1
|
Sumji S, Bhat A, Rashid A, Bashir R, Wani IA, Vasudevan V, Sehar T, Ganie MA. Efficacy of serum anti-mullerian hormone (AMH) levels for prediction of polycystic ovary syndrome (PCOS) and its association with clinical, biochemical and hormonal parameters. Indian J Clin Biochem 2023; 38:457-465. [PMID: 37746534 PMCID: PMC10516813 DOI: 10.1007/s12291-022-01058-4] [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: 04/29/2022] [Accepted: 06/06/2022] [Indexed: 10/14/2022]
Abstract
Anti-mullerian hormone (AMH) has been proposed to add significance to diagnosis of PCOS in case of ambiguity. However, variable cutoffs of AHM among PCOS women have been reported. Using case-control design, this study investigated the diagnostic threshold of serum AMH levels among age matched 113 PCOS and 75 normo-ovulatory women and its correlation with clinical, hormonal and ultrasonographic parameters.PCOS was defined as per Rotterdam criteria 2003. Results depicted the mean serum AMH level to be significantly higher in PCOS group (7.84 ± 3.67vs. 3.23 ± 1.56 ng/mL) than controls. The AMH levels were positively(p = 0.001) associated with ovarian volume (r = 0.521) as well as number of ovarian follicles(r = 0.461). Further, serum AMH levels showed a positive correlation with luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio (r = 0.206, p = 0.02), but no correlation significant with age, BMI,FG score and testosterone levels. As per receiver operating characteristic (ROC) curve, cut-off was worked out to be 3.76 ng/ml with 86.7% sensitivity and 62.7% specificity. The mean level of AMH were highest among PCOS women with phenotype A (12.67 ± 3.46 ng/ml) with least among PCOS women displaying phenotype B(7.28 ± 1.60 ng/ml) where there is absence of PCOM. In conclusion, serum AMH levels are highly predictive of PCOM and high LH/FSH ratio among PCOS women and may be a potent diagnostic marker of ovarian dysfunction either alone or in conjunction with other tools. Supplementary Information The online version contains supplementary material available at 10.1007/s12291-022-01058-4.
Collapse
Affiliation(s)
- Sajad Sumji
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
| | - Abid Bhat
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
| | - Aafia Rashid
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
- Department of Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
| | - Rohina Bashir
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
- Department of Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
| | - Imtiyaz A Wani
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
- Department of Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
| | - Vishnu Vasudevan
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
| | - Tajali Sehar
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
- Department of Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
| | - Mohd. Ashraf Ganie
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
- Department of Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
| |
Collapse
|
2
|
Vagios S, Sacha CR, James KE, Hammer KC, Fitz VW, Dimitriadis I, Bormann CL, Souter I. The impact of anti-Müllerian hormone on endometrial thickness in gonadotropin stimulation/intrauterine insemination cycles: is there an effect on pregnancy outcomes? J Assist Reprod Genet 2023; 40:845-850. [PMID: 36745295 PMCID: PMC10224886 DOI: 10.1007/s10815-023-02736-9] [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: 11/08/2022] [Accepted: 01/27/2023] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To study the association, if any, between anti-Müllerian hormone (AMH) and pre-ovulatory endometrial thickness (ET) in gonadotropin/intrauterine insemination (IUI) cycles. METHODS This retrospective cohort study included a total of 964 patients undergoing 1926 gonadotropin/IUI cycles at an academic fertility center. Primary outcome measure was the association between serum AMH and measured ET on the day of and the day before human chorionic gonadotropin hormone (hCG) ovulation trigger. The effect of a model combining AMH and ET on early pregnancy outcomes was a secondary measure. RESULTS In 52.8% of cycles, ET was last assessed and recorded on the day of hCG administration, while in the remaining 47.2% on the day prior to trigger. In unadjusted regression models, AMH was weakly correlated with ET on hCG trigger day [bAMH (95%CI) = 0.032 (- 0.008, 0.070), p = 0.015]. When adjusting for potential confounders, the positive correlation became significant [0.051 (0.006, 0.102), p = 0.047]. Similar findings were observed when assessing the correlation between AMH and ET on the day prior to hCG trigger. ET was non-significantly associated with the odds of clinical pregnancy, when adjusting for potential confounders, except for when restricting the analysis to couples with idiopathic infertility [OR (95%CI), p-value: 0.787 (0.623, 0.993), 0.044]. CONCLUSION Our findings support an effect of serum AMH on endometrial development in gonadotropin induced cycles, even when adjusting for the diagnosis of PCOS. ET was not associated with the odds of achieving a clinical pregnancy, except for couples with idiopathic infertility.
Collapse
Affiliation(s)
- Stylianos Vagios
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Obstetrics and Gynecology, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA.
| | - Caitlin R Sacha
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kaitlyn E James
- Deborah Kelly Center for Outcomes Research, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Karissa C Hammer
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Victoria W Fitz
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Irene Dimitriadis
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Charles L Bormann
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| |
Collapse
|
3
|
The Role of Serum Anti-Mullerian Hormone Measurement in the Diagnosis of Polycystic Ovary Syndrome. Diagnostics (Basel) 2023; 13:diagnostics13050907. [PMID: 36900051 PMCID: PMC10000702 DOI: 10.3390/diagnostics13050907] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrinological disorder in women with significant reproductive, metabolic, and psychological health implications. The lack of a specific diagnostic test poses challenges in making the diagnosis of PCOS, resulting in underdiagnosis and undertreatment. Anti-Mullerian hormone (AMH) synthesized by the pre-antral and small antral ovarian follicles appears to play an important role in the pathophysiology of PCOS, and serum AMH levels are often elevated in women with PCOS. The aim of this review is to inform the possibility of utilizing anti-Mullerian hormone either as a diagnostic test for PCOS or as an alternative diagnostic criterion in place of polycystic ovarian morphology, hyperandrogenism, and oligo-anovulation. Increased levels of serum AMH correlate highly with PCOS, polycystic ovarian morphology, hyperandrogenism, and oligo/amenorrhea. Additionally, serum AMH has high diagnostic accuracy as an isolated marker for PCOS or as a replacement for polycystic ovarian morphology.
Collapse
|
4
|
Nelson SM, Davis SR, Kalantaridou S, Lumsden MA, Panay N, Anderson RA. Anti-Müllerian hormone for the diagnosis and prediction of menopause: a systematic review. Hum Reprod Update 2023; 29:327-346. [PMID: 36651193 PMCID: PMC10152172 DOI: 10.1093/humupd/dmac045] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/20/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The early onset of menopause is associated with increased risks of cardiovascular disease and osteoporosis. As a woman's circulating anti-Müllerian hormone (AMH) concentration reflects the number of follicles remaining in the ovary and declines towards the menopause, serum AMH may be of value in the early diagnosis and prediction of age at menopause. OBJECTIVE AND RATIONALE This systematic review was undertaken to determine whether there is evidence to support the use of AMH alone, or in conjunction with other markers, to diagnose menopause, to predict menopause, or to predict and/or diagnose premature ovarian insufficiency (POI). SEARCH METHODS A systematic literature search for publications reporting on AMH in relation to menopause or POI was conducted in PubMed®, Embase®, and the Cochrane Central Register of Controlled Trials up to 31 May 2022. Data were extracted and synthesized using the Synthesis Without Meta-analysis for diagnosis of menopause, prediction of menopause, prediction of menopause with a single/repeat measurement of AMH, validation of prediction models, short-term prediction in perimenopausal women, and diagnosis and prediction of POI. Risk-of-bias was evaluated using the Tool to Assess Risk of Bias in Cohort Studies protocol and studies at high risk of bias were excluded. OUTCOMES A total of 3207 studies were identified, and 41, including 28 858 women, were deemed relevant and included. Of the three studies that assessed AMH for the diagnosis of menopause, one showed that undetectable AMH had equivalent diagnostic accuracy to elevated FSH (>22.3 mIU/ml). No study assessed whether AMH could be used to shorten the 12 months of amenorrhoea required for a formal diagnosis of menopause. Studies assessing AMH with the onset of menopause (27 publications [n = 23 835 women]) generally indicated that lower age-specific AMH concentrations are associated with an earlier age at menopause. However, AMH alone could not be used to predict age at menopause with precision (with estimates and CIs ranging from 2 to 12 years for women aged <40 years). The predictive value of AMH increased with age, as the interval of prediction (time to menopause) shortened. There was evidence that undetectable, or extremely low AMH, may aid early diagnosis of POI in young women with a family history of POI, and women presenting with primary or secondary amenorrhoea (11 studies [n = 4537]). WIDER IMPLICATIONS The findings of this systematic review support the use of serum AMH to study the age of menopause in population studies. The increased sensitivity of current AMH assays provides improved accuracy for the prediction of imminent menopause, but diagnostic use for individual patients has not been rigorously examined. Prediction of age at menopause remains imprecise when it is not imminent, although the finding of very low AMH values in young women is both of clinical value in indicating an increased risk of developing POI and may facilitate timely diagnosis.
Collapse
Affiliation(s)
- Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow, UK.,NIHR Bristol Biomedical Research Centre, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK.,TFP, Oxford Fertility, Institute of Reproductive Sciences, Oxford, UK
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Endocrinology and Diabetes, Alfred Health, Melbourne, VIC, Australia
| | - Sophia Kalantaridou
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Mary Ann Lumsden
- School of Medicine, University of Glasgow, Glasgow, UK.,International Federation of Gynecology and Obstetrics (FIGO), FIGO House, London, UK
| | - Nick Panay
- Queen Charlotte's & Chelsea and Westminster Hospitals, Imperial College London, London, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Heath, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
5
|
Age-related changes in serum anti-Müllerian hormone in women of reproductive age in Kenya. SOUTH AFRICAN JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2022. [DOI: 10.7196/sajog.2022.v28i2.2067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background. Anti-Müllerian hormone (AMH) is produced by the granulosa cells of ovarian antral follicles and plays a role in therecruitment of dominant follicles during folliculogenesis. The serum level of AMH is proportional to the number of developing folliclesin the ovaries and reflects ovarian reserve. Nomograms of AMH variation with age exist from Caucasian populations, but there are none drawn from local African data.Objectives. To establish age-specific median serum AMH levels in an unselected East African population of women of reproductive age.Methods. We retrospectively analysed data on 1 718 women who underwent AMH testing using the Beckman Coulter AMH Gen IIenzyme-linked immunosorbent assay during the period 2015 - 2019 at Aga Khan University Hospital, Nairobi, Kenya. Age-specific median AMH levels were derived and presented in 5-year age bands. AMH levels were then log-transformed and, using linear regression in a natural spline function, presented on a scatter plot to demonstrate variation across reproductive age.Results. The median (interquartile range (IQR)) age of women who were tested for AMH was 38 (19 - 49) years. For the study population, the median (IQR) serum AMH level was 0.87 (0.01 - 17.10) ng/mL. The AMH concentration was inversely related to age, with a progressive decline whereby an increase of 1 year resulted in a corresponding decrease in AMH of 0.18 ng/mL. The proportion of women with decreased ovarian reserve increased exponentially with age from 14.9% in those aged 20 - 24 years to 48.7% at 35 - 39 years.Conclusion. From a large dataset of mainly black African women, this study confirms that serum AMH declines with advancing age,as reported elsewhere in Caucasian populations. There was, however, a higher than expected number of women with diminished ovarian reserve for age. Future studies prospectively exploring ovarian reserve in the general population could unravel underlying biological, reproductive and environmental factors that may influence AMH levels and reproductive capacity in this indigenous population.
Collapse
|
6
|
Oncul M, Ozcivit IB, Basibuyuk Z, Cebi C, Sahmay S. Anti-Müllerian hormone, an ovarian reserve marker in hypogonadotropic hypogonadism. Eur J Obstet Gynecol Reprod Biol 2022; 273:54-58. [PMID: 35477042 DOI: 10.1016/j.ejogrb.2022.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 01/25/2022] [Accepted: 04/17/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the usefulness of Anti-Müllerian Hormone (AMH) and antral follicle count (AFC) as an ovarian reserve marker in hypogonadotropic hypogonadism (HH) patients and to find a limit value for the gonadotropin levels in the diagnosis of HH patients. STUDY DESIGN It is a retrospective cross-sectional single-center study. One hundred ninety-nine women with HH and 171 healthy controls with no cycle disorders were included into this study. Continuous variables were expressed as mean ± standard deviation. Statistical comparisons were carried out according to the intention to treat by Student's t-test, Mann-Whitney U test, where appropriate. Receiver operating characteristic curve-ROC was used to represent the sensitivity and specificity pair corresponding to decision threshold of FSH and LH levels in HH diagnosis. P < 0.05 was accepted to be statistically significant. RESULTS There was not any statistically significant difference between HH and control group regarding the age (23.94 ± 6.56 vs. 23.92 ± 3.01, respectively; p = 0.09). Serum AMH levels didn't show statistically significant difference between HH and control group (3.26 ± 2.61 ng/mL vs. 3.15 ± 1.46 ng/mL, respectively; p = 0.11). The difference of AFC between HH and control group was statistically significant (6.67 ± 6.33 vs. 10.91 ± 2.92, respectively; p < 0.001). Follicle-stimulating hormone (FSH), Luteinizing-hormone (LH) and Estradiol (E2) levels between the groups were found to be significantly different. Area under the receiver operating characteristic curve-ROC for FSH was 0.98 and for LH was 0.96. For the diagnosis of HH, FSH levels lower than 3.05 IU/L (with a sensitivity of 92% and specificity of 94%) and LH levels lower than 1.55 IU/L (with a sensitivity of 91% and specificity of 92%) can be used. CONCLUSION In conclusion, serum AMH levels reflect the follicle cohort in HH cases validly with negligible underestimation of ovarian reserve. FSH < 3.05 IU/L and LH < 1.55 IU/L could be used with high sensitivity and specificity for the diagnosis of HH.
Collapse
Affiliation(s)
- Mahmut Oncul
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Turkey
| | - Ipek Betul Ozcivit
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. Department of Obstetrics and Gynecology, Turkey.
| | - Zafer Basibuyuk
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. Department of Obstetrics and Gynecology, Turkey
| | - Ceren Cebi
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. Department of Obstetrics and Gynecology, Turkey
| | - Sezai Sahmay
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Turkey
| |
Collapse
|
7
|
Anand S, Kumar A, Prasad A, Trivedi K. Updated meta-analysis on the diagnostic accuracy of serum anti-Mullerian hormone in poly cystic ovary syndrome involving 13 509 subjects. J Obstet Gynaecol Res 2022; 48:2162-2174. [PMID: 35394100 DOI: 10.1111/jog.15233] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
Abstract
AIM To determine the diagnostic accuracy of anti-Mullerian hormone (AMH) in the diagnosis of polycystic ovary syndrome (PCOS). METHODS Two independent reviewers searched the electronic databases and search engines using PubMed, Cochrane library, and Google Scholar systematically to retrieve relevant articles published from inception to September 2021. The diagnostic efficacy of AMH was computed using the random-effects model in terms of pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence interval (CI). A meta-regression and subgroup analysis were performed to check for any source which could explain possible heterogeneity. Risk of bias assessment was conducted using the QUADAS-2 tool recommended by Cochrane Library. RESULTS This meta-analysis included a total of 41 studies involving 13 509 subjects. We observed promising pooled sensitivity 0.78 (95% CI 0.74 to 0.81), specificity 0.87 (95% CI 0.84 to 0.90), and diagnostic odds ratio (DOR) 24 (95% CI 15 to 37), for AMH in detecting PCOS and discriminatory power (summary receiver operating characteristic [SROC] curves, 0.89 [95% CI 0.86-0.92]). The most prominent bias was noted in the patient selection and index test assessment. CONCLUSIONS With the findings of this current meta-analysis, we conclude serum AMH to be a promising biomarker for the diagnosis of PCOS, however, substantial heterogeneity among studies needs individual patient data analysis in order to identify an optimal cut-off value and homogenous findings. REGISTRATION NUMBER AND GUIDELINES This meta-analysis was performed according to constructed protocol registered in the PROSPERO database with registration number CRD42021246910.
Collapse
Affiliation(s)
- Shikha Anand
- Department of Obstetrics and Gynecology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Amit Kumar
- Department of Laboratory Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Anupa Prasad
- Department of Biochemistry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Kiran Trivedi
- Department of Obstetrics and Gynecology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| |
Collapse
|
8
|
Gifford RM, O'Leary TJ, Wardle SL, Double RL, Homer NZM, Howie AF, Greeves JP, Anderson RA, Woods DR, Reynolds RM. Reproductive and metabolic adaptation to multistressor training in women. Am J Physiol Endocrinol Metab 2021; 321:E281-E291. [PMID: 34191631 DOI: 10.1152/ajpendo.00019.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/07/2021] [Indexed: 11/22/2022]
Abstract
Hypothalamic-pituitary-gonadal (HPG) axis suppression in exercising women can be caused by low energy availability (EA), but the impact of a real-world, multistressor training environment on reproductive and metabolic function is unknown. This study aimed to characterize reproductive and metabolic adaptation in women undertaking basic military training. A prospective cohort study in women undertaking 11-month initial military training (n = 47) was carried out. Dynamic low-dose 1-h gonadotrophin-releasing hormone (GnRH) tests were completed after 0 and 7 mo of training. Urine progesterone was sampled weekly throughout. Body composition (dual X-ray absorptiometry), fasting insulin resistance (homeostatic modeling assessment 2, HOMA2), leptin, sex steroids, anti-Müllerian hormone (AMH), and inhibin B were measured after 0, 7, and 11 mo with an additional assessment of body composition at 3 mo. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) responses were suppressed after 7 mo (both P < 0.001). Among noncontraceptive users (n = 20), 65% had regular (23-35 days) cycles preenrollment, falling to 24% by 7 mo of training. Of women in whom urine progesterone was measured (n = 24), 87% of cycles showed no evidence of ovulation. There was little change in AMH, LH, and estradiol, although inhibin B and FSH increased (P < 0.05). Fat mass fluctuated during training but at month 11 was unchanged from baseline. Fat-free mass did not change. Visceral adiposity, HOMA2, and leptin increased (all P < 0.001). HPG axis suppression with anovulation occurred in response to training without evidence of low EA. Increased insulin resistance may have contributed to the observed pituitary and ovarian dysfunction. Our findings are likely to represent an adaptive response of reproductive function to the multistressor nature of military training.NEW & NOTEWORTHY We characterized reproductive endocrine adaptation to prolonged arduous multistressor training in women. We identified marked suppression of hypothalamic-pituitary-gonadal (HPG) axis function during training but found no evidence of low energy availability despite high energy requirements. Our findings suggest a complex interplay of psychological and environmental stressors with suppression of the HPG axis via activation of the hypothalamic-pituitary adrenal (HPA) axis. The neuroendocrine impact of nonexercise stressors on the HPG axis during arduous training should be considered.
Collapse
Affiliation(s)
- Robert M Gifford
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- Research & Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Thomas J O'Leary
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom
| | - Sophie L Wardle
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom
| | - Rebecca L Double
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom
| | - Natalie Z M Homer
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - A Forbes Howie
- Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Julie P Greeves
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Richard A Anderson
- Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - David R Woods
- Research & Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, United Kingdom
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
- Northumbria and Newcastle NHS Trusts, Wansbeck General and Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Rebecca M Reynolds
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
9
|
Ida T, Fujiwara H, Taniguchi Y, Kohyama A. Longitudinal assessment of anti-Müllerian hormone after cesarean section and influence of bilateral salpingectomy on ovarian reserve. Contraception 2021; 103:394-399. [PMID: 33539802 DOI: 10.1016/j.contraception.2021.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to compare longitudinal changes in ovarian reserve markers after cesarean section (CS) with and without bilateral salpingectomy (BS). STUDY DESIGN We prospectively enrolled women >35 weeks' gestation scheduled for CS alone or CS + BS and obtained blood samples for anti-Müllerian hormone prior to surgery and at 3 and 6 months after surgery. At the 3-month visit, we similarly performed transvaginal ultrasound for antral follicle count. RESULTS We enrolled 50 women; 30 underwent CS only and 20 underwent CS + BS. Although anti-Müllerian hormone level increased over 6 months of follow-up in both groups, no clinically important differences in the geometric mean (interquartile range) (ng/mL) were observed at any timepoint (baseline [0.69 {0.36-1.21} {CS only} vs 0.49 {0.32-2.10} {CS + BS}, p = 0.64]; 3 months [1.35 {0.58-3.13} vs 1.45 {1.04-2.25}, p = 0.79]; and 6 months [1.74 {0.93-4.45} vs 2.60 {1.41-5.10}, p =0.27]). Similarly, we detected no difference in antral follicle count. CONCLUSION BS at the time of CS does not have a negative impact on ovarian reserve 6 months after surgery. IMPLICATION While our results provide reassuring data that bilateral salpingectomy for permanent contraception at the time of cesarean section does not impact ovarian reserve, longer adequately powered studies are needed.
Collapse
Affiliation(s)
- Tsutomu Ida
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan.
| | - Hiroyuki Fujiwara
- Department of Obstetrics and Gynecology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yoshimi Taniguchi
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Akira Kohyama
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| |
Collapse
|
10
|
Anderson RA, Nelson SM. Anti-Müllerian Hormone in the Diagnosis and Prediction of Premature Ovarian Insufficiency. Semin Reprod Med 2021; 38:263-269. [PMID: 33429444 DOI: 10.1055/s-0040-1722319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The menopause and its pathological version, premature ovarian insufficiency (POI), are characterized by the cessation of follicle growth in the ovary, with consequent lack of estrogen production and amenorrhea. The measurement of a specific product of ovarian follicles would therefore be expected to be a valuable biomarker in women with POI, and to be of likely clinical value in the diagnosis and perhaps prediction of POI. Anti-Müllerian hormone (AMH) is produced by the granulosa cells of growing follicles and is therefore likely to be of value in this context. Current data indicate that measurement of AMH is an accurate indicator of POI in many situations and has diagnostic validity and may facilitate more timely diagnosis. AMH seems to be of limited value in predicting age at natural menopause, even with multiple measurements, and there are scarce data regarding prediction of POI, other than when it is imminent, and in some contexts where there is an immediate iatrogenic threat to ovarian function. AMH therefore appears to have considerable value as a diagnostic test for POI, but apart from highlighting broadly those at increased risk, it has inadequate precision to be able to predict accurately the timing of onset of impending POI.
Collapse
Affiliation(s)
- Richard A Anderson
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow, United Kingdom.,NIHR Bristol Biomedical Research Centre, Bristol, United Kingdom
| |
Collapse
|
11
|
Jiao X, Meng T, Zhai Y, Zhao L, Luo W, Liu P, Qin Y. Ovarian Reserve Markers in Premature Ovarian Insufficiency: Within Different Clinical Stages and Different Etiologies. Front Endocrinol (Lausanne) 2021; 12:601752. [PMID: 33815272 PMCID: PMC8015703 DOI: 10.3389/fendo.2021.601752] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To characterize the ovarian reserve indicators for premature ovarian insufficiency (POI) at different disease stages and with various etiologies. METHODS According to different FSH levels and menstrual conditions, patients with normal ovarian reserve (NOR with 5 IU/L<FSH<10 IU/L, n=987), precursor stage of POI (pre-POI with 10 IU/L<FSH ≤ 25 IU/L, n=410), early POI (25 IU/L<FSH ≤ 40 IU/L n=147), and premature ovarian failure (POF with FSH>40 IU/L, n=454) were retrospectively screened and their records were abstracted from Reproductive Hospital Affiliated to Shandong University between 2014 and 2019. Based on the known etiologies, POI patients were subdivided into genetic, iatrogenic, autoimmune and idiopathic subsets according to the known etiologies. The phenotypic features were compared within different subgroups, and the predictive value of ovarian reserve markers was analyzed. RESULTS The ovarian reserve indicators consecutively deteriorated with the progress of ovarian insufficiency, indicated as an increase of FSH and LH but decrease of AMH, inhibin B, AFC, E2 and T (P<0.01). Most of them changed significantly from NOR to pre-POI while remained relatively stable at a low level or even undetectable at early POI and POF stage. AMH showed the highest predictive value for pre-POI (AUC 0.932, 95% CI 0.918-0.945) and POI (AUC 0.944, 95% CI 0.933-0.954), and the combination of AMH and AFC was highly promising for early prediction. Additionally, significant differences existed in AMH, inhibin B and AFC among women with different etiologies of POI (P<0.05), and the genetic POI presented the worst hormone status. CONCLUSIONS Our study indicated a high heterogeneity of POI in both endocrine hormones and etiological phenotypes. The quantitative changes and cutoff values of AMH and AFC could provide new insights in the prediction and early diagnosis of POI.
Collapse
Affiliation(s)
- Xue Jiao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Tingting Meng
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Yiwei Zhai
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Lijuan Zhao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Wei Luo
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Peihao Liu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Yingying Qin
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
- *Correspondence: Yingying Qin,
| |
Collapse
|
12
|
Wen J, Huang K, Du X, Zhang H, Ding T, Zhang C, Ma W, Zhong Y, Qu W, Liu Y, Li Z, Deng S, Luo A, Jin Y, Zhang J, Wang S. Can Inhibin B Reflect Ovarian Reserve of Healthy Reproductive Age Women Effectively? Front Endocrinol (Lausanne) 2021; 12:626534. [PMID: 33935966 PMCID: PMC8081350 DOI: 10.3389/fendo.2021.626534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/19/2021] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The reference range and potential value of inhibin B are still unclear and controversial. This study aimed to define the variation trend of inhibin B in healthy women with age and explore its value in the reflection of ovarian reserve. METHODS A total of 2524 healthy reproductive age women from eight medical institutes nationwide were recruited. The variation tendency of inhibin B with age was primarily established in the first group of 948 women and validated in another 605. We evaluated the relationship between inhibin B and classic ovarian reserve and function markers. The potency of inhibin B in predicting AFC <5-7 was also estimated and compared with FSH. RESULTS The nomogram showed that serum levels of inhibin B rapidly decreased after the age of 40. Inhibin B was positively correlated with AMH (R = 0.57, P < 0.001), AFC (R = 0.34, P < 0.001) and testosterone (R = 0.10, P = 0.002), and negatively correlated with FSH (R = -0.41, P < 0.001) and LH (R = -0.20, P < 0.001) and FSH/LH (R=-0.18, P < 0.001), while no correlation was found with PRL. Unexpectedly, Inhibin B (AUC = 0.74, P < 0.001 for the establishment population; AUC = 0.78, P < 0.001 for the validation population) had a slightly higher value than FSH (AUC = 0.71, P < 0.001 for the establishment population; AUC = 0.72, P < 0.001 for the validation population) in diagnosing AFC <5-7. CONCLUSIONS For healthy reproductive age women, the decline of inhibin B can reflect decreased ovarian reserve effectively, having a good consistency with AMH and AFC. More importantly, inhibin B had an advantage in predicting AFC <5-7 compared with FSH, which suggested the potential of inhibin B in predicting ovarian response. These results will be helpful to the clinical application of inhibin B in the evaluation of female ovarian reserve and the assessment of their reproductive capacity. Trial registration: http://clinicaltrials.gov; NCT02294500.
Collapse
Affiliation(s)
- Jingyi Wen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kecheng Huang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaofang Du
- Department of Obstetrics and Gynecology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hanwang Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Ding
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cuilian Zhang
- Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Wenmin Ma
- Reproductive Medical Center, Foshan Maternal and Child Health Care Hospital, Foshan, China
| | - Ying Zhong
- Reproductive Medical Center, Chengdu Jinjiang Maternal and Child Health Hospital, Chengdu, China
| | - Wenyu Qu
- Reproductive Medical Center, Shenyang Women’s and Children’s Hospital, Shenyang, China
| | - Yi Liu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiying Li
- Department of Obstetrics and Gynecology, Renhe Hospital, China Three Gorges University, Yichang, China
| | - Song Deng
- Department of Gynecology, Minda Hospital of Hubei Minzu University, Enshi, China
| | - Aiyue Luo
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Jin
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinjin Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Shixuan Wang, ; Jinjin Zhang,
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Shixuan Wang, ; Jinjin Zhang,
| |
Collapse
|
13
|
Capuzzo M, Donno V, La Marca A. Polycystic ovary syndrome, amenorrhea and the diagnostic role of anti-Müllerian hormone. MINERVA ENDOCRINOL 2020; 45:376-380. [PMID: 33478206 DOI: 10.23736/s0391-1977.20.03390-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The differential diagnosis of anovulatory disorders is actually based on serum gonadotrophin and estradiol levels. However, several other markers have been proposed. The purpose of this review was to underline the role of anti-Müllerian hormone (AMH) as a possible marker in differential diagnosis of the anovulatory diseases and its use as a predictive marker of prognosis. In this article we discuss clinical and experimental evidences actually existing in literature and we suggest new potential clinical application of AMH.
Collapse
Affiliation(s)
- Martina Capuzzo
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Donno
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio La Marca
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy -
- Clinica EUGIN, Modena, Italy
| |
Collapse
|
14
|
Vagios S, James KE, Sacha CR, Hsu JY, Dimitriadis I, Bormann CL, Souter I. A patient-specific model combining antimüllerian hormone and body mass index as a predictor of polycystic ovary syndrome and other oligo-anovulation disorders. Fertil Steril 2020; 115:229-237. [PMID: 33077236 DOI: 10.1016/j.fertnstert.2020.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/13/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine whether a patient-specific predictive model combining antimüllerian hormone (AMH) levels and body mass index (BMI) can aid in the diagnosis of polycystic ovary syndrome (PCOS) and other ovulatory dysfunction disorders (OVDYS) among infertile women. DESIGN Retrospective cohort study. SETTING Academic fertility center. PATIENT(S) One thousand and ten infertile women undergoing 3,160 intrauterine insemination (IUI) cycles, stratified by diagnosis in three groups: PCOS, OVDYS, and other etiologies. INTERVENTION(S) Ovulation induction followed by IUI or ultrasound-monitored natural cycles. MAIN OUTCOME MEASURE(S) The probability of either PCOS or OVDYS diagnosis based on AMH levels alone and a patient-specific predictive model that combines serum AMH and patient's BMI. RESULT(S) Median and interquartile range (IQR) for the serum AMH levels (ng/mL) were the highest in women with PCOS, and lowest in those with other infertility causes. Overall, for every 1 ng/mL increase in AMH, the odds of PCOS and OVDYS versus other causes increased by 55% and 24%, respectively. Postestimation from multivariate logistic regression models showed that PCOS diagnosis can be predicted with lower AMH values in women with a higher BMI compared with the AMH values predicting PCOS in normal-weight or underweight patients. The receiver operating characteristic curves reinforced these findings, and the best cutoffs for PCOS diagnosis were 7.5, 4.4, and 4.1 ng/mL for women belonging to the BMI groups 18.5-24.9, 25.0-29.9, and ≥30.0 kg/m2, respectively. CONCLUSION(S) Taking into account AMH and BMI, we developed a model that predicts the probability of an oligo-anovulation diagnosis, thus facilitating patient-specific counseling in the infertility setting.
Collapse
Affiliation(s)
- Stylianos Vagios
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Kaitlyn E James
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Caitlin R Sacha
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jennifer Y Hsu
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Irene Dimitriadis
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charles L Bormann
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
15
|
Galazzi E, Persani LG. Differential diagnosis between constitutional delay of growth and puberty, idiopathic growth hormone deficiency and congenital hypogonadotropic hypogonadism: a clinical challenge for the pediatric endocrinologist. MINERVA ENDOCRINOL 2020; 45:354-375. [PMID: 32720501 DOI: 10.23736/s0391-1977.20.03228-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Differential diagnosis between constitutional delay of growth and puberty (CDGP), partial growth hormone deficiency (pGHD) and congenital hypogonadotropic hypogonadism (cHH) may be difficult. All these conditions usually present with poor growth in pre- or peri-pubertal age and they may recur within one familial setting, constituting a highly variable, but somehow common, spectrum of pubertal delay. EVIDENCE ACQUISITION Narrative review of the most relevant English papers published between 1981 and march 2020 using the following search terms "constitutional delay of growth and puberty," "central hypogonadism," "priming," "growth hormone deficiency," "pituitary," "pituitary magnetic resonance imaging," with a special regard to the latest scientific acquisitions. EVIDENCE SYNTHESIS CDGP is by far the most prevalent entity in boys and recurs within families. pGHD is a rare, often idiopathic and transient condition, where hypostaturism presents more severely. Specificity of pGHD diagnosis is increased by priming children before growth hormone stimulation test (GHST); pituitary MRI and genetic analysis are recommended to personalize future follow-up. Diagnosing cHH may be obvious when anosmia and eunuchoid proportions concomitate. However, cHH can either overlap with pGHD in forms of multiple pituitary hormone deficiencies (MPHD) or syndromic conditions either with CDGP in family pedigrees, so endocrine workup and genetic investigations are necessary. The use of growth charts, bone age, predictors of adult height, primed GHST and low dose sex steroids (LDSS) treatment are recommended. CONCLUSIONS Only a step-by-step diagnostic process based on appropriate endocrine and genetic markers together with LDSS treatment can help achieving the correct diagnosis and optimizing outcomes.
Collapse
Affiliation(s)
- Elena Galazzi
- Department of Endocrinology and Metabolic Diseases, IRCCS Auxologico Italian Institute, Milan, Italy -
| | - Luca G Persani
- Department of Endocrinology and Metabolic Diseases, IRCCS Auxologico Italian Institute, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
16
|
Li H, He YL, Li R, Wong C, Sy B, Lam CW, Lam K, Peng HM, Mu S, Schooling M, Yeung W, Ho PC, Ng E. Age-specific reference ranges of serum anti-müllerian hormone in healthy women and its application in diagnosis of polycystic ovary syndrome: a population study. BJOG 2020; 127:720-728. [PMID: 32009280 DOI: 10.1111/1471-0528.16147] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To establish the age-specific centiles of serum anti-müllerian hormone (AMH) levels in Chinese women, and to explore the use of multiples of median (MoM) AMH levels for the diagnosis of polycystic ovary syndrome (PCOS). DESIGN An observational study. SETTING University-affiliated hospitals and community clinics. POPULATION We included 3137 healthy women aged 20-44 years recruited prospectively or who had archived serum samples from previous research projects. Another validation cohort of 751 women with PCOS as well as ovulatory controls, which was a convenient sample of women attending for infertility or menstrual disorders, was also studied. METHODS The serum samples were assayed for AMH by the automated Access AMH assay. MAIN OUTCOME MEASURES Age-specific reference ranges were constructed on the primary cohort with the Lambda-Mu-Sigma method. The MoM AMH of each subject in the validation cohort was calculated. RESULTS Centile curves of serum AMH level against age were established. MoM AMH was significantly higher in women with PCOS than in controls (P < 0.05). The area under the ROC curve was 0.852 (95% confidence interval [CI] 0.825-0.877) (P < 0.0001) for discriminating women with PCOS from ovulatory controls by MoM AMH. CONCLUSIONS We established a set of year-by-year age-specific reference ranges of serum AMH levels in Chinese women. The MoM AMH derived from this set of reference ranges is a promising tool to replace antral follicle count in the diagnosis of PCOS. TWEETABLE ABSTRACT A set of age-specific reference ranges of AMH levels was established in Chinese women. Multiples of median AMH may be used to diagnose PCOS.
Collapse
Affiliation(s)
- Hwr Li
- Key Laboratory of Fertility Regulation, Department of Obstetrics and Gynaecology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.,Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong.,The Family Planning Association of Hong Kong, Hong Kong, Hong Kong
| | - Y-L He
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - R Li
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Cyg Wong
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong.,The Family Planning Association of Hong Kong, Hong Kong, Hong Kong
| | - B Sy
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - C W Lam
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ksl Lam
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - H-M Peng
- Reproductive Medicine Center, People's Liberation Army General Hospital, Beijing, China
| | - S Mu
- Reproductive Medicine Center, People's Liberation Army General Hospital, Beijing, China
| | - M Schooling
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wsb Yeung
- Key Laboratory of Fertility Regulation, Department of Obstetrics and Gynaecology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.,Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - P C Ho
- Key Laboratory of Fertility Regulation, Department of Obstetrics and Gynaecology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.,Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ehy Ng
- Key Laboratory of Fertility Regulation, Department of Obstetrics and Gynaecology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.,Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| |
Collapse
|
17
|
Capuzzo M, La Marca A. Use of AMH in the Differential Diagnosis of Anovulatory Disorders Including PCOS. Front Endocrinol (Lausanne) 2020; 11:616766. [PMID: 33633686 PMCID: PMC7901963 DOI: 10.3389/fendo.2020.616766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/16/2020] [Indexed: 12/15/2022] Open
Abstract
Since the historical use of gonadotrophin and estradiol levels to define the different anovulatory disorders has shown some limitations, the use of other markers such as anti-müllerian hormone (AMH) has been proposed. This review addresses the role of AMH in the differential diagnosis of anovulatory disorders, especially focusing on its value in the prognostic characterization of their severity. Current limitations and future clinical applications are discussed.
Collapse
Affiliation(s)
- Martina Capuzzo
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio La Marca
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
- Clinica EUGIN, Modena, Italy
- *Correspondence: Antonio La Marca,
| |
Collapse
|
18
|
Yetim Şahin A, Baş F, Yetim Ç, Uçar A, Poyrazoğlu Ş, Bundak R, Darendeliler F. Determination of insulin resistance and its relationship with hyperandrogenemia,anti-Müllerian hormone, inhibin A, inhibin B, and insulin-like peptide-3 levels in adolescent girls with polycystic ovary syndrome. Turk J Med Sci 2019; 49:1117-1125. [PMID: 31286756 PMCID: PMC7018291 DOI: 10.3906/sag-1808-52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background/aim This study aims to investigate the association between polycystic ovary syndrome (PCOS) and obesity and insulin resistance (IR) with respect to anti-Müllerian hormone (AMH), inhibin A (INH-A), inhibin B (INH-B), and insulin-like peptide 3 (INSL3) levels, all factors which may have an impact on IR. Materials and methods In this cross sectional study, 52 adolescent girls diagnosed with PCOS[groups: nonobese (NO), n = 23; overweight/obese (OW/O), n = 29] were included. Blood samples were obtained to measure AMH, INH-B, INH-A, and INSL3 levels, together with hormonal and biochemical assessments. Oral glucose tolerance test (OGTT) was performed and the indexes of IR [homeostasis model assessment: insulin resistance (HOMA-IR) and Matsuda index] were calculated. Results Insulin resistance was 56.5% with OGTT and 30.4% with HOMA-IR in nonobese-PCOS girls. There was a correlation between INH-A and HOMA-IR even when controlled for body mass index (BMI). INH-B and FAI also had correlations with HOMA-IR which disappeared when controlled for BMI. In regression analyses, AMH (odds ratio = [0.903, P = 0.015) and FAI (odds ratio = 1.353, P = 0.023) are found to be contributors to IR. Their effect was BMI-independent. In ROC analysis, the cutoff value for FAI was 5.93 (sensitivity 71%) to define IR in PCOS girls. Conclusion AMH and FAI may contribute to IR (defined by OGTT) in PCOS. FAI might be used as a supporting IR marker (defined by OGTT) in adolescent girls with PCOS.
Collapse
Affiliation(s)
- Aylin Yetim Şahin
- Division of Adolescent Medicine, Department of Pediatrics, İstanbul School of Medicine, İstanbul University, İstanbul, Turkey
| | - Firdevs Baş
- Division of Adolescent Medicine, Department of Pediatrics, İstanbul School of Medicine, İstanbul University, İstanbul, Turkey,Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics,İstanbul School of Medicine, İstanbul University, İstanbul, Turkey
| | - Çağcıl Yetim
- Department of Gynecology and Obstetrics, School of Medicine, Biruni University, İstanbul, Turkey
| | - Ahmet Uçar
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics,İstanbul School of Medicine, İstanbul University, İstanbul, Turkey
| | - Rüveyde Bundak
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics,İstanbul School of Medicine, İstanbul University, İstanbul, Turkey
| | - Feyza Darendeliler
- Division of Adolescent Medicine, Department of Pediatrics, İstanbul School of Medicine, İstanbul University, İstanbul, Turkey,Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics,İstanbul School of Medicine, İstanbul University, İstanbul, Turkey
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Jiao X, Zhang H, Ke H, Zhang J, Cheng L, Liu Y, Qin Y, Chen ZJ. Premature Ovarian Insufficiency: Phenotypic Characterization Within Different Etiologies. J Clin Endocrinol Metab 2017; 102:2281-2290. [PMID: 28368522 DOI: 10.1210/jc.2016-3960] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/22/2017] [Indexed: 01/03/2023]
Abstract
CONTEXT Premature ovarian insufficiency (POI) is highly heterogeneous, both in phenotype and etiology. They are not yet clearly stated and correlated. OBJECTIVE To characterize clinical presentations of a large, well-phenotyped cohort of women with POI, and correlate phenotypes with etiologies to draw a comprehensive clinical picture of POI. DESIGN, PATIENTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES In this retrospective study, a total of 955 Chinese women with overt POI between 2006 and 2015 were systemically evaluated and analyzed. The phenotypic features, including menstrual characteristics, hormone profiles, ovarian ultrasonography/biopsy, pregnancy/family history, and genetic/autoimmune/iatrogenic etiologies were assessed and further compared within different subgroups. RESULTS Among 955 women with POI, 85.97% presented with secondary amenorrhea (SA) and 14.03% with primary amenorrhea (PA). PA represented the most severe ovarian dysfunction and more chromosomal aberrations than SA. The decline of ovarian function in patients with SA progressed quickly. They had shortened reproductive periods (approximately 10 years) and developed amenorrhea within 1 to 2 years after menstrual irregularity. The ovaries were invisible or small, and the presence of follicles (28.43%) was correlated with other good reproductive indicators. Familial patients (12.25%) manifested better ovarian status and fewer chromosomal aberrations than sporadic patients. The etiologies consisted of genetic (13.15%), autoimmune (12.04%), and iatrogenic (7.29%), approximately 68% remaining idiopathic. There were significant differences among different etiologies, with the genetic group representing the most severe phenotype. CONCLUSION Our results regarding distinct phenotypic characteristics and association with different etiologies further confirmed the high heterogeneity of POI. Additional longitudinal clinical studies and pathogenesis research are warranted.
Collapse
Affiliation(s)
- Xue Jiao
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, 250001, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, 250001, Shandong, China
- The Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, Jinan, 250001, Shandong, China
- Suzhou Institute of Shandong University, Suzhou, 215123, Jiangsu, China
| | - Huihui Zhang
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, 250001, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, 250001, Shandong, China
- The Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, Jinan, 250001, Shandong, China
- Center for Reproductive Medicine, Linyi People's Hospital, Linyi, 276003, Shandong, China
| | - Hanni Ke
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, 250001, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, 250001, Shandong, China
- The Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, Jinan, 250001, Shandong, China
| | - Jiangtao Zhang
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, 250001, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, 250001, Shandong, China
- The Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, Jinan, 250001, Shandong, China
| | - Lei Cheng
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, 250001, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, 250001, Shandong, China
- The Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, Jinan, 250001, Shandong, China
| | - Yixun Liu
- State Key Laboratory of Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Yingying Qin
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, 250001, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, 250001, Shandong, China
- The Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, Jinan, 250001, Shandong, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, 250001, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, 250001, Shandong, China
- The Key Laboratory of Reproductive Endocrinology, Shandong University, Ministry of Education, Jinan, 250001, Shandong, China
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200135, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China
| |
Collapse
|
21
|
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]
|
22
|
Bry-Gauillard H, Larrat-Ledoux F, Levaillant JM, Massin N, Maione L, Beau I, Binart N, Chanson P, Brailly-Tabard S, Hall JE, Young J. Anti-Müllerian Hormone and Ovarian Morphology in Women With Isolated Hypogonadotropic Hypogonadism/Kallmann Syndrome: Effects of Recombinant Human FSH. J Clin Endocrinol Metab 2017; 102:1102-1111. [PMID: 28324034 DOI: 10.1210/jc.2016-3799] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 01/24/2017] [Indexed: 02/13/2023]
Abstract
CONTEXT Isolated hypogonadotropic hypogonadism (IHH), characterized by gonadotropin deficiency and absent puberty, is very rare in women. IHH prevents pubertal ovarian stimulation, but anti-Müllerian hormone (AMH) and antral follicle count (AFC) have not been studied. OBJECTIVES (1) To compare, in IHH vs controls, AMH, ovarian volume (OV), and AFC. (2) To compare, in IHH, ovarian responses to recombinant human follicle-stimulating hormone (rhFSH) and rhFSH plus recombinant human luteinizing hormone (rhLH). SUBJECTS Sixty-eight IHH women; 51 matched healthy women. METHODS Serum LH, FSH, sex steroids, inhibin B (InhB), AMH, and OV and AFC (sonography) were compared. Ovarian response during rhFSH administration was assessed in 12 IHH women with low AMH levels and low AFC and compared with hormonal changes observed in six additional IHH women receiving rhFSH plus rhLH. RESULTS InhB was lower in IHH than in controls. AMH levels were also significantly lower in the patients, but two-thirds had normal values. Mean OV and total, larger, and smaller AFCs were lower in IHH than in controls. Ovarian stimulation by rhFSH led to a significant increase in serum estradiol and InhB levels and in the number of larger antral follicles. AMH and smaller AFC increased early during rhFSH stimulation but then declined despite continued stimulation. rhFSH plus rhLH stimulation led to a significantly higher increase in estradiol levels but to similar changes in circulating InhB and AMH than with rhFSH alone. CONCLUSIONS IHH women have both low AMH levels and low AFC. However, their decrease can be reversed by follicle-stimulating hormone. Serum AMH and AFC should not serve as prognostic markers of fertility in this population.
Collapse
Affiliation(s)
- Hélène Bry-Gauillard
- Assistance Publique-Hôpitaux de Paris
- Department of Reproductive Endocrinology
- Medical Procreation Unit, Gynecology-Obstetrics Department, University of Paris XII, Créteil Hospital, 94000 Créteil, France
| | | | - Jean-Marc Levaillant
- Assistance Publique-Hôpitaux de Paris
- Department of Gynecology-Obstetrics, and
- University of Paris-Sud, Paris-Sud Medical School, 94276 Le Kremlin-Bicêtre, France
- Medical Procreation Unit, Gynecology-Obstetrics Department, University of Paris XII, Créteil Hospital, 94000 Créteil, France
| | - Nathalie Massin
- Medical Procreation Unit, Gynecology-Obstetrics Department, University of Paris XII, Créteil Hospital, 94000 Créteil, France
| | - Luigi Maione
- Assistance Publique-Hôpitaux de Paris
- Department of Reproductive Endocrinology
- Department of Hormonology and Molecular Genetics, Bicêtre Hospital, 94275 Le Kremlin-Bicêtre, France
- University of Paris-Sud, Paris-Sud Medical School, 94276 Le Kremlin-Bicêtre, France
| | - Isabelle Beau
- Department of Reproductive Endocrinology
- University of Paris-Sud, Paris-Sud Medical School, 94276 Le Kremlin-Bicêtre, France
- INSERM Unité 1185, 94276 Le Kremlin-Bicêtre, France
| | - Nadine Binart
- University of Paris-Sud, Paris-Sud Medical School, 94276 Le Kremlin-Bicêtre, France
- INSERM Unité 1185, 94276 Le Kremlin-Bicêtre, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris
- Department of Reproductive Endocrinology
- University of Paris-Sud, Paris-Sud Medical School, 94276 Le Kremlin-Bicêtre, France
- INSERM Unité 1185, 94276 Le Kremlin-Bicêtre, France
| | - Sylvie Brailly-Tabard
- Assistance Publique-Hôpitaux de Paris
- Department of Hormonology and Molecular Genetics, Bicêtre Hospital, 94275 Le Kremlin-Bicêtre, France
- University of Paris-Sud, Paris-Sud Medical School, 94276 Le Kremlin-Bicêtre, France
- INSERM Unité 1185, 94276 Le Kremlin-Bicêtre, France
| | - Janet E Hall
- Reproductive Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
- Clinical Research Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709
| | - Jacques Young
- Assistance Publique-Hôpitaux de Paris
- Department of Reproductive Endocrinology
- University of Paris-Sud, Paris-Sud Medical School, 94276 Le Kremlin-Bicêtre, France
- INSERM Unité 1185, 94276 Le Kremlin-Bicêtre, France
| |
Collapse
|
23
|
Li H, Wong B, Ip W, Yeung W, Ho P, Ng E. Comparative evaluation of three new commercial immunoassays for anti-Müllerian hormone measurement. Hum Reprod 2016; 31:2796-2802. [DOI: 10.1093/humrep/dew248] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/25/2016] [Accepted: 09/06/2016] [Indexed: 11/13/2022] Open
|
24
|
Iwase A, Nakamura T, Osuka S, Takikawa S, Goto M, Kikkawa F. Anti-Müllerian hormone as a marker of ovarian reserve: What have we learned, and what should we know? Reprod Med Biol 2015; 15:127-136. [PMID: 29259429 DOI: 10.1007/s12522-015-0227-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 11/06/2015] [Indexed: 01/05/2023] Open
Abstract
Ovarian reserve reflects the quality and quantity of available oocytes. This reserve has become indispensable for the better understanding of reproductive potential. Measurement of the serum anti-Müllerian hormone (AMH) level allows quantitative evaluation of ovarian reserve. It has been applied to a wide range of clinical conditions, and it is well established that the measurement of serum AMH levels is more useful than qualitative evaluation based on the menstrual cycle. AMH levels are monitored during infertility treatments; in patients undergoing medically assisted reproductive technology; and in the diagnosis of ovarian failure, polycystic ovarian syndrome, and granulosa cell tumor. It is also useful in the evaluation of iatrogenic ovarian damage. Population-based studies have indicated a potential role for serum AMH in the planning of reproductive health management. While AMH is currently the best measure of ovarian reserve, its predictive value for future live births remains controversial. Furthermore, there is a serious practical issue in the interpretation of test results, as currently available assay kits use different assay ranges and coefficients of variation due to the absence of an international reference standard. The pros and cons of the serum AMH level as a definitive measure of ovarian reserve merits further review in order to guide future research.
Collapse
Affiliation(s)
- Akira Iwase
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
- Department of Maternal and Perinatal Medicine Nagoya University Hospital 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| | - Tomoko Nakamura
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| | - Satoko Osuka
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| | - Sachiko Takikawa
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| |
Collapse
|
25
|
Singh AK, Singh R. Can anti-Mullerian hormone replace ultrasonographic evaluation in polycystic ovary syndrome? A review of current progress. Indian J Endocrinol Metab 2015; 19:731-743. [PMID: 26693422 PMCID: PMC4673800 DOI: 10.4103/2230-8210.167548] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Several studies over the past decade have now consistently indicated that the serum anti-Mullerian hormone (AMH) levels are at least 2-3-fold higher in the patients with polycystic ovary syndrome (PCOS), which also corresponds to the increased number of AMH producing preantral and small antral follicles. Moreover, AMH levels have been found to be associated in direct proportion to the follicle numbers per ovary or antral follicular count, assessed by the transvaginal ultrasound (TVS). Furthermore, AMH correlates directly with the rising serum testosterone and luteinizing hormone levels in PCOS. Hence, serum AMH in women with oligo-anovulation and/or hyperandrogenemia could indicate the presence of underlying PCOS, when reliable TVS is not feasible, or not acceptable, either due to the virginal status or psycho-social issue. In addition, the imaging quality of abdominal ultrasound is often impaired by obesity, which typically occurs in PCOS women. Indeed, PCOS occurs most commonly in young females who cannot be subjected to invasive TVS for various reasons; therefore, a desirable alternative to TVS is urgently required to diagnose the most prevalent endocrine abnormality of young women. This review will analyze the currently available evidence regarding the role of AMH in the diagnosis of PCOS.
Collapse
Affiliation(s)
- Awadhesh Kumar Singh
- Department of Endocrinology, GD Hospital and Diabetes Institute, Kolkata, West Bengal, India
- Department of Endocrinology, Sun Valley Diabetes Hospital, Guwahati, Assam, India
| | - Ritu Singh
- Department of Gynecology, GD Hospital and Diabetes Institute, Kolkata, West Bengal, India
| |
Collapse
|
26
|
Lie Fong S, Schipper I, Valkenburg O, de Jong FH, Visser JA, Laven JS. The role of anti-Müllerian hormone in the classification of anovulatory infertility. Eur J Obstet Gynecol Reprod Biol 2015; 186:75-9. [DOI: 10.1016/j.ejogrb.2015.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 12/04/2014] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
|
27
|
AMH: An ovarian reserve biomarker in assisted reproduction. Clin Chim Acta 2014; 437:175-82. [DOI: 10.1016/j.cca.2014.07.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 07/18/2014] [Accepted: 07/23/2014] [Indexed: 11/22/2022]
|
28
|
Qin C, Yuan Z, Yao J, Zhu W, Wu W, Xie J. AMH and AMHR2 genetic variants in Chinese women with primary ovarian insufficiency and normal age at natural menopause. Reprod Biomed Online 2014; 29:311-8. [DOI: 10.1016/j.rbmo.2014.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 05/02/2014] [Accepted: 05/06/2014] [Indexed: 11/17/2022]
|
29
|
Pinola P, Morin-Papunen LC, Bloigu A, Puukka K, Ruokonen A, Järvelin MR, Franks S, Tapanainen JS, Lashen H. Anti-Müllerian hormone: correlation with testosterone and oligo- or amenorrhoea in female adolescence in a population-based cohort study. Hum Reprod 2014; 29:2317-25. [PMID: 25056088 PMCID: PMC4164146 DOI: 10.1093/humrep/deu182] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
STUDY QUESTIONS Can serum anti-Müllerian hormone (AMH) levels measured in female adolescents predict polycystic ovary syndrome (PCOS)-associated features in adolescence and early adulthood? SUMMARY ANSWER AMH levels associated well with PCOS-associated features (such as testosterone levels and oligoamenorrhoea) in adolescence, but was not an ideal marker to predict PCOS-associated features in early adulthood. WHAT IS KNOWN ALREADY Several studies have reported that there is a strong correlation between antral follicle count and serum AMH levels and that women with PCOS/PCO have significantly higher serum AMH levels than women with normal ovaries. Other studies have reported an association between AMH serum levels and hyperandrogenism in adolescence, but none has prospectively assessed AMH as a risk predictor for developing features of PCOS during adulthood. STUDY DESIGN, SIZE, DURATION A subset of 400 girls was selected from the prospective population-based Northern Finland Birth Cohort 1986 (n = 4567 at age 16 and n = 4503 at age 26). The population has been followed from 1986 to the present. PARTICIPANTS/MATERIAL, SETTING, METHODS At age 16, 400 girls (100 from each testosterone quartile: 50 with oligo- or amenorrhoea and 50 with a normal menstrual cycle) were selected at random from the cohort for AMH measurement. Metabolic parameters were also assessed at age 16 in all participants. Postal questionnaires enquired about oligo- or amenorrhoea, hirsutism, contraceptive use and reproductive health at ages 16 and 26. MAIN RESULTS AND ROLE OF CHANCE There was a significant correlation between AMH and testosterone at age 16 (r = 0.36, P < 0.001). AMH levels at age 16 were significantly higher among girls with oligo- or amenorrhoea compared with girls with normal menstrual cycles (35.9 pmol/l [95% CI: 33.2;38.6] versus 27.7 pmol/l [95% CI: 25.0;30.4], P < 0.001). AMH at age 16 was higher in girls who developed hirsutism at age 26 compared with the non-hirsute group (31.4 pmol/l [95% CI 27.1;36.5] versus 25.8 pmol/l [95% CI 23.3;28.6], P = 0.036). AMH at age 16 was also higher in women with PCOS at age 26 compared with the non-PCOS subjects (38.1 pmol/l [95% CI 29.1;48.4] versus 30.2 pmol/l [95% CI 27.9;32.4], P = 0.044). The sensitivity and specificity of the AMH (cut-off 22.5 pmol/l) for predicting PCOS at age 26 was 85.7 and 37.5%, respectively. The addition of testosterone did not significantly improve the accuracy of the test. There was no significant correlation between AMH levels and metabolic indices at age 16. IMPLICATIONS, REASONS FOR CAUTION AMH is related to oligo- or amenorrhoea in adolescence, but it is not a good marker for metabolic factors. The relatively low rate of participation in the questionnaire at age 26 may also have affected the results. AMH was measured in a subset of the whole cohort. AMH measurement is lacking international standardization and therefore the concentrations and cut-off points are method dependent. WIDER IMPLICATIONS FOR THE FINDINGS Using a high enough cut-off value of AMH to predict which adolescents are likely to develop PCOS in adulthood could help to manage the condition from an early age due to a good sensitivity. However, because of its low specificity, it is not an ideal diagnostic marker, and its routine use in clinical practice cannot, at present, be recommended. STUDY FUNDINGS AND COMPETING INTERESTS The study was funded by a grant from Wellcome Trust (089549/Z/09/Z) to H.L., S.F. and M.-R.J. Study funding was also received from Oulu University Hospital Research Funds, Sigrid Juselius Foundation and the Academy of Finland. None of the authors have any competing interest to declare.
Collapse
Affiliation(s)
- P Pinola
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu and Medical Research Center Oulu, Oulu, Finland
| | - L C Morin-Papunen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu and Medical Research Center Oulu, Oulu, Finland
| | - A Bloigu
- Department of Children and Young People and Families, National Institute for Health and Welfare, Aapistie 1, Box 310, FI-90101 Oulu, Finland
| | - K Puukka
- NordLab Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - A Ruokonen
- NordLab Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - M-R Järvelin
- Department of Children and Young People and Families, National Institute for Health and Welfare, Aapistie 1, Box 310, FI-90101 Oulu, Finland Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, Imperial College London, London, UK Institute of Health Sciences, University of Oulu, PO Box 5000, FI-90014 Oulu, Finland Biocenter Oulu, University of Oulu, Aapistie 5A, PO Box 5000, FI-90014 Oulu, Finland Unit of Primary Care, Oulu University Hospital, Kajaanintie 50, PO Box 20, FI-90220 Oulu, 90029 OYS, Finland
| | - S Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - J S Tapanainen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu and Medical Research Center Oulu, Oulu, Finland Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - H Lashen
- Department of Human Metabolism, University of Sheffield, Jessop Wing, Sheffield, UK
| |
Collapse
|
30
|
Deubzer B, Weber K, Lawrenz B, Schweizer R, Binder G. Anti-mullerian hormone deficiency in girls with congenital multiple pituitary hormone deficiency. J Clin Endocrinol Metab 2014; 99:E1045-9. [PMID: 24635131 DOI: 10.1210/jc.2013-4250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Anti-Mullerian hormone (AMH) is believed to validly reflect the ovarian reserve. We wanted to test whether congenital absence of gonadotropin stimulation of the ovaries affects AMH production. OBJECTIVE The objective of the study was to test the validity of AMH as a marker for the ovarian reserve in females with congenital multiple pituitary hormone deficiency (MPHD; deficiency of three or more axes). DESIGN This was a retrospective laboratory study. SETTING The study was conducted in the Department of Pediatric Endocrinology in a tertiary center. PATIENTS The AMH serum levels were assessed in females with congenital (n = 16; median age 12.5 y, range 0.7-31 y) or acquired (n = 20; 18.5 y, range 2-33 y) MPHD and in controls with short stature (n = 100; 9.7 y, range 2-17 y). MAIN OUTCOME MEASURE AMH was measured by AMH Gen II ELISA from Beckmann Coulter. RESULTS In the controls, AMH ranged between 1.8 (P3) and 67.8 pmol/L (P97). Three patients with a severe form of congenital MPHD were AMH deficient, whereas the other 33 patients with MPHD had normal AMH levels. There was significantly more AMH deficiency in congenital than in acquired MPHD (P < .05). CONCLUSIONS Most girls with MPHD have normal serum AMH levels. However, some females with severe congenital MPHD are AMH deficient. This deficiency might be the result of the total absence of gonadotropins. In these females, AMH is unlikely to be an accurate prognostic parameter of the efficacy of fertility treatment.
Collapse
Affiliation(s)
- Beate Deubzer
- Department of Pediatric Endocrinology (B.D., K.W., R.S., G.B.), University Children's Hospital Tübingen, and Department of Gynecological Endocrinology and Reproductive Medicine (B.L.), University Women's Hospital, 72076 Tübingen, Germany (now FakihIVF, Abu Dhabi, United Arab Emirates)
| | | | | | | | | |
Collapse
|
31
|
Dewailly D, Andersen CY, Balen A, Broekmans F, Dilaver N, Fanchin R, Griesinger G, Kelsey TW, La Marca A, Lambalk C, Mason H, Nelson SM, Visser JA, Wallace WH, Anderson RA. The physiology and clinical utility of anti-Müllerian hormone in women. Hum Reprod Update 2014; 20:370-85. [DOI: 10.1093/humupd/dmt062] [Citation(s) in RCA: 577] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
32
|
Johansson J, Stener-Victorin E. Polycystic ovary syndrome: effect and mechanisms of acupuncture for ovulation induction. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2013:762615. [PMID: 24073009 PMCID: PMC3773899 DOI: 10.1155/2013/762615] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/23/2013] [Indexed: 12/22/2022]
Abstract
Polycystic ovary syndrome (PCOS), the most common endocrine disorder among women of reproductive age, is characterized by the coexistence of hyperandrogenism, ovulatory dysfunction, and polycystic ovaries (PCO). PCOS also represents the largest part of female oligoovulatory infertility, and the management of ovulatory and menstrual dysfunction, comprises a third of the high costs of PCOS treatment. Current pharmacological and surgical treatments for reproductive symptoms are effective, however, associated with negative side effects, such as cardiovascular complications and multiple pregnancies. For menstrual irregularities and ovulation induction in women with PCOS, acupuncture has indicated beneficial effects. This review will focus on the results from randomized controlled acupuncture trials for regulation of menstrual dysfunction and for inducing ovulation in women with PCOS although there are uncontrolled trials with nonetheless interesting results. Animal experimental studies will be further discussed when they can provide a more mechanistic explanatory view.
Collapse
Affiliation(s)
- Julia Johansson
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Box 434, 405 30 Gothenburg, Sweden
| | - Elisabet Stener-Victorin
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Box 434, 405 30 Gothenburg, Sweden
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China
| |
Collapse
|
33
|
Dubourdieu S, Fréour T, Dessolle L, Barrière P. Prospective, randomized comparison between pulsatile GnRH therapy and combined gonadotropin (FSH+LH) treatment for ovulation induction in women with hypothalamic amenorrhea and underlying polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2013; 168:45-8. [DOI: 10.1016/j.ejogrb.2012.12.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 11/26/2012] [Accepted: 12/16/2012] [Indexed: 11/27/2022]
|
34
|
High prevalence of chronic thyroiditis in patients with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2013; 169:248-51. [PMID: 23548659 DOI: 10.1016/j.ejogrb.2013.03.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/18/2013] [Accepted: 03/05/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A higher prevalence (26.9% versus 8.3% of controls) of autoimmune thyroiditis (AIT) in polycystic ovary syndrome (PCOS) has been reported in one study to date. We aimed to evaluate the prevalence of clinical, subclinical, potential thyroid autoimmune diseases and other organ-specific autoimmunity in a group of Italian patients with PCOS. STUDY DESIGN 113 consecutive patients referred to our endocrinology unit as outpatients over 18 months, and diagnosed with PCOS according to the Rotterdam criteria, were included in the study, and 100 age-matched healthy women were enrolled as controls. Each patient was evaluated for family and personal history of autoimmune and non-autoimmune diseases and tested for autoantibodies against thyroperoxidase, thyroglobulin, parietal cells, intrinsic factor, adrenal-cortex, 21-hydroxylase, steroid-producing cells, 17-alpha-hydroxylase, side-chain cleavage enzyme, islet-cells, glutamic-acid decarboxylase, nuclei and mitochondria. All patients had serum TSH, FT4 and FT3 tested and patients with thyroid autoantibodies and/or abnormal TSH levels had an ultrasound thyroid scan. An oral glucose tolerance test and measurements of serum anti-Mullerian hormone (AMH) and inhibin B levels were carried out. RESULTS AIT was present in 30/113 (27%) patients compared with 8% of controls (p<0.001). Subclinical hypothyroidism was detected in 13/30 (43%) patients with AIT; the remaining patients had normal thyroid function. The prevalence of non-thyroid autoantibodies in PCOS patients was not different from controls. AMH concentration was higher in PCOS patients compared to controls, but there was no difference between AIT and non-AIT groups. CONCLUSIONS The prevalence of AIT in patients with PCOS was significantly higher than in controls. No other autoimmune diseases were associated with PCOS. This observation suggests that PCOS patients should be screened for AIT.
Collapse
|
35
|
Impact of breast cancer on anti-mullerian hormone levels in young women. Breast Cancer Res Treat 2012; 137:571-7. [PMID: 23224236 DOI: 10.1007/s10549-012-2361-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
Abstract
Young women with breast cancer face treatments that impair ovarian function, but it is not known if malignancy itself impacts ovarian reserve. As more breast cancer patients consider future fertility, it is important to determine if ovarian reserve is impacted by cancer, prior to any therapeutic intervention. A cross-sectional study was conducted comparing if ovarian reserve, as measured by anti-mullerian hormone (AMH), follicle stimulating hormone (FSH), and inhibin B (inhB), differed between 108 women with newly diagnosed breast cancer and 99 healthy women without breast cancer. Breast cancer participants were ages 28-44 and were recruited from two clinical breast programs. Healthy women ages 30-44 without a history of infertility were recruited from gynecology clinics and the community. The median age (interquartile range) was 40.2(5.5) years for breast cancer participants and 33.0(4.6) years for healthy controls. The unadjusted geometric mean AMH levels (SD) for breast cancer participants and controls were 0.66(3.6) and 1.1(2.9) ng/mL, respectively. Adjusting for age, body mass index, gravidity, race, menstrual pattern, and smoking, mean AMH levels were not significantly different between breast cancer participants and healthy controls (0.85 vs. 0.76 ng/mL, p = 0.60). FSH and inhB levels did not differ by breast cancer status. In exploratory analysis, the association between AMH and breast cancer status differed by age (p-interaction = 0.02). AMH may be lower with breast cancer status in women older than 37. In younger women, AMH levels did not differ significantly by breast cancer status. Among the youngest of breast cancer patients, ovarian reserve as measured by AMH, FSH, and inhibin B did not differ significantly from healthy women of similar age. In older breast cancer patients, ovarian reserve may be adversely impacted by cancer status. These findings support the potential success and need for fertility preservation strategies prior to institution of cancer treatment.
Collapse
|
36
|
Abstract
PURPOSE OF REVIEW To review what is understood about the pathophysiology of polycystic ovarian syndrome (PCOS), the diagnostic challenges of PCOS in adolescent women, associated risk factors, as well as the best evidence-based treatment options for adolescence. RECENT FINDINGS Diagnosing PCOS in adolescents requires a unique set of criteria for which no single marker currently exists. Adolescents at high risk for developing the syndrome are congenital virilization, low birth weight, premature pubarche, central precocious puberty, large for gestational age girls born to overweight mothers, obesity syndromes, insulin-resistant features, and girls born to parents with PCOS, central obesity, or diabetes in whom PCOS ought to be suspected when associated with irregular menses. Insulin, hyperandrogenemia, and adipocytokines are integral players in the pathophysiology of PCOS. PCOS may be an inheritable trait; however, no gene has yet been identified. Quality of life remains a concern for young women with PCOS. Lifestyle modifications geared to prevent long-term sequelae remain the first-line treatment in conjunction with oral contraceptive pills. SUMMARY Identifying PCOS in adolescents remains a diagnostic dilemma, but early intervention and treatment can improve long-term health.
Collapse
Affiliation(s)
- Katrina F Nicandri
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | | |
Collapse
|
37
|
Hagen CP, Vestergaard S, Juul A, Skakkebæk NE, Andersson AM, Main KM, Hjøllund NH, Ernst E, Bonde JP, Anderson RA, Jensen TK. Low concentration of circulating antimüllerian hormone is not predictive of reduced fecundability in young healthy women: a prospective cohort study. Fertil Steril 2012; 98:1602-8.e2. [DOI: 10.1016/j.fertnstert.2012.08.008] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 08/06/2012] [Accepted: 08/07/2012] [Indexed: 11/29/2022]
|
38
|
Li HWR, Ng EHY, Wong BPC, Anderson RA, Ho PC, Yeung WSB. Correlation between three assay systems for anti-Müllerian hormone (AMH) determination. J Assist Reprod Genet 2012; 29:1443-6. [PMID: 23117477 PMCID: PMC3528883 DOI: 10.1007/s10815-012-9880-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 10/16/2012] [Indexed: 12/01/2022] Open
Abstract
Purpose Analysis of anti-Müllerian hormone (AMH) is becoming of recognized importance in reproductive medicine, but assays are not standardized. We have evaluated the correlation between the new Gen II ELISA kit (Beckman-Coutler) and the older ELISA kits by Immunotech (IOT) and Diagnostic Systems Laboratories (DSL). Methods A total of 56 archived serum samples from patients with subfertility or reproductive endocrine disorders were retrieved and assayed in duplicate using the three AMH ELISA kits . The samples covered a wide range of AMH concentrations (1.9 to 142.5 pmol/L). Results We observed good correlations between the new (AMH Gen II) and old AMH assay kits by IOT and DSL (R2 = 0.971 and 0.930 respectively). The regression equations were AMH (Gen II) = 1.353 × AMH (IOT) + 0.051 and AMH (Gen II) = 1.223 × AMH (DSL) – 1.270 respectively. Conclusions AMH concentrations using the Gen II kit are slightly higher than those from the IOT and DSL kits. Standardization of assay results worldwide is urgently required but this analysis facilitates the interpretation of values obtained historically and in future studies using any of the 3 assays available. Meanwhile, adapting clinical cut-offs from previously published work by direct conversion is not recommended.
Collapse
Affiliation(s)
- Hang Wun Raymond Li
- Department of Obstetrics & Gynaecology, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, PR China.
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
The measurement anti-Müllerian hormone (AMH) is leading to new insights into ovarian function. AMH is produced by small growing follicles, thus is distinct from ovulation and is a step closer to being able to assess the true ovarian reserve. AMH is measureable from birth to near the menopause, with a peak in the mid-20s. Changes in adolescence are likely to lead to new understanding of ovarian maturation at puberty. AMH is becoming a routine test in assisted conception, reflecting a decline in the primordial follicle pool during the later reproductive years, and also identifying women at risk of over-response. Thus, its relationship with the ovarian reserve changes from an inverse one in the first quarter century to a positive one thereafter as both decline in parallel. AMH does not vary significantly across the menstrual cycle, but it is not fully gonadotrophin-independent, showing delayed changes consistent with the site of production from smaller growing follicles. There is considerable interest, both professional and public, in its ability to predict remaining reproductive lifespan, which clinically may be of value in the assessment of ovarian reserve following damage, for example postchemotherapy or ovarian surgery. AMH is markedly increased in polycystic ovarian syndrome and may be of diagnostic value. The considerable promise of AMH measurement is ahead of the robustness of the data in allowing clinical interpretation in most contexts, but it is clear that it will in the future offer novel opportunities for the assessment of ovarian function in health as well as disease.
Collapse
Affiliation(s)
- Richard A Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
40
|
Current World Literature. Curr Opin Obstet Gynecol 2012; 24:194-9. [DOI: 10.1097/gco.0b013e328353d51d] [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]
|
41
|
Sonntag B, Nawroth F, Ludwig M, Bullmann C. Anti-Müllerian hormone in women with hypopituitarism diagnosed before or during adolescence. Reprod Biomed Online 2012; 25:190-2. [PMID: 22683152 DOI: 10.1016/j.rbmo.2012.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 02/29/2012] [Accepted: 03/21/2012] [Indexed: 10/28/2022]
Abstract
In women, anti-Müllerian hormone (AMH) is exclusively expressed in granulosa cells and an established marker of ovarian reserve. In menstrual cycle disorders, low AMH is usually interpreted as an indicator of primary ovarian insufficiency. This study is a case series of 11 patients with hypopituitarism. AMH concentrations were on or below the age-specific 25th percentile in three of the four patients diagnosed in infancy, but not in the remaining seven patients, who were diagnosed during adolescence or later. In patients with hypopituitarism, the detection of low AMH serum concentrations can present a diagnostic pitfall and its value in the interpretation of ovarian reserve in these patients is challenging.
Collapse
Affiliation(s)
- B Sonntag
- Zentrum für Endokrinologie, Kinderwunsch und Pränatale Medizin, Mönckebergstr. 10, 20095 Hamburg, Germany.
| | | | | | | |
Collapse
|
42
|
Anderson R, Nelson S, Wallace W. Measuring anti-Müllerian hormone for the assessment of ovarian reserve: When and for whom is it indicated? Maturitas 2012; 71:28-33. [DOI: 10.1016/j.maturitas.2011.11.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 11/07/2011] [Indexed: 10/14/2022]
|