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Laven JSE, Louwers YV. Can we predict menopause and premature ovarian insufficiency? Fertil Steril 2024; 121:737-741. [PMID: 38382699 DOI: 10.1016/j.fertnstert.2024.02.029] [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: 01/02/2024] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
The prediction of menopause and premature ovarian insufficiency (POI) involves understanding the factors that contribute to the timing of these events. Menopause is a natural biological process marked by the cessation of menstrual periods, typically occurring around the age of 51. On the other hand, POI refers to the loss of ovarian function before the age of 40. Several factors have been used to predict menopause and POI such as age, antimüllerian hormone, inhibins and follicle-stimulating hormone serum levels, antral follicle counts, menstrual cycle length, and, recently, some genetic markers. It seems that age has the best predictive power and all the other ones are only adding in a very limited way to the prediction of menopause. Low levels of antimüllerian hormone in young women might indicate a greater risk for POI and could facilitate early diagnosis. It is, however, important to note that predicting the exact timing of menopause and POI is challenging, and individual variations are significant. Although these factors can provide some insights, they are not foolproof predictors. Advances in medical research and technology may lead to more accurate methods for predicting menopause and POI in the future.
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Affiliation(s)
- Joop S E Laven
- Division Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yvonne V Louwers
- Division Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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2
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Davis SR, Pinkerton J, Santoro N, Simoncini T. Menopause-Biology, consequences, supportive care, and therapeutic options. Cell 2023; 186:4038-4058. [PMID: 37678251 DOI: 10.1016/j.cell.2023.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/06/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023]
Abstract
Menopause is the cessation of ovarian function, with loss of reproductive hormone production and irreversible loss of fertility. It is a natural part of reproductive aging. The physiology of the menopause is complex and incompletely understood. Globally, menopause occurs around the age of 49 years, with geographic and ethnic variation. The hormonal changes of the menopause transition may result in both symptoms and long-term systemic effects, predominantly adverse effects on cardiometabolic and musculoskeletal health. The most effective treatment for bothersome menopausal symptoms is evidence-based, menopausal hormone therapy (MHT), which reduces bone loss and may have cardiometabolic benefits. Evidence-based non-hormonal interventions are also available for symptom relief. Treatment should be individualized with shared decision-making. Most MHT regimens are not regulator approved for perimenopausal women. Studies that include perimenopausal women are needed to determine the efficacy and safety of treatment options. Further research is crucial to improve menopause care, along with research to guide policy and clinical practice.
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Affiliation(s)
- Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; Department of Endocrinology and Diabetes, Alfred Health, Commercial Rd., Melbourne, VIC 3004, Australia.
| | - JoAnn Pinkerton
- Department of Obstetrics and Gynecology, Division of Midlife Health, The University of Virginia Health System, Charlottesville, VA, USA
| | | | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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3
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Kim C, Catov J, Schreiner PJ, Appiah D, Wellons MF, Siscovick D, Calderon‐Margalit R, Huddleston H, Ebong IA, Lewis CE. Women's Reproductive Milestones and Cardiovascular Disease Risk: A Review of Reports and Opportunities From the CARDIA Study. J Am Heart Assoc 2023; 12:e028132. [PMID: 36847077 PMCID: PMC10111436 DOI: 10.1161/jaha.122.028132] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
In 1985 to 1986, the CARDIA (Coronary Artery Risk Development in Young Adults) study enrolled 5115 Black or White participants, including 2788 women, aged 18 to 30 years. Over the following 35 years, the CARDIA study amassed extensive longitudinal data on women's reproductive milestones, spanning menarche to menopause. Although not initially conceived as a study of women's health, >75 CARDIA study publications address relationships between reproductive factors and events with cardiovascular and metabolic risk factors, subclinical and clinical cardiovascular disease, and social determinants of health. The CARDIA study was one of the earliest population-based reports to note Black-White differences in age at menarche and associations with cardiovascular risk factors. Adverse pregnancy outcomes, particularly gestational diabetes and preterm birth, have been assessed along with postpartum behaviors, such as lactation. Existing studies have examined risk factors for adverse pregnancy outcomes and lactation, as well as their relationship to future cardiovascular and metabolic risk factors, diagnoses, and subclinical atherosclerosis. Ancillary studies examining components of polycystic ovary syndrome and ovarian biomarkers, such as anti-Müllerian hormone, have facilitated examination of reproductive health in a population-based cohort of young adult women. As the cohort transitioned through menopause, examination of the importance of premenopausal cardiovascular risk factors along with menopause has improved our understanding of shared mechanisms. The cohort is now aged in the 50s to mid-60s, and women will begin to experience a greater number of cardiovascular events as well as other conditions, such as cognitive impairment. Thus, in the next decade, the CARDIA study will provide a unique resource for understanding how the women's reproductive life course epidemiology informs cardiovascular risk, as well as reproductive and chronological aging.
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Affiliation(s)
- Catherine Kim
- Departments of Medicine, Obstetrics and Gynecology, and EpidemiologyUniversity of MichiganAnn ArborMI
| | - Janet Catov
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of PittsburghPittsburghPA
| | - Pamela J. Schreiner
- Division of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisMN
| | - Duke Appiah
- Department of Public Health, Graduate School of Biomedical SciencesTexas Tech UniversityLubbockTX
| | | | | | | | - Heather Huddleston
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCA
| | | | - Cora E. Lewis
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAL
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4
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Huang Y, Wu M, Wu C, Zhu Q, Wu T, Zhu X, Wu M, Wang S. Effect of hysterectomy on ovarian function: a systematic review and meta-analysis. J Ovarian Res 2023; 16:35. [PMID: 36759829 PMCID: PMC9912518 DOI: 10.1186/s13048-023-01117-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Hysterectomy is one of the most frequently gynecologic surgeries performed in premenopausal women. Many premenopausal patients are unwilling to undergo hysterectomy due to the probable decreased ovarian function. The aim of this study is to determine the effect of hysterectomy on ovarian function. METHODS A meta-analysis has been reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and the A Measurement Tool to Assess Systematic Reviews (AMSTAR) guidelines. We mainly searched the Embase, PubMed and Web of Science databases for eligible studies. The outcomes were the levels of common indicators of ovarian function, such as anti-müllerian hormone (AMH), follicle stimulating hormone (FSH), inhibin B, estradiol (E2) and luteinizing hormone (LH). The evidence was synthesized using meta-analysis via fixed or random effect model according to heterogeneity. Subgroup analyses were performed to examine the potential sources of heterogeneity. RESULTS The 14 included studies were conducted between 1989 and 2021, involving a total of 1,457 premenopausal women with 760 and 697 in the hysterectomy and control group, respectively. We found that hysterectomy damage ovarian function compared to the control group, with lower AMH level [Weighted mean difference (WMD) = -0.56, 95% confidence interval (95% CI): -0.72 to -0.39, P = 0.000], higher FSH levels (WMD = 2.96, 95% CI: 1.47 to 4.44, P = 0.000), lower inhibin B levels (WMD = -14.34, 95% CI: -24.69 to -3.99, P = 0.000) and higher LH levels (WMD = 4.07, 95% CI: 1.78 to 6.37, P = 0.000). In addition, E2 levels have a decreasing trend (WMD = -17.13, 95% CI: -35.10 to 0.85, P = 0.631) in the hysterectomy group but were not statistically significant. CONCLUSION Hysterectomy has a negative impact on ovarian function, especially in female patients over 40 years old. So, the older patients should closely monitor their ovarian function for early diagnosis and treatment of menopausal symptoms.
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Affiliation(s)
- Yibao Huang
- grid.412793.a0000 0004 1799 5032National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei China ,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030 Hubei China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030 Hubei China
| | - Meng Wu
- grid.412793.a0000 0004 1799 5032National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei China ,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030 Hubei China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030 Hubei China
| | - Chuqing Wu
- grid.412793.a0000 0004 1799 5032National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei China ,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030 Hubei China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030 Hubei China
| | - Qingqing Zhu
- grid.412793.a0000 0004 1799 5032National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei China ,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030 Hubei China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030 Hubei China
| | - Tong Wu
- grid.412793.a0000 0004 1799 5032National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei China ,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030 Hubei China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030 Hubei China
| | - Xiaoran Zhu
- grid.412793.a0000 0004 1799 5032National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 Hubei China ,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030 Hubei China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030 Hubei China
| | - Mingfu Wu
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China. .,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China. .,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China.
| | - Shixuan Wang
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China. .,National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, 430030, Hubei, China. .,Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, 430030, Hubei, China.
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5
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Bedenk J, Režen T, Jančar N, Geršak K, Virant Klun I. Effect of In Vitro Maturation of Human Oocytes Obtained After Controlled Ovarian Hormonal Stimulation on the Expression of Development- and Zona Pellucida-Related Genes and Their Interactions. Reprod Sci 2023; 30:667-677. [PMID: 35915350 DOI: 10.1007/s43032-022-01047-1] [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: 05/23/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
In an in vitro fertilization program, approximately 10-15% of oocytes obtained after controlled ovarian stimulation are immature, with germinal vesicles (GVs). These oocytes are usually discarded in clinical practice; however, an in vitro maturation (IVM) procedure can be applied to mature them. There are scarce data in the literature on the effect of IVM on the expression of important development- and zona pellucida (ZP)-related genes in human oocytes; therefore, we wanted to determine this. One hundred nine human oocytes were collected from patients enrolled in an intracytoplasmic sperm injection program. The expression of the BMP4, GDF9, ZP1, ZP2, ZP3, and ZP4 genes was analyzed using RT-qPCR in oocytes matured in vitro with different reproductive hormones in the IVM medium (AMH, FSH + hCG, FSH + hCG + AMH), in in vivo matured oocytes and in immature oocytes with GVs. No statistically significant differences in the expression of selected genes in oocytes were observed among groups with different reproductive hormones in IVM medium. However, several interesting significant correlations were found between BMP4 and GDF9, and ZP1 and ZP4; between GDF9 and ZP1, and ZP2 and ZP4; and between ZP1 and ZP3 and ZP4 in the in vitro matured oocytes, while no such correlations were present in other groups of oocytes. The type of reproductive hormone in the maturation medium does not affect the expression of the analyzed genes in oocytes during the maturation process. However, the in vitro maturation procedure itself generated correlations among analyzed genes that were otherwise not present in in vivo matured and immature oocytes.
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Affiliation(s)
- Jure Bedenk
- Clinical Research Centre, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia.
| | - Tadeja Režen
- Institute of Biochemistry and Molecular Genetics, Centre for Functional Genomics and Bio-Chips, Faculty of Medicine, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Nina Jančar
- Department of Gynaecology and Obstetrics, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia
| | - Ksenija Geršak
- Faculty of Medicine, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Irma Virant Klun
- Clinical Research Centre, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia
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6
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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: 16] [Impact Index Per Article: 16.0] [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.
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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
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7
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Raeisi-Dehkordi H, Kummer S, Francis Raguindin P, Dejanovic G, Eylul Taneri P, Cardona I, Kastrati L, Minder B, Voortman T, Marques-Vidal P, Dhana K, Glisic M, Muka T. Risk Prediction Models of Natural Menopause Onset: A Systematic Review. J Clin Endocrinol Metab 2022; 107:2934-2944. [PMID: 35908226 DOI: 10.1210/clinem/dgac461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Predicting the onset of menopause is important for family planning and to ensure prompt intervention in women at risk of developing menopause-related diseases. OBJECTIVE We aimed to summarize risk prediction models of natural menopause onset and their performance. METHODS Five bibliographic databases were searched up to March 2022. We included prospective studies on perimenopausal women or women in menopausal transition that reported either a univariable or multivariable model for risk prediction of natural menopause onset. Two authors independently extracted data according to the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist. Risk of bias was assessed using a prediction model risk of bias assessment tool (PROBAST). RESULTS Of 8132 references identified, we included 14 articles based on 8 unique studies comprising 9588 women (mainly Caucasian) and 3289 natural menopause events. All included studies used onset of natural menopause (ONM) as outcome, while 4 studies also predicted early ONM. Overall, there were 180 risk prediction models investigated, with age, anti-Müllerian hormone, and follicle-stimulating hormone being the most investigated predictors. Estimated C-statistic for the prediction models ranged from 0.62 to 0.95. Although all studies were rated at high risk of bias mainly due to the methodological concerns related to the statistical analysis, their applicability was satisfactory. CONCLUSION Predictive performance and generalizability of current prediction models on ONM is limited given that these models were generated from studies at high risk of bias and from specific populations/ethnicities. Although in certain settings such models may be useful, efforts to improve their performance are needed as use becomes more widespread.
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Affiliation(s)
- Hamidreza Raeisi-Dehkordi
- Institute of Social and Preventive Medicine (ISPM), University of Bern, 3012 Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, 3012 Bern, Switzerland
| | - Stefanie Kummer
- Institute of Social and Preventive Medicine (ISPM), University of Bern, 3012 Bern, Switzerland
| | - Peter Francis Raguindin
- Institute of Social and Preventive Medicine (ISPM), University of Bern, 3012 Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, 3012 Bern, Switzerland
- Swiss Paraplegic Research, 6207, Nottwil, Switzerland
| | - Gordana Dejanovic
- Institute of Social and Preventive Medicine (ISPM), University of Bern, 3012 Bern, Switzerland
| | - Petek Eylul Taneri
- School of Nursing and Midwifery, National University of Ireland, Galway H91 CF50, Ireland
- HRB-Trials Methodology Research Network, National University Of Ireland, Galway H91 CF50, Ireland
| | - Isabel Cardona
- Institute of Social and Preventive Medicine (ISPM), University of Bern, 3012 Bern, Switzerland
- Department of Obstetrics and Gynaecology, McGill University Health Center, McGill University, Montreal H4A 3J1, Canada
| | - Lum Kastrati
- Institute of Social and Preventive Medicine (ISPM), University of Bern, 3012 Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, 3012 Bern, Switzerland
| | - Beatrice Minder
- Public Health & Primary Care Library, University Library of Bern, University of Bern, 3012 Bern, Switzerland
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, the Netherlands
- Division of Human Nutrition and Health, Wageningen University & Research, 6708 PB Wageningen, the Netherlands
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne CH-1015, Switzerland
| | - Klodian Dhana
- Section on Nutrition and Nutritional Epidemiology, Department of Internal Medicine, Rush University, Chicago, IL 60612, USA
| | - Marija Glisic
- Institute of Social and Preventive Medicine (ISPM), University of Bern, 3012 Bern, Switzerland
- Swiss Paraplegic Research, 6207, Nottwil, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, 3012 Bern, Switzerland
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8
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Menopause, wellbeing and health: A care pathway from the European Menopause and Andropause Society. Maturitas 2022; 163:1-14. [DOI: 10.1016/j.maturitas.2022.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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9
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Kim C, Puterman E, Hou L, Slaughter JC, Terry JG, Wellons MF. Antimüllerian hormone and leukocyte aging markers in the Coronary Artery Risk Development in Young Adults study. Fertil Steril 2022; 118:125-133. [PMID: 35610095 PMCID: PMC10598775 DOI: 10.1016/j.fertnstert.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine whether premenopausal reproductive age, as indicated by serum antimüllerian hormone (AMH), is associated with leukocyte aging biomarkers. DESIGN Prospective cohort analysis. SETTING The Coronary Artery Risk Development in Young Adults study, a population-based study of Black and White adults from four US communities (Birmingham, AL; Chicago, IL; Minneapolis, MN; Oakland, CA). PATIENT(S) Premenopausal women with serum AMH measures at examination year 15 as well as leukocyte aging markers. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Telomere length, mitochondrial deoxyribonucleic acid (mtDNA) copy number, and intrinsic and extrinsic epigenetic age acceleration (EAA) at examination years 15, 20, and 25 as well as change between examination years. RESULT(S) Women were 40.2 (standard deviation, 3.7) years of age at examination year 15 when the AMH and initial measures of telomere length and mtDNA copy number (n = 386) were obtained and EAA occurred. After adjustment for chronological age, race, and smoking history, AMH quartile at examination year 15 was not associated with telomere length at examination years 15 and 25 or telomere length change between these years, mtDNA copy number at examination years 15 and 25 or change between these years, or intrinsic EAA at examination years 15 and 20 or change between these years. Women in the second AMH quartile had faster extrinsic EAA than women in the lowest AMH quartile (β-coefficient, 1.84; 95% confidence interval, 0.20-3.49). CONCLUSION(S) In a population-based cohort, AMH did not have associations with leukocyte telomere length, mtDNA copy number, or intrinsic EAA.
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Affiliation(s)
- Catherine Kim
- Departments of Medicine, Obstetrics and Gynecology, and Epidemiology, University of Michigan, Ann Arbor, Michigan.
| | - Eli Puterman
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James G Terry
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa F Wellons
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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10
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Aykal G, Uzun N, Derbent AU, Yeğin A. Assessment of Ovarian Reserve in Patients with Migraine. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2022.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective
The aim of our study is to investigate the relationship between migraine and ovarian reserve. Methods
The study group consists of women between the ages of 25-51, including 44 patients diagnosed with migraine and 43 controls. Ovarian reserves were performed by antral follicle count and measured anti-Müllerian hormone level.
The cohort was divided into four subgroups according to age as follows: 30 years and below, 31-35 years, 36-40 years, and 41 years of age and above.
Results
Of the 87 individuals included in this study, 44 were migraine patients, and 43 were healthy controls. The mean ages of the study and control groups were 34.3 (minimum: 25, maximum: 51) and 36.5 (minimum: 27, maximum: 51) years, respectively. There was no statistically significant difference between the two groups regarding age (p=0.48). In the study and control groups, respectively; mean AMH levels were 2.67 ± 2.46 ng/mL and 2.55 ± 2.38 ng/mL (p=0.819), mean basal FSH levels were 7.92 ± 2.52 U/L and 9.11 ± 3.19 U/L (p=0.066), mean basal LH levels were 6.35 ± 3.59 U/L and 6.06 ± 2.86U/L (p=0.681), mean basal estradiol levels were 65.02 ± 69.54 ng/L and 49.47 ± 27.08 ng/L (p=0.244), and mean AFC were 10.9 ± 3.9 and 10.2 ± 3.7 (p=0.435). Between subgroups aged ≤30 years, serum anti-Müllerian hormone levels were found to be significantly different (p=0.036). There was no statistically significant difference between any age subgroups in terms of antral follicle count.
Conclusion
In conclusion, detecting possible reduction of ovarian reserves in reproductive-age (especially younger than 30 years) migraine patients by utilizing anti-Müllerian hormone and ultrasonographic markers would allow these women to make cognizant decisions regarding marriage and family planning, as well as inform them whether they are in early menopause risk
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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.
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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
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Tehrani FR, Firouzi F, Behboudi-Gandevani S. Investigating the Clinical Utility of the Anti-Mullerian Hormone Testing for the Prediction of Age at Menopause and Assessment of Functional Ovarian Reserve: A Practical Approach and Recent Updates. Aging Dis 2022; 13:458-467. [PMID: 35371603 PMCID: PMC8947835 DOI: 10.14336/ad.2021.0825] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Low ovarian reserve is a serious condition, leading to sterility in up to 10% of women in their mid-thirties. According to current knowledge, serum anti-Müllerian hormone (AMH) levels for age are the best available marker for the screening the quantity of a woman's functional ovarian reserve, better than age alone or other reproductive markers. This review summarizes recent findings, clinical utility and limitations in the application of serum AMH testing as an accurate marker for the screening of functional ovarian reserves and predicting age at menopause. AMH assessment hold promise in helping women make informed decisions about their future fertility and desired family size. However, screening of the functional ovarian reserve could be offered to all women at 26 years of age or older who seek to assess future fertility or in case of personal request, ovarian reserve screening may be considered beyond 30 years; however, it has never been advocated beyond 35 years, since it is not advisable to delay childbearing beyond this age. In this respect, an age-specific serum AMH levels lower than the 10th percentile may be used as a threshold for the identification of a low functional ovarian reserve in an individual woman. Its level should be interpreted with caution in the adolescent and young women aged below 25 years (since AMH levels peak at this age); recent users of hormonal contraceptives (since AMH levels transiently decrease until two months after discontinuation); and women with PCOS (which dramatically increases AMH levels). However, the ability of AMH levels to predict the time to menopause is promising but requires further investigation and routine AMH testing for the purposes of predicting the time to menopause is not recommended.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Faezeh Firouzi
- Pathology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Samira Behboudi-Gandevani
- Pathology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Correspondence should be addressed to: Dr. Samira Behboudi-Gandevani, Faculty of Health Sciences, Nord University, Bodø, Norway.
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Bedenk J, Režen T, Železnik Ramuta T, Jančar N, Vrtačnik Bokal E, Geršak K, Virant Klun I. Recombinant anti-Müllerian hormone in the maturation medium improves the in vitro maturation of human immature (GV) oocytes after controlled ovarian hormonal stimulation. Reprod Biol Endocrinol 2022; 20:18. [PMID: 35073905 PMCID: PMC8785574 DOI: 10.1186/s12958-022-00895-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/16/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND In vitro maturation (IVM) of oocytes is a laboratory method that allows the maturation of immature (GV) oocytes retrieved from patients enrolled in the in vitro fertilization (IVF) programme. However, this method is still sparsely researched and used in clinical practice, leading to suboptimal clinical results. Anti-Müllerian hormone (AMH) is an important hormone with known effects on human ovaries, especially on follicles (follicular cells) during folliculogenesis. In contrast, the effect of AMH on the human oocyte itself is unknown. Therefore, we wanted to determine whether human oocytes express AMH receptor 2 (AMHR2) for this hormone. Recombinant AMH was added to the IVM medium to determine whether it affected oocyte maturation. METHODS In total, 247 human oocytes (171 immature and 76 mature) were collected from patients enrolled in the intracytoplasmic sperm injection (ICSI) programme who were aged 20 to 43 years and underwent a short antagonist protocol of ovarian stimulation. The expression of AMHR2 protein and AMHR2 gene was analysed in immature and mature oocytes. Additionally, maturation of GV oocytes was performed in vitro in different maturation media with or without added AMH to evaluate the effect of AMH on the oocyte maturation rate. RESULTS Immunocytochemistry and confocal microscopy revealed that AMHR2 protein is expressed in both immature and mature human oocytes. AMHR2 was expressed in a spotted pattern throughout the whole oocyte. The IVM procedure revealed that AMH in maturation medium improved GV oocyte maturation in vitro, as all oocytes were successfully matured in maturation medium containing recombinant AMH only. Furthermore, antagonism between AMH and follicle-stimulating hormone (FSH) during the maturation process was observed, with fewer oocytes maturing when both AMH and FSH were added to the maturation medium. Finally, AMHR2 gene expression was found in immature and in vitro matured oocytes but absent in mature oocytes. CONCLUSIONS The positive AMHR2 protein and AMHR2 gene expression in human oocytes shows that AMH could directly act on human oocytes. This was further functionally confirmed by the IVM procedure. These findings suggest the potential clinical application of recombinant AMH to improve IVM of human oocytes in the future.
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Affiliation(s)
- Jure Bedenk
- Clinical Research Centre, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia.
| | - Tadeja Režen
- Institute of Biochemistry and Molecular Genetics, Centre for Functional Genomics and Bio-Chips, Faculty of Medicine, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Taja Železnik Ramuta
- Institute of Cell Biology, Faculty of Medicine, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Nina Jančar
- Department of Gynaecology and Obstetrics, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia
| | - Eda Vrtačnik Bokal
- Department of Gynaecology and Obstetrics, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia
| | - Ksenija Geršak
- Faculty of Medicine, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Irma Virant Klun
- Clinical Research Centre, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia
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14
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Sievert LL, Huicochea-Gómez L, Cahuich-Campos D, Whitcomb BW, Brown DE. Age at menopause among rural and urban women in the state of Campeche, Mexico. Menopause 2021; 28:1358-1368. [PMID: 34854837 DOI: 10.1097/gme.0000000000001886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to examine age at natural menopause among women of Maya and non-Maya ancestry living in urban and rural communities in the state of Campeche, Mexico. METHODS Women ages 40 to 60 (n = 543) participated in semi-structured interviews and anthropometric measures. The last names, languages spoken, and the birthplace of the woman, her parents, and her grandparents were used to determine Maya or non-Maya ethnicity. Recalled age at natural menopause was compared across four communities; analysis of variance was used to compare means and Kaplan-Meier analyses were used to compare medians. Probit analysis was also used to estimate median ages at menopause. Cox regression analyses were applied to identify variables associated with age at menopause. RESULTS Mean recalled age at natural menopause across all sites was 46.7 years, ranging from 47.8 years in the city of Campeche to 43.9 years in the rural Maya communities in the municipality of Hopelchén. Median ages at menopause across all sites were 50.55 years by probit analysis and 50.5 years by Kaplan-Meier. Variables associated with a later age at menopause included higher socioeconomic status, higher parity, and a later age at menarche. CONCLUSIONS The early mean recalled age at menopause in southern Hopelchén was consistent with previous studies in the Yucatán peninsula. As expected, probit and Kaplan-Meier analyses demonstrated later ages at menopause. Contrary to our expectations, Maya/non-Maya ethnicity was not associated with age at menopause. Demographic and reproductive factors were more important than ethnicity in explaining variation in age at menopause within the state of Campeche, Mexico.
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Affiliation(s)
| | - Laura Huicochea-Gómez
- Departamento de Sociedad y Cultura, El Colegio de la Frontera, ECOSUR, Campeche, México
| | - Diana Cahuich-Campos
- Departamento de Sociedad y Cultura, El Colegio de la Frontera, ECOSUR, Campeche, México
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, UMass Amherst, Amherst, MA
| | - Daniel E Brown
- Department of Anthropology, University of Hawai'i at Hilo, Hilo, HI
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15
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Roa-Díaz ZM, Raguindin PF, Bano A, Laine JE, Muka T, Glisic M. Menopause and cardiometabolic diseases: What we (don't) know and why it matters. Maturitas 2021; 152:48-56. [PMID: 34674807 DOI: 10.1016/j.maturitas.2021.06.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/20/2021] [Accepted: 06/26/2021] [Indexed: 01/11/2023]
Abstract
This narrative review discusses the current understanding, knowledge gaps and challenges in expanding our knowledge of the association between menopause and the reproductive aging process and cardiometabolic disease (CMD) in women, with a focus on type 2 diabetes and cardiovascular disease. The physiological changes that occur at different stages of the reproductive life span, as well as type of menopause and timing, are factors widely associated with CMD risk; however, the underlying mechanisms remain either unclear or insufficiently studied. Decreased ovarian estrogen production and relative androgen excess around menopause onset are the most studied factors linking menopause and cardiometabolic health; nevertheless, the evidence is not persuasive and other hypotheses might explain the changes in CMD risk during menopausal transition. In this context, hormone therapy has been widely adopted in the treatment and prevention of CMD, although uncertainty regarding its cardiometabolic effects has raised the need to optimize therapeutic modalities. Mechanisms such as the "iron overload theory" and new "omics" platforms could provide new insights into potential pathways underlying the association between menopause and cardiometabolic health, such as the DNA damage response. Although it has been widely reported that environmental and lifestyle factors affect both menopause and cardiometabolic health, there is little evidence on the role of these exposures in menopause-associated CMD risk.
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Affiliation(s)
- Zayne M Roa-Díaz
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Peter Francis Raguindin
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland
| | - Arjola Bano
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Jessica E Laine
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Marija Glisic
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland.
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16
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El-Attar EA, Hosny TA, Ichihara K, Bedair RN, Tork ASED. Nomogram of age-specific anti-Müllerian hormone levels in healthy Egyptian females. PLoS One 2021; 16:e0254858. [PMID: 34310641 PMCID: PMC8312962 DOI: 10.1371/journal.pone.0254858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Anti-Müllerian hormone (AMH) is an important determinant of ovarian reserve in fertility workups in many clinical settings. Thus, we investigated the age dependent decline in AMH specific to the Egyptian population and sought to establish an age dependent reference interval parametrically. METHODS Serum samples were collected from 841 apparently healthy women. AMH was measured using an electro-chemiluminescent technique. Box-Cox power transformation was used to make the AMH distribution Gaussian for parametric derivation of reference intervals. RESULTS Power of 0.4 was found optimal for Gaussian transformation of AMH reference values. We demonstrate the strong negative relation between circulating AMH and female age with Spearman's correlation coefficient of rS = -0.528. Age-specific reference interval was determined for every 5 years of age from 16 to 49, and nomogram was constructed by smoothing the lines connecting adjacent lower and upper reference limits. CONCLUSION The age-specific reference intervals and the age-AMH nomogram could be valuable in the clinical practice of in reproductive medicine. To our knowledge, this is the first study to confirm AMH levels in Egyptian females. We were able to explore age-related AMH levels specific to Egyptian females in the fertile age group and to treat skewed AMH data in a multi-step scheme using power transformation. Thus, a more accurate nomogram was constructed accommodating a profile delineated for a wide age range and a rescaled AMH axis improving its usability.
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Affiliation(s)
- Eman Ahmed El-Attar
- Chemical Pathology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Tamer A. Hosny
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Kiyoshi Ichihara
- Faculty of Health Sciences, Department of Clinical Laboratory Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Rania N. Bedair
- Chemical Pathology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Ahmed Salah El-Din Tork
- Chemical Pathology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
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17
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Grynberg M, Labrosse J, Bennani Smires B, Sifer C, Peigne M, Sonigo C. Could hormonal and follicular rearrangements explain timely menopause in unilaterally oophorectomized women? Hum Reprod 2021; 36:1941-1947. [PMID: 34037751 DOI: 10.1093/humrep/deab132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Does unilateral oophorectomy modify the relationship between serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC)? SUMMARY ANSWER No altered 'per-ovary' and 'per-follicle' AMH production and antral follicle distribution was evident in unilaterally oophorectomized women compared to matched controls. WHAT IS KNOWN ALREADY The age of menopause onset is relatively unchanged in patients having undergone unilateral oophorectomy. Mechanisms that occur to preserve and maintain ovarian function in this context remain to be elucidated. STUDY DESIGN, SIZE, DURATION Forty-one infertile women, with no polycystic ovary syndrome (PCOS) and no endometriosis, aged 19-42 years old, having undergone unilateral oophorectomy (One Ovary group; average time since surgery: 23.8 ± 2.2 months) were retrospectively age-matched (±1 year) with 205 infertile women having two intact ovaries and similar clinical features (Control group). PARTICIPANTS/MATERIALS, SETTING, METHODS Serum AMH levels, 3-4 mm AFC, 5-12 mm AFC, and total AFC (3-12 mm) were assessed on cycle Day 3 in both groups. Hormonal and ultrasonographic measurements obtained from patients in the Control group (i.e. having two ovaries) were divided by two to be compared with measurements obtained from patients of the One Ovary group (i.e. having one single remaining ovary). To estimate per-follicle AMH production, we calculated the ratio between serum AMH levels over 3-4 mm AFC, 5-12 mm AFC, and total AFC (3-12 mm), and the strength of the correlation between serum AMH levels and total AFC. The main outcome measure was to assess Day 3 AMH/Day 3 AFC ratio and hormonal-follicular correlation. MAIN RESULTS AND THE ROLE OF CHANCE As expected, before correction, mean serum AMH levels (1.46 ± 0.2 vs 2.77 ± 0.1 ng/ml, P < 0.001) and total AFC (7.3 ± 0.6 vs 15.1 ± 0.4 follicles, P < 0.0001) were lower in the One Ovary group compared to the Control group, respectively. Yet, after correction, per-ovary AMH levels (1.46 ± 0.2 vs 1.39 ± 0.1 ng/ml) and total AFC (7.3 ± 0.6 vs 7.5 ± 0.2 follicles) values were comparable between the two groups. Consistently, per-follicle AMH levels (3-4 mm, 5-12 mm, and total) were not significantly different between the two groups (0.39 ± 0.05 vs 0.37 ± 0.02 ng/ml/follicle; 0.69 ± 0.12 vs 0.59 ± 0.05 ng/ml/follicle, and 0.23 ± 0.03 vs 0.19 ± 0.01 ng/ml/follicle; respectively). In addition, the prevalence of 3-4 mm follicles was comparable between the two groups (66.7% for One Ovary group vs 58.8% for Control group, respectively). Finally, the correlation between serum AMH levels and total AFC was similar for patients in the One Ovary group (r = 0.70; P < 0.0001) compared to those in the Control group (r = 0.68; P < 0.0001). LIMITATIONS/REASONS FOR CAUTION The retrospective character of the analysis might lead to potential bias. WIDER IMPLICATIONS OF THE FINDINGS The present investigation did not provide evidence of altered 'per-ovary' and 'per-follicle' AMH production and antral follicle distribution in unilaterally oophorectomized women compared to matched controls. Further studies are warranted to support the hypothesis that follicle-sparing mechanisms are clearly at stake in remaining ovaries after unilateral oophorectomy to explain their long-lasting function and timely menopausal onset. STUDY FUNDING/COMPETING INTEREST(S) The authors have no funding or competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Grynberg
- AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine Béclère, Clamart, France.,AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Jean Verdier, Bondy, France.,University Paris-Sud, Clamart, France
| | - J Labrosse
- AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Jean Verdier, Bondy, France
| | - B Bennani Smires
- Department of Cytogenetic and Reproductive Biology, Hôpital Jean Verdier, Bondy, France
| | - C Sifer
- Department of Cytogenetic and Reproductive Biology, Hôpital Jean Verdier, Bondy, France
| | - M Peigne
- AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Jean Verdier, Bondy, France
| | - C Sonigo
- AP-HP, Department of Reproductive Medicine & Fertility Preservation, Hôpital Antoine Béclère, Clamart, France.,University Paris-Sud, Clamart, France
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18
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Searching for female reproductive aging and longevity biomarkers. Aging (Albany NY) 2021; 13:16873-16894. [PMID: 34156973 PMCID: PMC8266318 DOI: 10.18632/aging.203206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/31/2021] [Indexed: 12/21/2022]
Abstract
Female reproductive aging is, in a way, a biological phenomenon that develops along canonical molecular pathways; however, it has particular features. Recent studies revealed complexity of the interconnections between reproductive aging and aging of other systems, and even suggested a cause-effect uncertainty between them. It was also shown that reproductive aging can impact aging processes in an organism at the level of cells, tissues, organs, and systems. Women at the end of their reproductive lives are characterized by the accelerated incidence of age-related diseases. Timing of the onset of menarche and menopause and variability in the duration of reproductive life carry a latent social risk: not having enough information about the reproductive potential, women keep on postponing childbirth. Identification and use of the most accurate and sensitive aging biomarkers enable the prediction of menopause timing and quantification of the true biological and reproductive ages of an organism. We discuss current views on reproductive aging and peculiarities of using available biomarkers of aging. We also consider latest advances in the search for potential genetic markers of reproductive aging. Finally, we posit the importance of determining the female biological age and highlight potential research directions in this area.
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Hyvärinen M, Karvanen J, Aukee P, Tammelin TH, Sipilä S, Kujala UM, Kovanen V, Rantalainen T, Laakkonen EK. Predicting the age at natural menopause in middle-aged women. Menopause 2021; 28:792-799. [PMID: 33857956 PMCID: PMC8284377 DOI: 10.1097/gme.0000000000001774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To predict the age at natural menopause (ANM). METHODS Cox models with time-dependent covariates were utilized for ANM prediction using longitudinal data from 47 to 55-year-old women (n = 279) participating in the Estrogenic Regulation of Muscle Apoptosis study. The ANM was assessed retrospectively for 105 women using bleeding diaries. The predictors were chosen from the set of 32 covariates by using the lasso regression (model 1). Another easy-to-access model (model 2) was created by using a subset of 16 self-reported covariates. The predictive performance was quantified with c-indices and by studying the means and standard deviations of absolute errors (MAE ± SD) between the predicted and observed ANM. RESULTS Both models included alcohol consumption, vasomotor symptoms, self-reported physical activity, and relationship status as predictors. Model 1 also included estradiol and follicle-stimulating hormone levels as well as SD of menstrual cycle length, while model 2 included smoking, education, and the use of hormonal contraception as additional predictors. The mean c-indices of 0.76 (95% CI 0.71-0.81) for model 1 and 0.70 (95% CI 0.65-0.75) for model 2 indicated good concordance between the predicted and observed values. MAEs of 0.56 ± 0.49 and 0.62 ± 0.54 years respectively for model 1 and 2 were clearly smaller than the MAE for predicted sample mean (1.58 ± 1.02). CONCLUSIONS In addition to sex hormone levels, irregularity of menstrual cycle, and menopausal symptoms, also life habits and socioeconomic factors may provide useful information for ANM prediction. The suggested approach could add value for clinicians' decision making related to the use of contraception and treatments for menopausal symptoms in perimenopausal women.
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Affiliation(s)
- Matti Hyvärinen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Juha Karvanen
- Department of Mathematics and Statistics, University of Jyväskylä, Jyväskylä, Finland
| | - Pauliina Aukee
- Department of Obstetrics and Gynecology, Pelvic Floor Research and Therapy Unit, Central Finland Central Hospital, Jyväskylä, Finland
| | - Tuija H. Tammelin
- LIKES Research Centre for Physical Activity and Health, Jyväskylä, Finland
| | - Sarianna Sipilä
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Urho M. Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Vuokko Kovanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Timo Rantalainen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eija K. Laakkonen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Xu H, Zhang M, Zhang H, Alpadi K, Wang L, Li R, Qiao J. Clinical Applications of Serum Anti-Müllerian Hormone Measurements in Both Males and Females: An Update. Innovation (N Y) 2021; 2:100091. [PMID: 34557745 PMCID: PMC8454570 DOI: 10.1016/j.xinn.2021.100091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/03/2021] [Indexed: 12/17/2022] Open
Abstract
Infertility is one of the most common non-communicable diseases, affecting both men and women equally. Ovarian reserve, the number of primordial follicles in the ovaries is believed to be the most important determinants for female fertility. Anti-Müllerian hormone (AMH) secreted from granulosa cells of growing follicles is recognized as the most important biomarker for ovarian reserve. Ovarian reserve models have been developed using AMH and other hormonal indicators, thus childbearing plans and reproductive choices could be arranged by women. In assisted reproductive technology cycles, measurement of AMH helps to predict ovarian response and guide recombinant follicle-stimulating hormone dosing in women. Serum AMH level is increasingly being recognized as a potential surrogate marker for polycystic ovarian morphology, one of the criteria for diagnosis of polycystic ovarian syndrome. AMH is also secreted by Sertoli cells of testes in men, and AMH measurements in the prediction of surgical sperm recovery rate in men have also been investigated. AMH levels are significantly higher in boys than in girls before puberty. Therefore, serum levels of AMH in combination with testosterone is used for the differential diagnosis of disorders of sex development, anorchia, non-obstructive azoospermia, and persistent Müllerian duct syndrome. Recently, serum AMH measurements have also been used in fertility preservation programs in oncofertility, screening for granulosa cell tumors, and prediction of menopause applications. In this review, we will focus on clinical application of AMH in fertility assessments for healthy men and women, as well as for cancer patients. Anti-Müllerian hormone (AMH) plays a key role in models assessing ovarian reserve AMH is used for the differential diagnosis of disorders of sex development AMH provides a molecular marker for related fertility and infertility disorders An international standard will aid in the development of various AMH assays
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Affiliation(s)
- Huiyu Xu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, P.R. China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, P.R. China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, P.R. China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, P.R. China
| | - Mengqian Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, P.R. China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, P.R. China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, P.R. China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, P.R. China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Beijing 100191, P.R. China
| | | | - Lina Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, P.R. China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, P.R. China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, P.R. China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, P.R. China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, P.R. China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, P.R. China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, P.R. China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, P.R. China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, P.R. China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, P.R. China.,Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, P.R. China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, P.R. China
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21
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Nelson SM, Anderson RA. Prediction of premature ovarian insufficiency: foolish fallacy or feasible foresight? Climacteric 2021; 24:438-443. [PMID: 33522318 DOI: 10.1080/13697137.2020.1868426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Prediction of premature ovarian insufficiency (POI) would be of substantial individual benefit, but being a heterogeneous and fluctuating condition, with an extensive range of complex etiologies and arbitrary diagnostic criteria, might make this seem foolhardy. However, contemporary and complementary genetic strategies assessing consanguineous and large POI pedigrees and cohorts with age at natural menopause have shown strong enrichment in genes regulating DNA damage repair, homologous recombination, and meiosis, processes that are critical to oogenesis and folliculogenesis. Recognition of the molecular architecture of POI and its contribution to baseline genotypic risk may enable these estimates to be refined further by estimation of the residual ovarian reserve. Increasing data derived from spontaneous and gonadotoxic-induced POI cohorts demonstrate the utility of anti-Müllerian hormone (AMH) to predict POI. This review presents current understanding of how genetics in combination with AMH may facilitate the prediction of POI.
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Affiliation(s)
- S M Nelson
- School of Medicine, University of Glasgow, Glasgow, UK.,NIHR Bristol Biomedical Research Centre, Bristol, UK.,The Fertility Partnership, London, UK
| | - R A Anderson
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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22
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Premature Ovarian Insufficiency in a Popular Sample of Women in the Pribaykalsky Region: Prevalence and Age Features. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2020-5.6.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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23
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Ramezani Tehrani F, Sheidaei A, Firouzi F, Tohidi M, Azizi F, Behboudi-Gandevani S. Does the Anti-Mullerian Hormone Decline Rate Improve the Prediction of Age at Menopause? Front Endocrinol (Lausanne) 2021; 12:727229. [PMID: 34603205 PMCID: PMC8481767 DOI: 10.3389/fendo.2021.727229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES There are controversial studies investigating whether multiple anti-Mullerian hormone (AMH) measurements can improve the individualized prediction of age at menopause in the general population. This study aimed to reexplore the additive role of the AMH decline rate in single AMH measurement for improving the prediction of age at physiological menopause, based on two common statistical models for analysis of time-to-event data, including time-dependent Cox regression and Cox proportional-hazards regression models. METHODS A total of 901 eligible women, aged 18-50 years, were recruited from the Tehran Lipid and Glucose Study (TLGS) population and followed up every 3 years for 18 years. The serum AMH level was measured at the time of recruitment and twice after recruitment within 6-year intervals using the Gen II AMH assay. The added value of repeated AMH measurements for the prediction of age at menopause was explored using two different statistical approaches. In the first approach, a time-dependent Cox model was plotted, with all three AMH measurements as time-varying predictors and the baseline age and logarithm of annual AMH decline as time-invariant predictors. In the second approach, a Cox proportional-hazards model was fitted to the baseline data, and improvement of the complex model, which included repeated AMH measurements and the logarithm of the AMH annual decline rate, was assessed using the C-statistic. RESULTS The time-dependent Cox model showed that each unit increase in the AMH level could reduce the risk of menopause by 87%. The Cox proportional-hazards model also improved the prediction of age at menopause by 3%, according to the C-statistic. The subgroup analysis for the prediction of early menopause revealed that the risk of early menopause increased by 10.8 with each unit increase in the AMH annual decline rate. CONCLUSION This study confirmed that multiple AMH measurements could improve the individual predictions of the risk of at physiological menopause compared to single AMH measurements. Different alternative statistical approaches can also offer the same interpretations if the essential assumptions are met.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faezeh Firouzi
- Pathology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samira Behboudi-Gandevani
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- *Correspondence: Samira Behboudi-Gandevani,
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24
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Moolhuijsen LME, Visser JA. Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function. J Clin Endocrinol Metab 2020; 105:5890022. [PMID: 32770239 PMCID: PMC7486884 DOI: 10.1210/clinem/dgaa513] [Citation(s) in RCA: 208] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/11/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Anti-müllerian hormone (AMH) is produced by granulosa cells of small, growing follicles in the ovary. Serum AMH levels strongly correlate with the number of growing follicles, and therefore AMH has received increasing attention as a marker for ovarian reserve. This review summarizes recent findings and limitations in the application of serum AMH in ovarian reserve assessment. EVIDENCE ACQUISITION A PubMed search was conducted to find recent literature on the measurements and use of serum AMH as a marker for ovarian reserve. EVIDENCE SYNTHESIS Serum AMH levels are measured to assess the "functional ovarian reserve," a term that is preferred over "ovarian reserve," since AMH levels reflect the pool of growing follicles that potentially can ovulate. Serum AMH levels are used in individualized follicle-stimulating hormone dosing protocols and may predict the risk of poor response or ovarian hyperstimulation syndrome but has limited value in predicting ongoing pregnancy. Serum AMH levels are studied to predict natural or disease-related age of menopause. Studies show that the age-dependent decline rates of AMH vary among women. The generalized implementation of serum AMH measurement has also led to an increase in diagnostic assays, including automated assays. However, direct comparison of results remains problematic. CONCLUSION Serum AMH remains the preferred ovarian reserve marker. However, the lack of an international standard for AMH limits comparison between AMH assays. Furthermore, little is known about endogenous and exogenous factors that influence serum AMH levels, which limits proper interpretation of AMH values in a clinical setting.
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Affiliation(s)
- Loes M E Moolhuijsen
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jenny A Visser
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Correspondence and Reprint Requests: J.A. Visser, Dept of Internal Medicine, Rm Ee532, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail:
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25
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Antimüllerian hormone and F2-isoprostanes in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Fertil Steril 2020; 114:646-652. [DOI: 10.1016/j.fertnstert.2020.04.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/16/2020] [Accepted: 04/10/2020] [Indexed: 01/23/2023]
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26
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Wang L, Lv S, Mao W, Bai E, Yang X. Fecundity disorders in older women: declines in follicular development and endometrial receptivity. BMC WOMENS HEALTH 2020; 20:115. [PMID: 32487204 PMCID: PMC7268486 DOI: 10.1186/s12905-020-00979-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/24/2020] [Indexed: 02/07/2023]
Abstract
Background Little research is available on follicular development and endometrial receptivity in older women. This study aimed to assess follicular development and endometrial receptivity, and to evaluate ultrasonic parameters in predicting endometrial receptivity during the implantation window in older women. Methods For this prospective case-control study, 224 older women and 215 young women were recruited. The follicular development and endometrial thickness were monitored by transvaginal ultrasound. During the implantation window, the pulsatility index (PI) and resistance index (RI) of the uterine arteries and subendometrial region, endometrial volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated between the two groups. The ultrasonic parameters were used to assess endometrial receptivity in older women. Results The serum anti-Mullerian hormone (AMH) concentration and antral follicle count (AFC) were significantly lower in older women than in young women. The average diameter of the dominant follicle on days 14, 16, and 18 of the menstrual cycle were significantly smaller, and the subendometrial region RI on days 12, 14, 16, and 18 of the menstrual cycle were significantly higher in older women than in young women. The normal ovulation rate was significantly lower in older women than in young women. The subendometrial region RI was significantly higher, and the endometrial VI, FI, and VFI were significantly lower in older women compared with young women. The biochemical pregnancy rate, clinical pregnancy rate and ongoing pregnancy rate of older women were significantly lower than in young women. The best ultrasonic parameter for predicting endometrial receptivity during the implantation window in older women was VI (AUC =0.889, sensitivity 92.6% and specificity 85.4%). Conclusions Older women present decreased serum AMH concentrations and AFC, defined as indicators of ovarian reserve function. Older women are characterized by decreased follicular development and endometrial receptivity, which may lead to fecundity disorders.
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Affiliation(s)
- Li Wang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shulan Lv
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wenjun Mao
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - E Bai
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaofeng Yang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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27
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Ramezani Tehrani F, Bidhendi Yarandi R, Solaymani-Dodaran M, Tohidi M, Firouzi F, Azizi F. Improving Prediction of Age at Menopause Using Multiple Anti-Müllerian Hormone Measurements: the Tehran Lipid-Glucose Study. J Clin Endocrinol Metab 2020; 105:5766353. [PMID: 32109280 DOI: 10.1210/clinem/dgaa083] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/26/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Several statistical models were introduced for the prediction of age at menopause using a single measurement of anti-müllerian hormone (AMH); however, individual prediction is challenging and needs to be improved. OBJECTIVE The objective of this study was to determine whether multiple AMH measurements can improve the prediction of age at menopause. DESIGN All eligible reproductive-age women (n = 959) were selected from the Tehran Lipid and Glucose Study. The serum concentration of AMH was measured at the time of recruitment and twice after that at an average of 6-year intervals. An accelerated failure-time model with Weibull distribution was used to predict age at menopause, using a single AMH value vs a model that included the annual AMH decline rate. The adequacy of these models was assessed using C statistics. RESULTS The median follow-up period was 14 years, and 529 women reached menopause. Adding the annual decline rate to the model that included single AMH improved the model's discrimination adequacy from 70% (95% CI: 67% to 71%) to 78% (95% CI: 75% to 80%) in terms of C statistics. The median of differences between actual and predicted age at menopause for the first model was -0.48 years and decreased to -0.21 in the model that included the decline rate. The predicted age at menopause for women with the same amount of age-specific AMH but an annual AMH decline rate of 95 percentiles was about one decade lower than in those with a decline rate of 5 percentiles. CONCLUSION Prediction of age at menopause could be improved by multiple AMH measurements; it will be useful in identifying women at risk of early menopause.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Razieh Bidhendi Yarandi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Solaymani-Dodaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faezeh Firouzi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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28
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Finkelstein JS, Lee H, Karlamangla A, Neer RM, Sluss PM, Burnett-Bowie SAM, Darakananda K, Donahoe PK, Harlow SD, Prizand SH, Joffe H, Kumar A, Martin DE, McConnell D, Merrilat S, Morrison A, Pastore LM, Randolph JF, Greendale GA, Santoro N. Antimullerian Hormone and Impending Menopause in Late Reproductive Age: The Study of Women's Health Across the Nation. J Clin Endocrinol Metab 2020; 105:dgz283. [PMID: 31965189 PMCID: PMC7067546 DOI: 10.1210/clinem/dgz283] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND A test that helps predict the time to the final menstrual period (FMP) has been sought for many years. OBJECTIVE To assess the ability of antimullerian hormone (AMH) measurements to predictions the time to FMP. DESIGN Prospective longitudinal cohort study. SETTING The Study of Women's Health Across the Nation. PARTICIPANTS AND MEASUREMENTS AMH and FSH were measured in 1537 pre- or early perimenopausal women, mean age 47.5 ± 2.6 years at baseline, then serially until 12 months of amenorrhea occurred. AMH was measured using a 2-site ELISA with a detection limit of 1.85 pg/mL. MAIN OUTCOME MEASURE Areas under the receiver operating curves (AUC) for AMH-based and FSH-based predictions of time to FMP, stratified by age. Probabilities that women would undergo their FMP in the next 12, 24, or 36 months across a range of AMH values were assessed. RESULTS AUCs for predicting that the FMP will occur within the next 24 months were significantly greater for AMH-based than FSH-based models. The probability that a woman with an AMH <10 pg/mL would undergo her FMP within the next 12 months ranged from 51% at h<48 years of age to 79% at ≥51 years. The probability that a woman with an AMH >100 pg/mL would not undergo her FMP within the next 12 months ranged from 97% in women <48 years old to 90% in women ≥51 years old. CONCLUSIONS AMH measurement helps estimate when a woman will undergo her FMP, and, in general, does so better than FSH.
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Affiliation(s)
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Arun Karlamangla
- Division of Geriatrics, UCLA School of Medicine, Los Angeles, California
| | - Robert M Neer
- Endocrine Unit, Massachusetts General Hospital, Boston, MA
| | - Patrick M Sluss
- Department of Clinical Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Patricia K Donahoe
- Pediatric Surgical Research Laboratories, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sioban D Harlow
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | | | - Hadine Joffe
- Department of Psychiatry and Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Deborah E Martin
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel McConnell
- Central Ligand Assay Satellite Services (CLASS) Laboratories, University of Michigan, Ann Arbor, Michigan
| | | | | | - Lisa M Pastore
- Department of Obstetrics and Gynecology and Reproductive Medicine, Stony Brook University, Stony Brook, New York
| | - John F Randolph
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Michigan, Ann Arbor, Michigan
| | - Gail A Greendale
- Division of Geriatrics, UCLA School of Medicine, Los Angeles, California
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado Medical School, Aurora, Colorado
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29
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Steiner AZ. AMH as a Predictor of the Final Menstrual Period. J Clin Endocrinol Metab 2020; 105:5714339. [PMID: 31970419 DOI: 10.1210/clinem/dgaa025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/15/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Anne Z Steiner
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
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30
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Rodgers R, Carter J, Reid G, Krishnan S, Ludlow J, Cooper M, Abbott J. The effect of laparoscopic salpingectomy for ectopic pregnancy on ovarian reserve. Aust N Z J Obstet Gynaecol 2020; 60:278-283. [PMID: 32065384 DOI: 10.1111/ajo.13129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Salpingectomy may damage ovarian reserve by direct vascular interruption to the ovary or thermal vascular injury from electrosurgery. It is plausible that this risk may increase in the context of salpingectomy conducted for ectopic pregnancy due to the distension of the fallopian tube and vascular changes associated with pregnancy. AIM To report anti-Müllerian hormone (AMH) concentrations before and after laparoscopic salpingectomy for ectopic pregnancy as an indicator of change in ovarian reserve. MATERIALS AND METHODS Women aged 18-44 years scheduled for salpingectomy for tubal ectopic pregnancy were prospectively recruited. Serum AMH concentrations were measured immediately prior to surgery, then repeated four months post-operatively. In all cases, salpingectomy was conducted laparoscopically using bipolar electrosurgery and mechanical scissors. A group of women scheduled for uterine curettage for first trimester miscarriage was recruited to ensure any observed change in AMH concentration in the women undergoing salpingectomy was secondary to surgery, rather than an effect of pregnancy. RESULTS Paired pre- and post-operative serum AMH concentrations were obtained from 32 women with tubal ectopic pregnancy. The mean age of the women was 33.6 ± 4.6 years. There was no significant difference in the median pre- and post-operative AMH concentrations (13.00 pmol/L (range 5-67 pmol/L) vs 15.25 pmol/L (range 3-96 pmol/L), P = 0.575). Median AMH concentrations also remained stable in women experiencing a first trimester miscarriage (10.40 pmol/L (range 3.9-37.8 pmol/L) vs 13.67 pmol/L (range 2.8-30.5 pmol/L), P = 0.185). CONCLUSION Laparoscopic salpingectomy using electrosurgery and mechanical scissors does not damage ovarian reserve. AMH concentrations do not fluctuate from baseline in the first trimester of pregnancy.
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Affiliation(s)
- Rachael Rodgers
- Department of Reproductive Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia.,Genea, Sydney, New South Wales, Australia
| | - Jonathan Carter
- Department of Gynaecological Oncology, Chris O'Brian Lifehouse, Sydney, New South Wales, Australia
| | | | - Surya Krishnan
- Department of Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia.,Department of Gynaecology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Joanne Ludlow
- Department of Gynaecology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael Cooper
- Genea, Sydney, New South Wales, Australia.,Department of Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Jason Abbott
- School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia.,GRACE Group, Royal Hospital for Women, Sydney, New South Wales, Australia
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31
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von Wolff M, Roumet M, Stute P, Liebenthron J. Serum anti-Mullerian hormone (AMH) concentration has limited prognostic value for density of primordial and primary follicles, questioning it as an accurate parameter for the ovarian reserve. Maturitas 2020; 134:34-40. [PMID: 32143774 DOI: 10.1016/j.maturitas.2020.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/21/2019] [Accepted: 02/03/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To evaluate the prognostic value of anti-Mullerian hormone (AMH) levels in estimating the ovarian density of primordial and primary follicles, which can be assumed to reflect the real ovarian reserve. STUDY DESIGN A total of 537 women, average age 30.4 years (range 8.0-43.7 years), underwent ovarian tissue cryopreservation prior to gonadotoxic therapies due to malignant diseases which do not affect ovarian reserve parameters. Standardized ovarian biopsies were obtained, and follicular density was analysed. The prognostic accuracy of serum AMH in estimating ovarian follicle density was evaluated. MAIN OUTCOME MEASURES Histologically determined follicle density, AMH serum concentration and their correlation. RESULTS In children, follicle density was high but AMH concentration was low. AMH concentration was predicted to be maximum at the age of 15.5 years. In women aged over 15.5 years, the relationship between AMH concentration and follicle density was evaluated. Crude analysis revealed that serum AMH levels and follicular density were moderately correlated (r = 0.34, p < 0.001). From the adjusted regression model the predicted value of follicle density of women aged 20, 30 and 40 years as well as the associated 50 % and 95 % prediction intervals (50 % PI and 95 % PI, respectively) were calculated. For example, for women aged 40 years with a serum AMH level of 1 ng/ml, a follicle density of 2.3/mm3 (50 %PI: [1.1, 4.6]; 95 %PI: [0.3, 18]) was predicted. These large prediction intervals demonstrate the low predictive value of serum AMH for the ovarian follicle density. CONCLUSIONS Serum AMH levels have limited prognostic value for the follicle density and therefore for the real ovarian reserve.
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Affiliation(s)
- Michael von Wolff
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, Inselspital, University of Berne, Berne, Switzerland.
| | - Marie Roumet
- CTU Berne, Institute of Social and Preventive Medicine (ISPM), University of Berne, Berne, Switzerland
| | - Petra Stute
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, Inselspital, University of Berne, Berne, Switzerland
| | - Jana Liebenthron
- UniCareD, University Cryobank for Assisted Reproductive Medicine and Fertility Protection at UniKiD Düsseldorf, University Hospital Düsseldorf, Germany
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The role of anti-Müllerian hormone (AMH) in ovarian disease and infertility. J Assist Reprod Genet 2019; 37:89-100. [PMID: 31755000 DOI: 10.1007/s10815-019-01622-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/25/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE In this review, the current knowledge on anti-Müllerian hormone (AMH) is presented, concerning its value in disease and IVF treatment as well as in terms of its prospective clinical use. METHODS AMH is becoming the most appropriate biomarker for the ovarian reserve measured predominantly for assisted reproductive treatment (ART) patients in comparison to the currently used antral follicle count (AFC). However, this is not the only way AMH measurements can be used in the clinics. Because of this, we reviewed the current literature for the use of AMH in current or prospective clinical practice. RESULTS We found that AMH has a high predictive value in assessing the ovarian reserve, which can lead to a better efficiency of in vitro fertilization (IVF) procedures. It has a high potential to be developed as a staple diagnostic marker of ovarian disease, especially for ovarian cancers and even as a possible treatment tool for certain cancers. It could potentially be used to prevent oocyte loss due to chemo- or radiotherapy. CONCLUSION AMH is an important hormone especially in women reproductive organs and is currently seen as the best biomarker for a multitude of uses in reproductive medicine. Currently, the biggest issue lies in the lack of international standardization of AMH. However, it is encouraging to see that there is interest in AMH in the form of research on its action and use in reproductive medicine.
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Affiliation(s)
- Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, Aurora
| | - Joshua Johnson
- Department of Obstetrics and Gynecology, University of Colorado, Aurora
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Johnson CY, Tanz LJ, Lawson CC, Howards PP, Bertone-Johnson ER, Eliassen AH, Schernhammer ES, Rich-Edwards JW. Anti-Müllerian hormone levels in nurses working night shifts. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2019; 75:136-143. [PMID: 30945620 PMCID: PMC6776712 DOI: 10.1080/19338244.2019.1577210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Our objective was to examine associations between night shift work and serum anti-Müllerian hormone (AMH) levels. We analyzed 1,537 blood samples from premenopausal female nurses in the Nurses' Health Study II, assayed for AMH. Rotating or permanent night shifts worked in the two weeks before blood collection and years of rotating night shift work were obtained via questionnaire. We found no associations between recent night shifts or rotating night shift work and AMH. The median difference in AMH was 0.3 (95% CI: -0.4, 0.8) ng/mL for ≥5 versus 0 recent night shifts and -0.1 (95% CI: -0.4, 0.3) ng/mL for ≥6 versus 0 years of rotating night shift work. Although we found no associations between night shift work and AMH, this does not preclude associations between night shift work and fertility operating through other mechanisms.
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Affiliation(s)
- Candice Y Johnson
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Lauren J Tanz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christina C Lawson
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Eva S Schernhammer
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Connor Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Abstract
Perimenopause, or the menopausal transition, represents a period of time during which newly arising symptoms can present complex management decisions for providers. Many women present to care with complaints of hot flashes, vaginal and sexual changes, altered mood and sleep, and changing bleeding patterns. The effect of these symptoms on quality of life, even before a woman enters menopause, can be significant. The appropriate evaluation and evidence-based management of women in this transition is reviewed in this article. Two case vignettes are used to highlight certain evaluation and treatment challenges.
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Wong QHY, Anderson RA. The role of antimullerian hormone in assessing ovarian damage from chemotherapy, radiotherapy and surgery. Curr Opin Endocrinol Diabetes Obes 2018; 25:391-398. [PMID: 30299433 PMCID: PMC6226218 DOI: 10.1097/med.0000000000000447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Iatrogenic ovarian damage can occur after chemotherapy, radiotherapy and surgery for cancer as well as for non-malignant conditions. This review describes the effects of such treatment on antimullerian hormone (AMH) and the implications of the fall in AMH in relation to ovarian function and fertility, especially in the era of improved fertility preservation strategies. RECENT FINDINGS The risk of gonadotoxicity differs between chemotherapy regimens. There is growing evidence that pretreatment AMH has prognostic significance for the degree of fall in AMH after treatment, the reversibility of ovarian damage and risk of premature ovarian insufficiency. The accuracy of prediction increases when age is coupled with AMH. The adverse effect of removal of endometriomas is increasingly clear, and AMH pre and post surgery useful is assessing the degree of damage to the ovary. The implications of low AMH after such treatment on natural fertility and reproductive lifespan are less clear. Apart from treatment effects, there are other coexisting conditions that can affect AMH which needs to be taken into consideration during interpretation of AMH before and after treatment. SUMMARY A fall in AMH in women after gonadotoxic treatment has been consistently described, with variable recovery, the accurate interpretation and clinical application of post-treatment AMH level on reproductive lifespan and fertility prediction needs to be studied in future larger prospective studies with longer follow-up.
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Affiliation(s)
- Queenie Ho Yan Wong
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Hong Kong
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Hawkins Bressler L, Steiner A. Anti-Müllerian hormone as a predictor of reproductive potential. Curr Opin Endocrinol Diabetes Obes 2018; 25:385-390. [PMID: 30299431 DOI: 10.1097/med.0000000000000440] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Anti-Müllerian hormone (AMH), a marker of ovarian reserve, declines over a woman's reproductive lifespan. AMH is highly correlated with a woman's age and number of primordial ovarian follicles, and has been shown to predict time to menopause in women in their 40s. For these reasons, it was assumed that AMH levels could predict a woman's reproductive potential or serve as a 'fertility test'. Recently, studies have sought to determine the association between AMH and fertility. RECENT FINDINGS Although a small, prospective, time-to-pregnancy study of 98 women suggested that an AMH level less than 0.7 ng/ml was associated with lower day-specific probabilities of conception, the follow-up, larger cohort did not identify an association with AMH and fecundability. Women with AMH values less than 0.7 ng/ml had similar pregnancy rates after 12 cycles of attempting to conceive as women with normal AMH values after adjusting for age. Four additional studies, including a secondary analysis of the NICHD EAGER trial including over 1200 women confirmed these findings. SUMMARY Although AMH is a marker of ovarian reserve, existing literature does not support the use of AMH as a marker of reproductive potential in the general population.
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Affiliation(s)
- Leah Hawkins Bressler
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Anne Steiner
- Department of Obstetrics & Gynecology, Duke University, Durham, NC, USA
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Stute P. Hörvermögen in den Wechseljahren. GYNAKOLOGISCHE ENDOKRINOLOGIE 2018. [DOI: 10.1007/s10304-018-0192-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kyweluk MA, Sievert LL, Huicochea-Gómez L, Cahuich-Campos D, McDade T, Brown DE. Variation in levels of AMH among Maya and non-Maya women in Campeche, Mexico. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2018; 167:282-290. [PMID: 30159886 DOI: 10.1002/ajpa.23627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/09/2018] [Accepted: 05/19/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The purpose of this study was to examine anti-Müllerian hormone (AMH) levels among women of Maya and non-Maya ancestry in the city of Campeche, Mexico. Levels of AMH can potentially predict age at menopause. Previous studies have indicated an early mean age at menopause among the Maya. MATERIALS AND METHODS Women aged 40-60 (n = 97) participated in semistructured interviews, anthropometric measures, and blood samples. Maya/non-Maya ethnicity was determined by the last names, languages spoken, and birthplace of the woman, her parents, and her grandparents. AMH values were categorized as detectable (0.05-4.19 ng/mL) and undetectable (<0.05 ng/mL). Logistic regressions calculated odds ratios (OR) for undetectable AMH. RESULTS Women were categorized as Maya (n = 44), not Maya (n = 39), or not able to be clearly defined (n = 14). In bivariate comparisons, women with detectable levels of AMH were younger, more likely to be pre-menopausal, and not Maya. Age, menopausal status, and ethnicity remained significant in a logistic regression models after controlling for age at menarche. Maya women were more than five times as likely to have nondetectable AMH levels as non-Maya women. DISCUSSION Increasing age and progression through the menopausal transition were both associated with declining levels of AMH. The association between Maya ethnicity and a lower likelihood of detecting AMH is consistent with the early ages at menopause reported in previous studies. We considered a rapid life history model as an explanatory framework, and suggest, from an ecological perspective, that future research should consider measures of developmental stress that may compromise ovarian reserves.
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Affiliation(s)
- Moira A Kyweluk
- Department of Anthropology, Northwestern University, Evanston, Illinois, 60208
| | | | | | - Diana Cahuich-Campos
- Depto de Sociedad y Cultura, El Colegio de la Frontera, ECOSUR, Campeche, México
| | - Thomas McDade
- Department of Anthropology, Northwestern University, Evanston, Illinois, 60208.,Institute for Policy Research Northwestern University, Evanston, Illinois, 60208
| | - Daniel E Brown
- Department of Anthropology, University of Hawai'i at Hilo, Hawaii, 96720
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Iwase A, Osuka S, Goto M, Murase T, Nakamura T, Takikawa S, Kikkawa F. Clinical application of serum anti-Müllerian hormone as an ovarian reserve marker: A review of recent studies. J Obstet Gynaecol Res 2018. [PMID: 29517134 DOI: 10.1111/jog.13633] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
It has been more than 15 years since the measurement of serum anti-Müllerian hormone (AMH) first allowed the quantitative assessment of ovarian reserve. Meanwhile, the clinical implication of serum AMH has been expanding. The measurement of serum AMH has been applied in various clinical fields, including assisted reproduction, menopause, reproductive disorders and assessment of ovarian damage/toxicity. Well-known findings about the usefulness of serum AMH revealed by numerous studies executed in the early era include decline with aging, a good correlation with oocyte yield in assisted reproduction, upregulation in polycystic ovarian syndrome and a decrease on ovarian surgery and toxic treatment. More intensive research, including a meta-analysis, cutting-edge clinical trial and advances in AMH assays, has yielded newer findings and firmer clinical interpretations in serum AMH in the past few years. Variations in the AMH decline trajectory in the general population do not support the accurate prediction of menopause. The ability to predict pregnancy in infertility treatment and natural conception is poor, while a nomogram integrating serum AMH as a stimulation protocol is useful for avoiding poor and/or hyper-responses. On the other hand, improvements in measuring very low concentrations of serum AMH may be capable of distinguishing women with poor ovarian function. Age-independent standardization of AMH values may be helpful for comparing ovarian reserves among women at different ages.
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Affiliation(s)
- Akira Iwase
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Maternal and Perinatal Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Satoko Osuka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Maternal and Perinatal Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohiko Murase
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sachiko Takikawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Detti L, Fletcher NM, Saed GM, Peregrin-Alvarez I, Uhlmann RA. Anti-Müllerian Hormone (AMH) May Stall Ovarian Cortex Function Through Modulation of Hormone Receptors Other Than the AMH Receptor. Reprod Sci 2017; 25:1218-1223. [DOI: 10.1177/1933719117737850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Laura Detti
- University of Tennessee Health Science Center, Department of Obstetrics and Gynecology, Memphis, TN, USA
| | - Nicole M. Fletcher
- The C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ghassan M. Saed
- The C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI, USA
| | - Irene Peregrin-Alvarez
- University of Tennessee Health Science Center, Department of Obstetrics and Gynecology, Memphis, TN, USA
| | - Rebecca A. Uhlmann
- University of Tennessee Health Science Center, Department of Obstetrics and Gynecology, Memphis, TN, USA
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