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Komorowski AS, Hughes L, Sarkar P, Aaby DA, Kumar A, Kalra B, Legro RS, Boots CE. Antimüllerian hormone level predicts ovulation in women with polycystic ovary syndrome treated with clomiphene and metformin. Fertil Steril 2024; 121:660-668. [PMID: 38154770 PMCID: PMC10978249 DOI: 10.1016/j.fertnstert.2023.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To describe the serum anti-Müllerian hormone (AMH) concentrations in a large, well-phenotyped cohort of women with polycystic ovary syndrome (PCOS) and evaluate whether AMH predicts successful ovulation induction in women treated with clomiphene and metformin. DESIGN Secondary analysis of randomized controlled trial. SETTING Not applicable. PATIENT(S) A total of 333 women with anovulatory infertility attributed to PCOS who participated in the double-blind randomized trial entitled the Pregnancy in Polycystic Ovary Syndrome I (PPCOS I) study (registration number, NCT00068861) who had serum samples from baseline laboratory testing available for further serum analysis were studied. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) The association between the baseline AMH levels in each of the 3 treatment groups and ovulation, pregnancy, and live birth rates were assessed. RESULT(S) A total of 322 individuals had a baseline AMH concentration available, of which the mean AMH was 11.7 ± 8.3 ng/mL (range 0.1-43.0 ng/mL). With each unit (1 ng/mL) increase in baseline AMH, the odds of ovulation decreased by 10% (odds ratio, 0.90; 95% confidence interval, 0.86-0.93); this effect did not differ by treatment group. Women with a high baseline AMH concentration (>8 ng/mL) were significantly less likely to ovulate compared with those with a normal baseline AMH concentration (<4 ng/mL) (odds ratio, 0.23; 95% confidence interval, 0.05-0.68). This remained statistically significant when controlling for confounders, including age, body mass index, time in study, and Homeostatic Model Assessment for Insulin Resistance score. Ovulation occurred even at very high AMH concentrations; there was no maximum level noted at which no ovulation events occurred. Baseline AMH concentration was not associated with pregnancy or live birth rates when controlling for confounders. CONCLUSION(S) These AMH values in well-phenotyped individuals with PCOS add to the literature and will aid in identifying AMH criteria for the diagnosis of PCOS. In women with infertility and PCOS, a higher AMH concentration was associated with reduced odds of ovulation with ovulation induction with clomiphene, clomiphene + metformin, and metformin. CLINICAL TRIAL REGISTRATION NUMBER The original trial from which this analysis is derived was entitled "Pregnancy in Polycystic Ovary Syndrome: A 30 Week Double-Blind Randomized Trial of Clomiphene Citrate, Metformin XR, and Combined Clomiphene Citrate/Metformin XR For the Treatment of Infertility in Women With Polycystic Ovary Syndrome" and was registered on ClinicalTrials.gov as number NCT00068861. The URL for the trial is https://clinicaltrials.gov/study/NCT00068861. The first subject was enrolled in November 2002.
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Affiliation(s)
- Allison S Komorowski
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
| | - Lydia Hughes
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Prottusha Sarkar
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David A Aaby
- Department of Preventative Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State Health, Hershey, Pennsylvania
| | - Christina E Boots
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
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Sellami I, Barbotin AL, Bernard V, Robin G, Catteau-Jonard S, Sonigo C, Peigné M. Anti-Mullerian Hormone Assessment in Assisted Reproductive Technique Outcome and Natural Conception. Semin Reprod Med 2024; 42:25-33. [PMID: 39025077 DOI: 10.1055/s-0044-1787273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
In recent years, the prevalence of infertility has increased, and appears to affect approximately one in six couples. Some of them must perform assisted reproductive techniques (ART) in order to achieve pregnancy. As a result, growing interest has arisen about predictive factors of pregnancy and live birth with and without ART. Anti-Mullerian hormone (AMH) is a glycoprotein discovered in the 1950s in male embryonic sexual differentiation. Later, in 1984, its role in folliculogenesis was reported: secreted by granulosa cells, this hormone is involved in the regulation of the recruitment of primordial follicles and in follicular growth. AMH assays were developed for women in 1990s, and the serum AMH level has rapidly become a crucial element in managing women's fertility. Based mainly on its ability to be a quantitative but indirect marker of ovarian reserve, the serum AMH assay is widely used in reproductive medicine and ART. This review summarizes current knowledge of the AMH assessment in the field of reproductive medicine. We focus on the role of AMH level to predict spontaneous pregnancy occurrence, ART outcomes, and fertility preservation outcomes.
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Affiliation(s)
- Inès Sellami
- Service de Médecine de la Reproduction et Préservation de la Fertilité, APHP-Université Paris-Saclay, Hôpital Antoine Béclère, Clamart, France
| | - Anne Laure Barbotin
- CHU Lille, Service de Biologie de la Reproduction, Université de Lille, Hôpital Jeanne de Flandre, Lille, France
- CHU Lille, Faculté de Médecine Henri Warembourg, Université de Lille, Lille Cedex, France
| | - Valérie Bernard
- Service de Gynécologie et Médecine de la Reproduction, Centre Aliénor d'Aquitaine, Bordeaux University Hospital, Bordeaux, France
- University Bordeaux, Bordeaux Institute in Oncology-BRIC-BioGo Team, INSERM U1312, Bordeaux, France
| | - Geoffroy Robin
- CHU Lille, Faculté de Médecine Henri Warembourg, Université de Lille, Lille Cedex, France
- CHU Lille, Service Assistance Médicale à la Procréation et Préservation de la Fertilité - Service de Gynécologie Médicale, Orthogénie et Sexologie, Hôpital Jeanne de Flandre, Lille, France
| | - Sophie Catteau-Jonard
- CHU Lille, Faculté de Médecine Henri Warembourg, Université de Lille, Lille Cedex, France
- CHU Lille, Service Assistance Médicale à la Procréation et Préservation de la Fertilité - Service de Gynécologie Médicale, Orthogénie et Sexologie, Hôpital Jeanne de Flandre, Lille, France
| | - Charlotte Sonigo
- Service de Médecine de la Reproduction et Préservation de la Fertilité, APHP-Université Paris-Saclay, Hôpital Antoine Béclère, Clamart, France
- Université Paris Saclay, Inserm, Physiologie et Physiopathologie Endocrinienne, Le Kremlin-Bicêtre, France
| | - Maeliss Peigné
- Service de Médecine de la Reproduction et Préservation de la Fertilité, AP-HP-Université Sorbonne Paris Nord, Hôpital Jean Verdier, Bondy, France
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Huang H, Gao H, Shi Y, Deng B, He X, Lin J, Li P. Can AMH levels predict the need to step up FSH dose for controlled ovarian stimulation following a long GnRH agonist protocol in PCOS women? Reprod Biol Endocrinol 2023; 21:121. [PMID: 38110998 PMCID: PMC10726541 DOI: 10.1186/s12958-023-01173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/10/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND To explore the role of anti-Mullerian hormone (AMH) in predicting the need to step up recombinant FSH (rFSH) dose following long GnRH agonist protocol in IVF/ICSI cycles of polycystic ovarian syndrome (PCOS) women. METHODS This is a retrospective cohort study of 825 PCOS women undergoing long GnRH agonist protocol enrolled from Jan 2019 to Dec 2021. The daily rFSH dose at which the first response to rFSH were recorded. The dose at which the first response to rFSH was based on folliculometry during follow up in which two or more follicles reached ≥ 11 mm. A receiver operating characteristic (ROC) curve analysis was done to investigate the ability of AMH to predict the need to step up initial rFSH dose. RESULTS PCOS women who needed to step up initial rFSH dose had a significantly higher AMH compared with those didn't step up initial rFSH dose (11.37 ± 3.25ng/ml vs. 8.69 ± 3.16ng/ml, p < 0.001). In multivariate logistic regression analysis, increased AMH level was an independent factor for the need to step up initial rFSH dose in PCOS patients after adjusted for confounding factors. ROC curve analysis showed AMH could predict the need to step up initial rFSH dose (AUC = 0.738, 95%CI: 0.704-0.773), having 75.4% specificity and 63% sensitivity when the threshold AMH concentration was 9.30ng/ml. 58.8% PCOS women with AMH > 9.30 ng/ml required increased rFSH dose compared to 18.8% of women with AMH ≤ 9.30ng/ml (p < 0.001). Although the clinical pregnancy rate and live birth rate were not significantly different, there was a higher incidence of OHSS among women with AMH > 9.30 ng/ml vs. AMH ≤ 9.30ng/ml (20.8% vs. 15.3%, p = 0.043). CONCLUSION PCOS women with AMH > 9.30 ng/ml were resistant to rFSH stimulation and require increased dose for the cycle recruitment of ovarian follicles.
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Affiliation(s)
- Hui Huang
- Department of Reproductive medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Zhenhai Road 10, Xiamen, 361000, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Haijie Gao
- Department of Reproductive medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Zhenhai Road 10, Xiamen, 361000, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Yingying Shi
- Department of Reproductive medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Zhenhai Road 10, Xiamen, 361000, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Bingbing Deng
- Department of Reproductive medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Zhenhai Road 10, Xiamen, 361000, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Xuemei He
- Department of Reproductive medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Zhenhai Road 10, Xiamen, 361000, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Jin Lin
- Department of Reproductive medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Zhenhai Road 10, Xiamen, 361000, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Ping Li
- Department of Reproductive medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Zhenhai Road 10, Xiamen, 361000, Fujian, China.
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China.
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Huyghe L, Robin C, Dumont A, Decanter C, Kyheng M, Dewailly D, Catteau-Jonard S, Robin G. How to Choose the Optimal Starting Dose of Clomiphene Citrate (50 or 100 mg per Day) for a First Cycle of Ovulation Induction in Anovulatory PCOS Women? J Clin Med 2023; 12:4943. [PMID: 37568345 PMCID: PMC10420149 DOI: 10.3390/jcm12154943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/13/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
RESEARCH QUESTION Clomiphene citrate (CC) is one of the first-line treatments for ovulation induction in women with anovulatory polycystic ovary syndrome (PCOS). However, nearly 1 out of 2 women is resistant to 50 mg/day of CC. The objective of this study is to investigate the clinical, biological, and/or ultrasound factors that may predict the resistance to 50 mg/day of CC in the first cycle of treatment in women with anovulatory PCOS. This would make it possible to identify PCOS patients to whom the dose of 100 mg/day would be offered as of the first cycle. DESIGN A retrospective and monocentric study was conducted on 283 women with anovulatory PCOS who required the use of ovulation induction with CC (903 cycles). RESULTS During the first cycle of treatment, 104 patients (36.8%) were resistant to 50 mg/day of CC. Univariate regression analysis showed that patients who resisted 50 mg/day of CC had significantly higher BMI, waist circumference, serum levels of AMH, total testosterone, Δ4-androstenedione, 17-OHP, and insulin (p < 0.05), compared to patients ovulating with this dose. Serum levels of SHBG were significantly lower in patients resistant to 50 mg/day (p < 0.05). After multivariate analysis, only AMH and SHBG remained statistically significant (p = 0.01 and p = 0.001, respectively). However, areas under the ROC curves were weak (0.59 and 0.68, respectively). CONCLUSION AMH and SHBG are the only two parameters significantly associated with the risk of resistance to 50 mg/day of CC. However, no satisfactory thresholds have been established to predict resistance to 50 mg CC.
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Affiliation(s)
- Lucie Huyghe
- Department of Reproductive Medicine and Fertility Preservation, Lille University Hospital, 59000 Lille, France; (L.H.); (C.R.); (A.D.); (S.C.-J.)
| | - Camille Robin
- Department of Reproductive Medicine and Fertility Preservation, Lille University Hospital, 59000 Lille, France; (L.H.); (C.R.); (A.D.); (S.C.-J.)
| | - Agathe Dumont
- Department of Reproductive Medicine and Fertility Preservation, Lille University Hospital, 59000 Lille, France; (L.H.); (C.R.); (A.D.); (S.C.-J.)
| | - Christine Decanter
- Department of Reproductive Medicine and Fertility Preservation, Lille University Hospital, 59000 Lille, France; (L.H.); (C.R.); (A.D.); (S.C.-J.)
| | - Maeva Kyheng
- Department of Biostatistics, Lille University Hospital, 59000 Lille, France
- ULR 2694—METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, University of Lille, 59000 Lille, France
| | - Didier Dewailly
- Faculty of Medicine, University of Lille, 59000 Lille, France
- UMRS-1172, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Jean-Pierre Aubert Research Centre, 59000 Lille, France
| | - Sophie Catteau-Jonard
- Department of Reproductive Medicine and Fertility Preservation, Lille University Hospital, 59000 Lille, France; (L.H.); (C.R.); (A.D.); (S.C.-J.)
- Faculty of Medicine, University of Lille, 59000 Lille, France
- UMRS-1172, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Jean-Pierre Aubert Research Centre, 59000 Lille, France
- Department of Medical Gynecology and Sexology, Lille University Hospital, 59000 Lille, France
| | - Geoffroy Robin
- Department of Reproductive Medicine and Fertility Preservation, Lille University Hospital, 59000 Lille, France; (L.H.); (C.R.); (A.D.); (S.C.-J.)
- Faculty of Medicine, University of Lille, 59000 Lille, France
- UMRS-1172, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Jean-Pierre Aubert Research Centre, 59000 Lille, France
- Department of Medical Gynecology and Sexology, Lille University Hospital, 59000 Lille, France
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Guo Z, Chen S, Chen Z, Hu P, Hao Y, Yu Q. Predictors of response to ovulation induction using letrozole in women with polycystic ovary syndrome. BMC Endocr Disord 2023; 23:90. [PMID: 37098539 PMCID: PMC10127327 DOI: 10.1186/s12902-023-01336-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/07/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the predictive value of the initial screening characteristics of women with anovulatory polycystic ovary syndrome (PCOS) who did or did not respond to 2.5 mg letrozole (LET). METHODS The clinical and laboratory characteristics of women with PCOS who underwent LET treatment were evaluated. Women with PCOS were stratified according to their responses to LET (2.5 mg). The potential predictors of their responses to LET were estimated using logistic regression analysis. RESULTS Our retrospective study included 214 eligible patients with a response to 2.5 mg LET (n = 131) or no response to 2.5 mg LET (n = 83). PCOS patients who responded to 2.5 mg LET showed better outcomes than those who did not (2.5 mg LET) for pregnancy rate, live birth rate, pregnancy rate per patient, and live birth rate per patient. Logistic regression analyses showed that late menarche (odds ratio [OR], 1.79 [95% confidence intervals (CI), 1.22-2.64], P = 0.003), and increased anti-müllerian hormone (AMH) (OR, 1.12 [95% CI, 1.02-1.23], P = 0.02), baseline luteinizing hormone (LH)/ follicle stimulating hormone (FSH) (OR, 3.73 [95% CI, 2.12-6.64], P < 0.001), and free androgen index (FAI) (OR, 1.37 [95% CI, 1.16-1.64], P < 0.001) were associated with a higher possibility of no response to 2.5 mg LET. CONCLUSIONS PCOS patients with an increased LH/FSH ratio, AMH, FAI, and late menarche may need an increased dosage of LET for a treatment response, which could be helpful in designing a personalized treatment strategy.
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Affiliation(s)
- Zaixin Guo
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Shuwen Chen
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiyan Chen
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Beijing, China
| | - Pan Hu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yanfang Hao
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Yu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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Yin WW, Huang CC, Chen YR, Yu DQ, Jin M, Feng C. The effect of medication on serum anti-müllerian hormone (AMH) levels in women of reproductive age: a meta-analysis. BMC Endocr Disord 2022; 22:158. [PMID: 35698127 PMCID: PMC9195431 DOI: 10.1186/s12902-022-01065-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/30/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The study aims to address whether serum anti-müllerian hormone (AMH) levels fluctuate in the short term after medication application, including oral contraceptives (OCs), metformin (MET), Gonadotropin-releasing hormone agonist (GnRH-a), dehydroepiandrosterone (DHEA), vitamin D (VD), clomiphene citrate (CC), and letrozole (LET). METHODS Published literature from PubMed, Embase, and Cochrane central was retrieved up until 19 September 2021. A total of 51 self-control studies with an average Newcastle-Ottawa quality assessment scale (NOS) score of 6.90 were analyzed. The extracted data were entered into Stata software, and the weighted mean difference/standardized mean difference (WMD/SMD) and 95% confidence interval (CI) were used for data analysis. RESULTS After OCs treatment the AMH level showed a significant decline in women with normal ovarian function, which was significant within 3 months (WMD = -1.43, 95% CI: -2.05 to -0.80, P < 0.00001). After MET treatment, the serum AMH decreased in polycystic ovary syndrome (PCOS) patients (WMD = -1.79, 95% CI: -2.32 to -1.26, P < 0.00001), in both obese and non-obese patients. GnRH-a treatment in endometriosis patients led to dynamic changes in the serum AMH levels, that is, ascent at 1 month (P = 0.05), and descent at 3 months (P = 0.02). After DHEA treatment the serum AMH increased in diminished ovarian reserve (DOR) / poor ovarian response (POR) patients (WMD = 0.18, 95% CI: 0.09 to 0.27, P < 0.0001). After VD treatment the serum AMH increased, and it was obvious in non-PCOS patients (WMD = 0.78, 95% CI: 0.34 to 1.21, P = 0.0004). After CC treatment the serum AMH decreased significantly in PCOS patients, specifically in non-obese patients (WMD = -1.24, 95% CI: -1.87 to -0.61, P = 0.0001). CONCLUSIONS Serum AMH levels may be affected in the short term after drug application. Specifically, OC, MET and CC lead to decreased AMH level, DHEA and VD lead to increased AMH level, and GnRH-a leads to dynamic variation, which is correlated with PCOS, obesity, age, and duration of medication. The impacts of these medications should be taken into consideration when AMH is used as a marker of ovarian reserve.
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Affiliation(s)
- Wei-Wei Yin
- Department of Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Chang-Chang Huang
- Department of Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Yi-Ru Chen
- Department of Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Dan-Qing Yu
- Department of Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Min Jin
- Department of Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Chun Feng
- Department of Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
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Holzer I, Parry JP, Beitl K, Pozderovic B, Marculescu R, Ott J. Parameters for Calcium Metabolism in Women with Polycystic Ovary Syndrome Who Undergo Stimulation with Letrozole: A Prospective Cohort Study. J Clin Med 2022; 11:jcm11092597. [PMID: 35566720 PMCID: PMC9101906 DOI: 10.3390/jcm11092597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 12/16/2022] Open
Abstract
For women with polycystic ovarian syndrome (PCOS) and infertility, stimulation with the aromatase-inhibitor letrozole has been recommended as a first-line for ovulation induction. Calcium-associated signaling has also been a component for other ovulation induction and superovulation medications. This study’s aim was to evaluate parameters of calcium metabolism in PCOS women. In a prospective cohort study, 61 anovulatory, infertile PCOS patients who underwent letrozole stimulation were included. Outcome measures were: follicular maturation after letrozole stimulation; parathyroid hormone (PTH); 25-hydroxyvitamin D3 (25OHD3); serum levels of calcium, phosphorus, magnesium, albumin, and total protein. Successful recruitment of a dominant follicle was achieved in 35 patients (57.4%). Women with and without successful follicular development did not differ in serum levels of PTH (38.4 ± 19.7 vs. 39.6 ± 16.2 pg/mL), 25OHD3 (62.5 ± 32.1 vs. 65.4 ± 30.9 nmol/L), calcium (2.36 ± 0.08 vs. 2.37 ± 0.12 mmol/L), or protein (70.2 ± 13.3 vs. 74.0 ± 3.7 g/L), respectively (p > 0.05). However, women who were not responsive to letrozole for ovulation induction demonstrated higher anti-Müllerian hormone (AMH) levels (9.7 ± 4.7 vs. 5.0 ± 3.2 ng/mL, p = 0.005). In conclusion, the success of letrozole stimulation in women with PCOS is independent from calcium metabolism parameters. However, AMH levels seem predictive of medication resistance.
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Affiliation(s)
- Iris Holzer
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, 1090 Vienna, Austria; (I.H.); (K.B.); (B.P.)
| | - John Preston Parry
- Parryscope and Positive Steps Fertility, Madison, WI 39110, USA;
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Klara Beitl
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, 1090 Vienna, Austria; (I.H.); (K.B.); (B.P.)
| | - Boban Pozderovic
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, 1090 Vienna, Austria; (I.H.); (K.B.); (B.P.)
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria;
| | - Johannes Ott
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, 1090 Vienna, Austria; (I.H.); (K.B.); (B.P.)
- Correspondence: ; Tel.: +43-1-40400-28130
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Rashid D, Bardan R. Anti-mullerian Hormone Serum Level as a Predictor of Responsiveness to Clomiphene Citrate Therapy in Iraqi Women with PCOS. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Ovulation induction in polycystic ovarian syndrome is one of the most common interventions used in the treatment of infertility and prediction of the response is very important. Although the serum anti-mullerian hormone (AMH) concentrations are known to be a reliable predictor of ovarian response in in vitro fertilization, in women with polycystic ovary syndrome (PCOS) with a higher level of AMH ovulation induction by clomiphene citrate may be not enough to increase the level of follicle-stimulating hormone and reduce the intraovarain AMH to a level that compatible with the restoration of ovulation.
AIM: Our study aimed to identify those females who will respond to treatment and the starting dose of anti-mullerian hormone serum level as a predictor of responsiveness to clomiphene citrate therapy in Iraqi women with PCOS.
METHODS: 79 females with polycystic ovarian syndrome were included in the study. AMH serum concentrations were determined on the second or 3rd day of the early follicular phase of the menstrual cycle before initiating clomiphene citrate in the first treatment cycle.
RESULTS: The females were falling-out into two groups according to their response to treatment. The patient who ovulated had a significantly lower AMH level among responders 7.89 +−3.2 compared to non-responder 9.41 +−3.27. The women who responded at 50 mg dose had lower AMH 6.56 +−2.2 compared to women who responded at 100mg clomiphene citrate had AMH of 8.74 +−3 with optimum cutoff value for AMH is 6.25 to respond.
CONCLUSION: Serum AMH level measurement prior to treatment initiation in women with PCOS may be a useful method for predicting the outcome of clomiphene citrate treatment, and for each specific ethnic group, there is a cutoff value for AMH above which the response to clomiphene citrate is impaired.
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Anti-Müllerian Hormone in Pathogenesis, Diagnostic and Treatment of PCOS. Int J Mol Sci 2021; 22:ijms222212507. [PMID: 34830389 PMCID: PMC8619458 DOI: 10.3390/ijms222212507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 01/19/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive-aged women. It is characterized by chronic anovulation, hyperandrogenism, and the presence of polycystic ovary in ultrasound examination. PCOS is specified by an increased number of follicles at all growing stages, mainly seen in the preantral and small antral follicles and an increased serum level of Anti-Müllerian Hormone (AMH). Because of the strong correlation between circulating AMH levels and antral follicle count on ultrasound, Anti-Müllerian Hormone has been proposed as an alternative marker of ovulatory dysfunction in PCOS. However, the results from the current literature are not homogeneous, and the specific threshold of AMH in PCOS and PCOM is, therefore, very challenging. This review aims to update the current knowledge about AMH, the pathophysiology of AMH in the pathogenesis of PCOS, and the role of Anti-Müllerian Hormone in the treatment of this syndrome.
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Munira S, Banu J, Ishrat S, Shume MM, Uddin MJ, Sultana S. Anti-Mullerian Hormone (AMH) as a Predictor of Ovarian Response to Clomiphene Citrate in Polycystic Ovarian Syndrome. FERTILITY & REPRODUCTION 2021. [DOI: 10.1142/s2661318221500134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Serum Anti-Mullerian hormone (AMH) levels in women with polycystic ovary syndrome (PCOS) are two- to threefold higher than in ovulatory women with normal ovaries, corresponding to the two- to threefold increase in the number of small follicles in PCOS. The increased AMH has been hypothesized to reduce follicle sensitivity to follicle stimulating hormone (FSH) and estradiol production, thus preventing follicle selection, resulting in follicular arrest at the small antral phase with failure of dominance. Objective: The study was undertaken to test the hypothesis that high AMH level is associated with poor response to ovulation induction in PCOS women. Methods: This was a cross-sectional comparative study of 50 infertile women with PCOS, grouped into those with AMH level <8 ng/mL and those with AMH level [Formula: see text] 8 ng/mL. All participants received an initial dose of 100 mg/day of clomiphene citrate from 2nd to 6th day of menstrual cycle. Ovarian response (follicle size) was assessed by transvaginal monitoring on 12th day of cycle. Results: A total of 50 women were recruited, of which 4 dropped out. Women with AMH [Formula: see text] 8 ng/mL comprised only 23.91% of the PCOS women. AMH and day 12 follicle size had a statistically significant association. Adjusting for other confounding variables in linear, logarithmic, and logistic analysis, serum AMH had significant negative relationship with follicle size (r = 0.511, p < 0.001). AMH was also positively correlated with serum LH, testosterone and negatively correlated with serum follicle stimulating hormone (FSH), serum TSH and BMI. Conclusion: We observed that higher AMH level women had poor response to ovulation induction compared to women with low AMH level.
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Affiliation(s)
- Serajoom Munira
- Department of Reproductive Endocrinology & Infertility, Banagabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Jesmine Banu
- Department of Reproductive Endocrinology & Infertility, Banagabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shakeela Ishrat
- Department of Reproductive Endocrinology & Infertility, Banagabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Mehnaz Mustary Shume
- Department of Reproductive Endocrinology & Infertility, Banagabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Muhammad Jasim Uddin
- Department of Reproductive Endocrinology & Infertility, Banagabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sabiha Sultana
- Department of Reproductive Endocrinology & Infertility, Banagabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Wu Q, Li J, Ng EHY, Liu J, Mol BWJ, Wu X, Wang CC, Kuang H, Ma H, Gao J, Hou L, Hu Z, Shao X, Ge J, Zhang J, Xue H, Xu X, Liang R, Ma H, Yang H, Huang D, Sun Y, Hao C, Du S, Ding C, Gao Y, Wu T, Stener‐Victorin E, Zhang H, Legro RS. Do baseline AMH levels in women with polycystic ovary syndrome predict ovulation rate and time to ovulation: a secondary analysis of PCOSAct trial? BJOG 2021. [DOI: 10.1111/1471-0528.16742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Q Wu
- Department of Obstetrics and Gynaecology, Obstetrics and Gynecology Hospital Fudan University Shanghai China
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong City Hong Kong
| | - J Li
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong City Hong Kong
- Department of Obstetrics and Gynecology The Affiliated Hospital Gui Zhou Medical University Gui Zhou China
| | - EHY Ng
- Department of Obstetrics and Gynaecology The University of Hong Kong Hong Kong City Hong Kong
| | - J‐P Liu
- Centre for Evidence‐Based Chinese Medicine Beijing University of Chinese Medicine Beijing China
| | - BWJ Mol
- Department of Obstetrics and Gynaecology Monash Medical Centre Monash University 246 Clayton Road Clayton Vic. 3168 Australia
| | - X‐K Wu
- Department of Obstetrics and Gynaecology First Affiliated Hospital Heilongjiang University of Chinese Medicine Harbin China
- Heilongjiang Provincial Hospital Harbin Institute of Technology Harbin China
| | - CC Wang
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong City Hong Kong
- Reproduction and Development Laboratory Li Ka Shing Institute of Health Sciences The Chinese University of Hong Kong Hong Kong City Hong Kong
- School of Biomedical Sciences The Chinese University of Hong Kong Hong Kong City Hong Kong
- Chinese University of Hong Kong‐Sichuan University Joint Laboratory in Reproductive Medicine The Chinese University of Hong Kong Hong Kong City Hong Kong
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Vagios S, Sacha CR, Hammer KC, Dimitriadis I, James KE, Bormann CL, Souter I. Response to ovulation induction treatments in women with polycystic ovary syndrome as a function of serum anti-Müllerian hormone levels. J Assist Reprod Genet 2021; 38:1827-1833. [PMID: 33934267 DOI: 10.1007/s10815-021-02217-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/28/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To assess whether anti-Müllerian hormone (AMH) can predict response to ovulation induction (OI) with clomiphene citrate (CC), letrozole (LET), or follicle-stimulating hormone (FSH) in women with polycystic ovary syndrome (PCOS) undergoing OI/intrauterine inseminations (IUI). METHODS A total of 738 OI/IUI cycles from 242 patients at an academic center were stratified in three groups by medication: CC (n = 295), LET (n = 180), and FSH (n = 263), in a retrospective fashion. Ovarian response to treatment (RT, development of at least one dominant follicle) was assessed using mixed effects logistic regression models. RESULTS Overall, RT cycles had lower AMH levels compared to no-RT cycles (p < 0.001). This finding persisted when analysis was limited to oral agents but attenuated in FSH cycles. For CC and LET cycles, the predicted probability (PProb) for RT decreased as AMH levels increased (PProb (95%CI): 97% (93-100), 79% (70-88), and 75% (61-89); 85% (78-93), 75% (67-83), and 73% (63-86) for AMH pct.: ≤ 25th, ≥ 50th, and ≥ 75th, for CC and LET, respectively)). However, RT was noted in 98.5% of FSH/IUI cycles regardless of AMH. For CC cycles, those with AMH ≥ 75th pct. had lower odds for RT over cycles with AMH < 75th pct. (OR 0.2, 95%CI 0.04-0.8, p = 0.02). Similarly, lower odds for RT were observed in LET cycles with AMH ≥ 75th pct. (0.6, 0.3-1.4, p = 0.25). CONCLUSION In PCOS, increasing serum AMH levels are associated with lower probability of RT to oral agents. Our findings constitute a valuable tool for the clinician when counseling PCOS patients and designing a personalized ovulation induction treatment strategy.
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Affiliation(s)
- Stylianos Vagios
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Caitlin R Sacha
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA
| | - Karissa C Hammer
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA
| | - Irene Dimitriadis
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kaitlyn E James
- Deborah Kelly Center for Outcomes Research, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Charles L Bormann
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA
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Tadaion Far F, Jahanian Sadatmahalleh S, Ziaei S, Kazemnejad A. Comparison of the umbilical cord Blood's anti-Mullerian hormone level in the newborns of mothers with polycystic ovary syndrome (PCOS) and healthy mothers. J Ovarian Res 2019; 12:111. [PMID: 31735163 PMCID: PMC6858970 DOI: 10.1186/s13048-019-0583-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 10/17/2019] [Indexed: 01/18/2023] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases. At present, the cause of the disease is not fully understood, but many studies have shown that PCOS is associated with genetic and environmental factors. The present study aimed to assess the umbilical cord blood’s Anti-mullerian hormone (AMH) level in the newborns of mothers suffering from PCOS comparing to healthy mothers. Methods This prospective cohort study was conducted on 120 pregnant women with PCOS, who were selected through Rotterdam criteria, and 60 healthy pregnant women as the control group. The subjects in each group were divided into obese and non-obese mothers according to their body mass index (BMI) before pregnancy. The cord blood samples were collected from the offsprings on the time of childbirth. Finally, the circulating concentrations of AMH in both sexes of the newborns were determined by specific assays. Results The research results showed that the blood level of AMH was higher in the neonates of obese mothers with PCOS comparing to the controls (P < 0.001). Mean AMH level was higher in male neonates born from non-obese PCOS mothers than in the controls (P < 0.001); however, there was not a significant difference in the level of AMH in female neonates between these two groups (P = 0.264). Also the level of the above biomarker was higher in both sexes of the neonates belonging to obese PCOS mothers compared with the neonates born from non-obese PCOS mothers (P < 0.001). Conclusion(s) It can be said that the cord blood AMH level of neonates from obese women with PCOS is higher than that in the newborns of non-obese PCOS mothers. Further longitudinal studies are needed to confirm the clinical findings of the present research.
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Affiliation(s)
- Faezeh Tadaion Far
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Saeideh Ziaei
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Di Paola R, Garzon S, Giuliani S, Laganà AS, Noventa M, Parissone F, Zorzi C, Raffaelli R, Ghezzi F, Franchi M, Zaffagnini S. Are we choosing the correct FSH starting dose during controlled ovarian stimulation for intrauterine insemination cycles? Potential application of a nomogram based on woman's age and markers of ovarian reserve. Arch Gynecol Obstet 2018; 298:1029-1035. [PMID: 30242498 DOI: 10.1007/s00404-018-4906-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/12/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the potential application of a nomogram based on woman's age and ovarian reserve markers as a tool to optimize the follicle-stimulating hormone (FSH) starting dose in intrauterine insemination (IUI) cycles. METHODS We conducted a retrospective analysis enrolling 179 infertile women undergoing controlled ovarian stimulation (COS), followed by IUI. Each woman received an FSH starting dose according to clinical decision. After collecting data about COS and IUI procedures, we calculated the FSH starting dose according to the nomogram. The main outcomes measured were women's baseline characteristics, COS, and clinical outcomes. RESULTS The FSH starting dose calculated by the nomogram was significantly lower than the one actually prescribed (p < 0.001), in only 14.8% of the cycles nomogram calculated a higher starting dose. When gonadotropin dose was decreased during COS, and similarly in case of hyper-response (more than two follicles ≥ 16 mm retrieved), the FSH starting dose calculated by the nomogram would have been lower in most of the cases (81.8% and 48.8%, respectively). Conversely, when gonadotropin dose was increased during COS and in case of low ovarian response (no follicle ≥ 16 mm retrieved), the FSH starting dose calculated by the nomogram would have been lower in most of the cases (64.7% and 100%, respectively); in these groups median anti-Müllerian hormone (AMH) level was 5.62 ng/mL. CONCLUSIONS The application of this nomogram in IUI cycles would lead to a more tailored FSH starting dose and improved cost-effectiveness, although in PCOS women, particularly the ones with high AMH, it does not seem adequate.
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Affiliation(s)
- Rossana Di Paola
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy.
| | - Sara Giuliani
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, VA, Italy
| | - Marco Noventa
- Department of Woman and Child Health, University of Padua, Via Nicolò Giustiniani, 3, 35128, Padua, PD, Italy
| | - Francesca Parissone
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Carlotta Zorzi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, VA, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Stefano Zaffagnini
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
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