gyn.2010.0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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112
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Pellatt L, Rice S, Dilaver N, Heshri A, Galea R, Brincat M, Brown K, Simpson ER, Mason HD. Anti-Müllerian hormone reduces follicle sensitivity to follicle-stimulating hormone in human granulosa cells. Fertil Steril 2011; 96:1246-51.e1. [DOI: 10.1016/j.fertnstert.2011.08.015] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 07/13/2011] [Accepted: 08/10/2011] [Indexed: 10/17/2022]
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113
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Antimüllerian hormone and polycystic ovary syndrome. Fertil Steril 2011; 96:230-5. [DOI: 10.1016/j.fertnstert.2011.04.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 03/28/2011] [Accepted: 04/05/2011] [Indexed: 11/21/2022]
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114
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HAMPL R, ŠNAJDEROVÁ M, MARDEŠIĆ T. Antimüllerian Hormone (AMH) Not Only a Marker for Prediction of Ovarian Reserve. Physiol Res 2011; 60:217-23. [DOI: 10.33549/physiolres.932076] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The main characteristics of the Antimüllerian hormone from the points of view of biochemistry, molecular genetics, physiological functions and importance for diagnostics in reproductive endocrinology and related biomedical fields are reviewed. The role of the hormone in male and female development, its participation in oocyte maturation including selection of a dominant follicle are summarized, as well as its changes under various pathological situations in both sexes. The physiological changes of serum AMH leves in the life span in both sexes and their alterations under various pathological conditions are provided, too.
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Affiliation(s)
- R. HAMPL
- Institute of Endocrinology, Prague, Czech Republic
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115
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Bukulmez O, Carr BR, Doody KJ. Reply of the Authors. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2010.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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116
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117
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Falbo A, Rocca M, Russo T, D'Ettore A, Tolino A, Zullo F, Orio F, Palomba S. Serum and follicular anti-Mullerian hormone levels in women with polycystic ovary syndrome (PCOS) under metformin. J Ovarian Res 2010; 3:16. [PMID: 20663178 PMCID: PMC2912910 DOI: 10.1186/1757-2215-3-16] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 07/21/2010] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND No data regarding metformin effects on follicular fluid anti-Müllerian hormone (AMH) levels were to date available in literature. The aim of the present study was to evaluate in patients with polycystic ovary syndrome (PCOS) whether metformin administration affects serum and follicular AMH levels, and whether this is related to ovarian response to the treatment. METHODS Twenty young patients with PCOS who had received metformin were enrolled. Ten patients were anovulatory (Met-anov group), whereas the other 10 were ovulatory (Met-ov group) but had failed to conceive. Further untreated PCOS (PCOS controls, n. 10) and healthy controls (non-PCOS controls, n. 10) who were scheduled for laparoscopic surgery were enrolled. In each subjects, clinical and biochemical evaluations were performed. AMH concentrations in blood and antral follicular fluid were assayed. RESULTS In both Met-anov and Met-ov groups, and without difference between them, serum androgens and AMH, and indices of insulin resistance were significantly (p < 0.05) improved after treatment. On the other hand, significant differences (p < 0.05) between the two groups were detected with respect to the same biochemical parameters in antral follicular fluid. In the Met-anov group, no significant correlation was observed between AMH concentrations in the follicular fluid and variation in serum androgens, AMH and insulin resistance indexes; whereas in Met-ov group significant correlations were detected between AMH levels in the follicular fluid and variation in serum androgens, AMH and insulin resistance indexes. CONCLUSIONS Metformin administration in patients with PCOS exerts a differential action on the ovarian AMH levels on the basis of ovulatory response. Changes in AMH levels in antral follicular fluid during metformin treatment could be involved in the local mechanisms mediating the ovulatory restoration.
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Affiliation(s)
- Angela Falbo
- Department of Obstetrics & Gynecology, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.
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