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Yerushalmi GM, Avraham S, Kedem A, Youngster M, Barkat J, Baruchin O, Gat I, Yaakov O, Gidoni Y, Hourvitz A. GnRH agonist early follicular challenge test as a predictor of ovarian response in antagonist cycles for fertility preservation. Sci Rep 2024; 14:14308. [PMID: 38906914 PMCID: PMC11192755 DOI: 10.1038/s41598-024-65059-4] [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: 01/04/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024] Open
Abstract
The aim of our study was to evaluate if the response to follicular GnRH agonist (GnRHa) trigger be used to predict intracycle ovarian response in GnRH antagonist cycles among women undergoing fertility preservation IVF. We conducted a prospective study of 146 GnRH antagonist oocyte pickup (OPU) cycles to evaluate GnRHa stimulation test (GAST). On day 2 of the cycle, basal E2 were measured, followed by injection of 0.2 mg GnRHa as part of the initial ovarian stimulation. 12 h later blood sampling was repeated (GAST E3). E2 response was used as test parameter. The major outcome was the number of mature cryopreserved oocytes. We found a linear correlation between both GAST E3 level and GAST E3/E2 ratio and number of M2 oocytes. ROC curve analysis of GAST E3, GAST E3/E2 ratio, AFC and day 3 FSH for > 15 M2 and < 5 M2 oocytes was calculated. For GAST E3 levels obtaining < 5 M2 oocytes, an AUC value of 0.79 was found. For GAST E3 levels obtaining > 15 M2 oocytes, AUC value of 0.8. Patients with GAST E3 ≤ 384 pmol/l has 58.6% risk to obtain < 5 oocytes. Patients younger than 35 with GAST E3 > 708 pmol/l have 66% chance for freezing > 15 oocytes. The response to single GnRHa administration during GnRH antagonist cycle can be used as biomarker of ovarian reserve. This simple, widely available marker, which reflect the estradiol response of small follicles, might predict the response of the specific cycle, and can potentially be used to adjust the treatment dose.Trial registration number: 0304-20-ASF.
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Affiliation(s)
- Gil M Yerushalmi
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel.
| | - Sarit Avraham
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Alon Kedem
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Michal Youngster
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Barkat
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Baruchin
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Itai Gat
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Odelia Yaakov
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Gidoni
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Hourvitz
- IVF Unit, Department of Obstetrics and Gynecology, Shamir Medical Centre, Tzrifin, affiliated with the Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
- Alan and Ada Selwyn Chair for Clinical Infertility Research and Molecular Medicine, Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv, Israel
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Liu Y, Pan Z, Wu Y, Song J, Chen J. Comparison of anti-Müllerian hormone and antral follicle count in the prediction of ovarian response: a systematic review and meta-analysis. J Ovarian Res 2023; 16:117. [PMID: 37370145 DOI: 10.1186/s13048-023-01202-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Increasingly studies reported that the Anti-Müllerian hormone (AMH) seems to be a promising and reliable marker of functional ovarian follicle reserve, even better than the AFC test. Our study aimed to conduct a meta-analysis to assess the predictive value of AMH and AFC for predicting poor or high response in IVF treatment. An electronic search was conducted, and the following databases were used: PubMed, EMBASE, and the Cochrane Library (up to 7 May 2022). The bivariate regression model was used to calculate the pooled sensitivity, specificity, and area under the receiver operator characteristic (ROC) curve. Subgroup analyses and meta-regression also were used in the presented study. Overall performance was assessed by estimating pooled ROC curves between AMH and AFC. RESULTS Forty-two studies were eligible for this meta-analysis. Comparison of the summary estimates for the prediction of poor or high response showed significant difference in performance for AMH compared with AFC [poor (sensitivity: 0.80 vs 0.74, P < 0.050; specificity: 0.81 vs 0.85, P < 0.001); high (sensitivity: 0.81 vs 0.87, P < 0.001)]. However, there were no significant differences between the ROC curves of AMH and AFC for predicting high (P = 0.835) or poor response (P = 0.567). The cut-off value was a significant source of heterogeneity in the present study. CONCLUSIONS The present meta-analysis demonstrated that both AMH and AFC have a good predictive ability to the prediction of poor or high responses in IVF treatment.
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Affiliation(s)
- Yang Liu
- Department of Reproduction, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.
| | - Zhengmei Pan
- Department of Reproduction, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Yanzhi Wu
- Department of Reproduction, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Jiamei Song
- Department of Reproduction, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Jingsi Chen
- Department of Reproduction, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.
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Hua L, Zhe Y, Jing Y, Fujin S, Jiao C, Liu L. Prediction model of gonadotropin starting dose and its clinical application in controlled ovarian stimulation. BMC Pregnancy Childbirth 2022; 22:810. [PMID: 36333671 PMCID: PMC9635211 DOI: 10.1186/s12884-022-05152-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background Selecting an appropriate and personalized Gn starting dose (GSD) is an essential procedure for determining the quality and quantity of oocytes in the controlled ovarian stimulation (COS) process of the in-vitro fertilization (IVF) treatment cycle. The current approach for determining the GSD is mainly based on the experience of a clinician, lacking unified and scientific standards. This study aims to establish a prediction model of GSD, based on which good COS outcomes can be achieved with the influencing factors comprehensively evaluated quantitatively. Material and methods We collected a total of 1555 patients undergoing the first oocytes retrieving cycle and conducted correlation analysis to find the significant factors related to the GSD. Two GSD models are built based on two popular machine learning approaches, and the one with better model performance is selected as the final model. Finally, clinical application and validation were conducted to verify the effectiveness of the proposed model. Results (1) Age, duration of infertility, type of infertility, body mass index (BMI), antral follicle count (AFC), basal follicle stimulating hormone (bFSH), estradiol (E2), luteinizing hormone (LH), anti-Müllerian hormone (AMH) and COS treatment regimen were closely related to the GSD (P < 0.05). (2) The selected model has good modeling performance in terms of both root mean square error (RMSE) (29.87 ~ 34.21) and regression coefficient R (0.947 ~ 0.953). (3) A comprehensive evaluation of influencing factors for GSD is conducted and shows that the top four most significant factors are age, AMH, AFC, and BMI. (4) The proposed GSD can approximate the actual value well in the clinical application, with the mean absolute error of only 11.26 units, and the recommended results can prompt the number of oocytes retrieved (NOR) close to the optimal number. Conclusion Modeling the GSD value with machine learning approaches is feasible and effective, and the proposed model has good clinical application for determining the GSD in the IVF treatment cycle.
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Affiliation(s)
- Liang Hua
- grid.412632.00000 0004 1758 2270Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yang Zhe
- grid.412632.00000 0004 1758 2270Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yang Jing
- grid.412632.00000 0004 1758 2270Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shen Fujin
- grid.412632.00000 0004 1758 2270Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chen Jiao
- grid.412632.00000 0004 1758 2270Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Liu Liu
- grid.412632.00000 0004 1758 2270Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
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Lee J, Hong DG. Serum anti-Müllerian hormone recovery after ovarian cystectomy for endometriosis: A retrospective study among Korean women. Medicine (Baltimore) 2022; 101:e30977. [PMID: 36221377 PMCID: PMC9542760 DOI: 10.1097/md.0000000000030977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Serum anti-Müllerian hormone (sAMH) is a useful marker of ovarian reserve. In many patients, the sAMH levels gradually recover after falling to the lowest level after surgery (nadir phenomenon). This study aimed to analyze the factors related to sAMH recovery from the nadir after an ovarian cystectomy for endometriosis among Korean women. A total of 159 patients with ovarian endometriosis were included in the study. The sAMH levels were measured before surgery and at least twice within 12 months after the surgery. The patients were divided into two groups: those with recovery (nadir group) and those without recovery (reduction group). Postoperative recovery of the sAMH levels from the nadir was not related to the stage and bilaterality of the lesion, surgical methods, such as robot-assisted or laparoscopic surgery, or surgical time. In the nadir group, the level of preoperative cancer antigen 125 was significantly higher, and it decreased significantly after the surgery than in the reduction group (P = .02 and P = .02). Additionally, the postoperative C-reactive protein (CRP) level was significantly higher in the nadir group, and it increased significantly after the surgery than in the reduction group (P = .03 and P = .04). The increasing degree of perioperative CRP level showed a cutoff value on the receiver operating characteristic curve (0.735 mg/dL, area under curve = 0.604; P = .04). Increased serum CRP levels after surgery are significantly related to the recovery of sAMH levels from the nadir. Therefore, postoperative serum CRP level could be used as a marker to predict the sAMH nadir after surgery.
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Affiliation(s)
- Juhun Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
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Iwasawa T, Takahashi T, Maeda E, Ishiyama K, Takahashi S, Suganuma R, Matsuo K, Tachibana M, Fukuhara R, Shirasawa H, Sato W, Kumazawa Y, Terada Y. Effects of localisation of uterine adenomyosis on outcome of in vitro fertilisation/intracytoplasmic sperm injection fresh and frozen-thawed embryo transfer cycles: a multicentre retrospective cohort study. Reprod Biol Endocrinol 2021; 19:84. [PMID: 34088314 PMCID: PMC8176737 DOI: 10.1186/s12958-021-00764-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/19/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Uterine adenomyosis is a benign disease, common among women in their 40 and 50 s, characterised by ectopic endometrial tissue in the uterine myometrial layer. Adenomyosis causes infertility and has a negative effect on the outcomes of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) embryo transfer (ET) cycles. It has also been reported to have different characteristics depending on the adenomyotic lesion localisation. The effect of its localisation on IVF/ICSI-ET outcomes is unclear. This study aimed to investigate whether adenomyotic lesion localisation, assessed using magnetic resonance imaging (MRI), was associated with outcomes of IVF/ICSI-ET cycles. METHODS This multicentre, joint, retrospective cohort study analysed the medical records of 67 infertile patients with adenomyosis who underwent IVF/ICSI with fresh and frozen-thawed ET at five participating facilities from January 2012 to December 2016 and for whom MRI data were available. Fifteen patients were excluded; therefore, the MRI data of 52 patients were evaluated by two radiologists. We assessed the localisation of and classified adenomyotic lesions into advanced (invades the full thickness of the uterine myometrium), extrinsic (localised on the serosal side), and intrinsic (localised on the endometrial side) subtypes. RESULTS There were 40 advanced, nine extrinsic, and three intrinsic cases, and the outcomes of 100, 27, and nine ET cycles, respectively, were analysed. Pregnancy loss/clinical pregnancy and live birth rates of the advanced, extrinsic, and intrinsic groups were 64 % (16/25) and 9 % (9/100), 33.3 % (3/9) and 22.2 % (6/27), and 50 % (1/2) and 11.1 % (1/9), respectively. A logistic regression analysis adjusted for age, prior miscarriage, and body mass index showed that the extrinsic group had fewer pregnancy losses (odds ratio 0.06; 95 % confidence interval [CI]: 0.00-0.54, p = 0.026) and more live births (odds ratio 6.05; 95 % CI: 1.41-29.65, p = 0.018) than the advanced group. CONCLUSIONS Adenomyotic lesions exert different effects on IVF/ICSI-ET outcomes. Thus, MRI assessments of adenomyosis in infertile patients are beneficial. Establishment of treatment plans based on adenomyotic lesion localisation should be considered.
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Affiliation(s)
- Takuya Iwasawa
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, 010-8543, Akita, Japan.
- Department of Obstetrics and Gynecology, Omagari Kousei Medical Center, 014- 0027, Daisen, Akita, Japan.
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, 960-1295, Fukushima, Japan
| | - Eri Maeda
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, 010-8543, Akita, Japan
| | - Koichi Ishiyama
- Department of Radiology, Akita University Graduate School of Medicine, 010-8543, Akita, Japan
| | - Satoshi Takahashi
- Department of Radiology, Hiraka General Hospital, 013-8610, Akita, Japan
| | - Ryota Suganuma
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 960-1295, Fukushima, Japan
| | - Koki Matsuo
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, 990-9585, Yamagata, Japan
| | - Masahito Tachibana
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, 980-8574, Sendai, Miyagi, Japan
| | - Rie Fukuhara
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, 036-8563, Hirosaki, Aomori, Japan
| | - Hiromitsu Shirasawa
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, 010-8543, Akita, Japan
| | - Wataru Sato
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, 010-8543, Akita, Japan
| | - Yukiyo Kumazawa
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, 010-8543, Akita, Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, 010-8543, Akita, Japan
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Danis RB, Sriprasert I, Ho JR, McGinnis LK, Kumar A, Stanczyk FZ. Association of bioavailable inhibin B and oocyte yield in controlled ovarian stimulation. F S Rep 2021; 2:189-194. [PMID: 34278353 PMCID: PMC8267401 DOI: 10.1016/j.xfre.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 12/03/2022] Open
Abstract
Objective To determine if the biologically active or bioavailable inhibin B (bio-inhB) correlated with the oocyte yield in controlled ovarian stimulation (COS). Design Cross-sectional study. Setting Academic center. Patient(s) Women undergoing oocyte cryopreservation. Intervention(s) None. Main Outcome Measure(s) Serum of women were sampled to measure bio-inhB at three points: baseline (“start”); middle (“mid”); and end of COS. A validated, highly specific enzyme-linked immunosorbent assay (Ansh Labs, Webster, TX) measured bio-inhB. The Spearman tests analyzed correlations between bio-inhB and other ovarian reserve markers, including age, follicle-stimulating hormone (FSH), antral follicle count (AFC), and antimüllerian hormone (AMH), and correlations between these markers and oocyte yield. Result(s) A total of 144 women were included. Bioavailable inhibin B at the mid and end of COS, plus its delta, were strongly correlated with other ovarian reserve markers. As the bio-inhB concentration increased, the AFC and AMH levels also increased, whereas the FSH concentration and age decreased. Bioavailable inhibin B values, except at the start of COS, were more strongly correlated with oocyte yield than the FSH concentration (r = 0.72–0.82 vs. r = −0.44) and correlated similarly to the AFC and AMH concentration (r = 0.79 and 0.81, respectively). These correlations strengthened in those with diminished ovarian reserve, specifically age ≥35 years or AMH concentration <2 ng/mL (r = 0.71–0.86 vs. r = 0.49–0.67). Conclusion(s) Predicting COS outcome is imperfect. When using a highly specific enzyme-linked immunosorbent assay, bio-inhB correlated with the oocyte yield similar to or more strongly than traditionally used ovarian reserve markers. These correlations strengthened in cases of diminished ovarian reserve. Bioavailable inhibin B provides physicians with an additional clinical tool for estimating COS outcome.
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Affiliation(s)
- Rachel B Danis
- Departments of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Intira Sriprasert
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jacqueline R Ho
- Departments of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lynda K McGinnis
- Departments of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Frank Z Stanczyk
- Departments of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California.,Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
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Sireesha MU, Chitra T, Subbaiah M, Nandeesha H. Effect of Laparoscopic Ovarian Cystectomy on Ovarian Reserve in Benign Ovarian Cysts. J Hum Reprod Sci 2021; 14:56-60. [PMID: 34083993 PMCID: PMC8057152 DOI: 10.4103/jhrs.jhrs_94_20] [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: 05/16/2020] [Revised: 01/03/2021] [Accepted: 01/30/2021] [Indexed: 11/11/2022] Open
Abstract
Background: Laparoscopic cystectomy is one of the common modes of treatment for benign ovarian cysts. The data related to the effect of cystectomy on ovarian reserve are limited. Aim: The aim of this study was to investigate the effect of laparoscopic ovarian cystectomy on anti-Mullerian hormone (AMH) levels in benign ovarian cysts. Settings and Design: It was a prospective clinical study conducted in a tertiary care hospital from March 2017 to August 2018. Materials and Methods: Seventy-two benign ovarian cyst patients who were admitted for cystectomy were enrolled in the study. Serum AMH levels were estimated in all the patients at baseline, 1 week, and 3 months after cystectomy. Statistical Analysis: Paired t-test was used to assess the differences in AMH levels before and after laparoscopic cystectomy. Results: AMH was significantly reduced after 1 week (P < 0.05) and 3 months (P < 0.05) of cystectomy compared to preoperative levels in both endometriotic and nonendometriotic cysts. The percentage of reduction in the AMH values measured on the 7th postoperative day was found to be greater with endometriotic cysts (54%) followed by mucinous cystadenoma (32%). On day 90, greater recoveries of the AMH values to the baseline AMH levels were observed with cystic teratoma (83% of the baseline AMH levels). Conclusions: Laparoscopic ovarian cystectomy reduces AMH levels immediately after surgery, and improvement in AMH level was observed after 3 months.
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Affiliation(s)
- Madeti Usharani Sireesha
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Thyagaraju Chitra
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Murali Subbaiah
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Hanumanthappa Nandeesha
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Penzias A, Azziz R, Bendikson K, Falcone T, Hansen K, Hill M, Hurd W, Jindal S, Kalra S, Mersereau J, Racowsky C, Rebar R, Reindollar R, Shannon CN, Steiner A, Stovall D, Tanrikut C, Taylor H, Yauger B. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril 2020; 114:1151-1157. [DOI: 10.1016/j.fertnstert.2020.09.134] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
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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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Jiang L, Chen Y, Wang Q, Wang X, Luo X, Chen J, Han H, Sun Y, Shen H. A Chinese practice guideline of the assisted reproductive technology strategies for women with advanced age. J Evid Based Med 2019; 12:167-184. [PMID: 31144467 DOI: 10.1111/jebm.12346] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 01/31/2023]
Abstract
More women postpone childbearing nowadays while female fertility begins to decline with advancing age. Furthermore, with the rolling out of the two-child policy, there is a huge demand for a second child for Chinese aged women. There are various assisted reproductive technology (ART) strategies applied for age-related infertility without solid evidence. On behalf of the Society of Reproductive Medicine, Chinese Medical Association, we would like to develop a Chinese guideline of ART strategies for age-related infertility. This guideline was produced following the recommendations for standard guidelines described in the 2012 WHO Handbook for guideline development. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was also followed. A protocol was formulated and a Guideline Development Group was formed with specialists of reproductive medicine, methodologists from Chinese GRADE working group, and patient representative. Questions regarding the ART strategies for aged infertility were formulated and 8 most important ones were chosen to be structured in PICO format (Population, Intervention, Comparison, Outcomes). Comprehensive search and review of the literature were performed and the quality of the evidence was assessed and rated based on certain criteria and be categorized as high, moderate, low, or very low. Twenty-five recommendations were formulated among members of the Guidelines Development Group (Delphi method) basing on the overall quality of the evidence, in addition to the balance between benefits and harms, values and preferences, and resource implications. The final recommendations were agreed on by consensus during face-to-face meetings. This is the first Chinese practice guideline in reproductive medicine developed following the standard and scientific method.
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Affiliation(s)
- Li Jiang
- Reproductive Medicine Center, Peking University People's Hospital, Beijing, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Chinese GRADE Center, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Qi Wang
- Health Policy PhD Program, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- McMaster Health Forum, McMaster University, Hamilton, Canada
| | - Xiaoqin Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Chinese GRADE Center, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Xufei Luo
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Chinese GRADE Center, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Junqiao Chen
- Faculty of Science, University of Lisbon, Lisbon, Portugal
| | - Hongjing Han
- Reproductive Medicine Center, Peking University People's Hospital, Beijing, China
| | - Yingpu Sun
- Reproductive Medicine Center, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Huan Shen
- Reproductive Medicine Center, Peking University People's Hospital, Beijing, China
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Saumet J, Petropanagos A, Buzaglo K, McMahon E, Warraich G, Mahutte N. No 356-Congélation d'ovules pour pallier le déclin de la fertilité lié à l'âge. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:369-383. [DOI: 10.1016/j.jogc.2017.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lee Y, Kim TH, Park JK, Eum JH, Lee HJ, Kim J, Lyu SW, Kim YS, Lee WS, Yoon TK. Predictive value of antral follicle count and serum anti-Müllerian hormone: Which is better for live birth prediction in patients aged over 40 with their first IVF treatment? Eur J Obstet Gynecol Reprod Biol 2018; 221:151-155. [DOI: 10.1016/j.ejogrb.2017.12.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 12/15/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
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Shahrokhi SZ, Kazerouni F, Ghaffari F. Anti-Müllerian Hormone: genetic and environmental effects. Clin Chim Acta 2018; 476:123-129. [DOI: 10.1016/j.cca.2017.11.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 02/08/2023]
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Saumet J, Petropanagos A, Buzaglo K, McMahon E, Warraich G, Mahutte N. No. 356-Egg Freezing for Age-Related Fertility Decline. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:356-368. [PMID: 29223749 DOI: 10.1016/j.jogc.2017.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide a comprehensive review and evidence based recommendations for Canadian fertility centres that offer social egg freezing. OUTCOMES In social egg freezing cycles we evaluated thawed oocyte survival rates, fertilization rates, embryo quality, pregnancy rates, and live birth rates. We also review how these outcomes are impacted by age, ovarian reserve, and the number of eggs cryopreserved. Finally, we discuss the risks of social egg freezing, the alternatives, the critical elements for counselling and informed consent, and future reporting of egg freezing outcome data. EVIDENCE Published literature was reviewed through searches of MEDLINE and CINAHL using appropriate vocabulary and using key words ("oocyte cryopreservation," "egg freezing," "egg vitrification," "social egg freezing," and "elective egg freezing"). Results included systematic reviews, randomized controlled trials, controlled clinical trials, and observational studies. Expert opinion based on clinical experience, descriptive studies, or reports of expert committees was also included to discuss aspects of egg freezing not currently rigorously studied. VALUES The evidence obtained was reviewed and evaluated by the Clinical Practice Guideline (CPG) Committees of the Canadian Fertility and Andrology Society (CFAS) under the leadership of the principal authors. BENEFITS, HARMS, AND COSTS Implementation of this guideline should assist the clinician to develop an optimal approach in providing counselling for egg freezing while minimizing harm and improving patient outcomes during treatment. VALIDATION These guidelines have been reviewed and approved by the membership of the CFAS and by the CPG Committees of CFAS and The Society of Obstetricians and Gynaecologists of Canada (SOGC). SPONSORS CFAS and SOGC. RECOMMENDATIONS
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Affiliation(s)
- Julio Saumet
- ART Center, CHU Sainte-Justine Hospital, Montréal, QC
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Greenwood EA, Cedars MI, Santoro N, Eisenberg E, Kao CN, Haisenleder DJ, Diamond MP, Huddleston HG. Antimüllerian hormone levels and antral follicle counts are not reduced compared with community controls in patients with rigorously defined unexplained infertility. Fertil Steril 2017; 108:1070-1077. [PMID: 29202959 DOI: 10.1016/j.fertnstert.2017.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 08/11/2017] [Accepted: 09/13/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To test the hypothesis that women with unexplained infertility demonstrate evidence of diminished ovarian reserve when compared with a population of community controls. DESIGN Cross-sectional study. SETTING Multicenter university-based clinical practices. PATIENT(S) Study participants included 277 healthy, normo-ovulatory female partners with rigorously defined unexplained infertility randomly selected from a multicenter trial (Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation). Controls included 226 healthy, normo-ovulatory women not seeking treatment for fertility from a community-based cohort (Ovarian Aging study). INTERVENTION(S) Serum antimüllerian hormone (AMH) assay at a central laboratory, FSH, fasting serum metabolic testing, transvaginal ultrasonography for antral follicle counts (AFCs), anthropometric measurements. MAIN OUTCOME MEASURE(S) Average AMH, AFC, and AMH/AFC were compared between infertile and control women by age. Analyses of covariance compared these outcomes while controlling for confounders, including age, race, body mass index, smoking history, and study site. RESULT(S) In our models, AMH, AFC, and AMH/AFC ovarian reserve indices did not differ between infertile women and community-based controls, after controlling for age, race, body mass index, smoking history, and study site. CONCLUSION(S) Currently utilized predictors of ovarian reserve do not discriminate women with rigorously defined unexplained infertility from healthy community-based women of similar demographic characteristics. Contrary to our hypothesis, among women with FSH in the normal range (≤12 IU/L), women with unexplained infertility did not show evidence of decreased ovarian reserve as measured by AMH and AFC. Ovarian reserve markers in isolation may not serve as predictors of future fertility.
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Affiliation(s)
- Eleni A Greenwood
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California.
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado
| | - Esther Eisenberg
- Fertility and Infertility Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
| | - Chia-Ning Kao
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Daniel J Haisenleder
- Ligand Core Laboratory, University of Virginia Center for Research in Reproduction, Charlottesville, Virginia
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta, Georgia
| | - Heather G Huddleston
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California
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Ashrafi M, Hemat M, Arabipoor A, Salman Yazdi R, Bahman-Abadi A, Cheraghi R. Predictive values of anti-müllerian hormone, antral follicle count and ovarian response prediction index (ORPI) for assisted reproductive technology outcomes. J OBSTET GYNAECOL 2016; 37:82-88. [DOI: 10.1080/01443615.2016.1225025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mahnaz Ashrafi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Mandana Hemat
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Arezoo Arabipoor
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Reza Salman Yazdi
- Department of Andrology, Reproductive Biomedicine Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Akram Bahman-Abadi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Rezvaneh Cheraghi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Park HJ, Lee GH, Gong DS, Yoon TK, Lee WS. The meaning of anti-Müllerian hormone levels in patients at a high risk of poor ovarian response. Clin Exp Reprod Med 2016; 43:139-45. [PMID: 27689035 PMCID: PMC5039305 DOI: 10.5653/cerm.2016.43.3.139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 04/16/2016] [Accepted: 05/18/2016] [Indexed: 11/23/2022] Open
Abstract
Measurements of ovarian reserve play an important role in predicting the clinical results of assisted reproductive technology (ART). The ideal markers of ovarian reserve for clinical applications should have high specificity in order to determine genuine poor responders. Basal follicle-stimulating hormone levels, antral follicle count, and serum anti-Müllerian hormone (AMH) levels have been suggested as ovarian reserve tests that may fulfill this requirement, with serum AMH levels being the most promising parameter. Serum AMH levels have been suggested to be a predictor of clinical pregnancy in ART for older women, who are at a high risk for decreased ovarian response. We reviewed the prognostic significance of ovarian reserve tests for patients undergoing ART treatment, with a particular focus on the significance of serum AMH levels in patients at a high risk of poor ovarian response.
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Affiliation(s)
- Hyun Jong Park
- Department of Obstetrics and Gynecology, CHA Gumi Medical Center, Gumi, Korea
| | - Geun Ho Lee
- Department of Obstetrics and Gynecology, CHA Gumi Medical Center, Gumi, Korea
| | - Du Sik Gong
- Department of Obstetrics and Gynecology, CHA Gumi Medical Center, Gumi, Korea
| | - Tae Ki Yoon
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Woo Sik Lee
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul, Korea
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Bozkurt B, Erdem M, Mutlu MF, Erdem A, Guler I, Mutlu I, Oktem M. Comparison of age-related changes in anti-Müllerian hormone levels and other ovarian reserve tests between healthy fertile and infertile population. HUM FERTIL 2016; 19:192-8. [DOI: 10.1080/14647273.2016.1217431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Banu Bozkurt
- Department of Obstetrics & Gynaecology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Erdem
- Department of Obstetrics & Gynaecology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Firat Mutlu
- Department of Obstetrics and Gynaecology, Yuksek Ihtisas University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Erdem
- Department of Obstetrics & Gynaecology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ismail Guler
- Department of Obstetrics & Gynaecology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ilknur Mutlu
- IVF Unit, Novaart IVF and Women Health Centre, Ankara, Turkey
| | - Mesut Oktem
- Department of Obstetrics & Gynaecology, Gazi University Faculty of Medicine, Ankara, Turkey
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20
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Song T, Kim MK, Kim ML, Jung YW, Yun BS, Seong SJ, Kwon SH. Impact of opportunistic salpingectomy on anti-Müllerian hormone in patients undergoing laparoscopic hysterectomy: a multicentre randomised controlled trial. BJOG 2016; 124:314-320. [DOI: 10.1111/1471-0528.14182] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 01/24/2023]
Affiliation(s)
- T Song
- Department of Obstetrics & Gynaecology; Kangbuk Samsung Hospital; Sungkyunkwan University School of Medicine; Seoul Korea
| | - MK Kim
- Department of Obstetrics & Gynaecology; CHA Gangnam Medical Centre; CHA University; Seoul Korea
| | - M-L Kim
- Department of Obstetrics & Gynaecology; CHA Gangnam Medical Centre; CHA University; Seoul Korea
| | - YW Jung
- Department of Obstetrics & Gynaecology; CHA Gangnam Medical Centre; CHA University; Seoul Korea
| | - BS Yun
- Department of Obstetrics & Gynaecology; CHA Gangnam Medical Centre; CHA University; Seoul Korea
| | - SJ Seong
- Department of Obstetrics & Gynaecology; CHA Gangnam Medical Centre; CHA University; Seoul Korea
| | - S-H Kwon
- Department of Obstetrics & Gynaecology; Dongsan Hospital; Keimyung University School of Medicine; Daegu Korea
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Moon KY, Kim H, Lee JY, Lee JR, Jee BC, Suh CS, Kim KC, Lee WD, Lim JH, Kim SH. Nomogram to predict the number of oocytes retrieved in controlled ovarian stimulation. Clin Exp Reprod Med 2016; 43:112-8. [PMID: 27358830 PMCID: PMC4925866 DOI: 10.5653/cerm.2016.43.2.112] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 02/22/2016] [Accepted: 02/26/2016] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Ovarian reserve tests are commonly used to predict ovarian response in infertile patients undergoing ovarian stimulation. Although serum markers such as basal follicle-stimulating hormone (FSH) or random anti-Müllerian hormone (AMH) level and ultrasonographic markers (antral follicle count, AFC) are good predictors, no single test has proven to be the best predictor. In this study, we developed appropriate equations and novel nomograms to predict the number of oocytes that will be retrieved using patients' age, serum levels of basal FSH and AMH, and AFC. METHODS We analyzed a database containing clinical and laboratory information of 141 stimulated in vitro fertilization (IVF) cycles performed at a university-based hospital between September 2009 and December 2013. We used generalized linear models for prediction of the number of oocytes. RESULTS Age, basal serum FSH level, serum AMH level, and AFC were significantly related to the number of oocytes retrieved according to the univariate and multivariate analyses. The equations that predicted the number of oocytes retrieved (log scale) were as follows: model (1) 3.21-0.036×(age)+0.089×(AMH), model (2) 3.422-0.03×(age)-0.049×(FSH)+0.08×(AMH), model (3) 2.32-0.017×(age)+0.039×(AMH)+0. 03×(AFC), model (4) 2.584-0.015×(age)-0.035×(FSH)+0.038×(AMH)+0.026×(AFC). model 4 showed the best performance. On the basis of these variables, we developed nomograms to predict the number of oocytes that can be retrieved. CONCLUSION Our nomograms helped predict the number of oocytes retrieved in stimulated IVF cycles.
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Affiliation(s)
- Kyoung Yong Moon
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.; Seoul Maria Fertility Hospital, Seoul, Korea
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | | | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | | | - Won Don Lee
- Seoul Maria Fertility Hospital, Seoul, Korea
| | - Jin Ho Lim
- Seoul Maria Fertility Hospital, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
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Giampaolino P, Bifulco G, Di Spiezio Sardo A, Mercorio A, Bruzzese D, Di Carlo C. Endometrioma size is a relevant factor in selection of the most appropriate surgical technique: a prospective randomized preliminary study. Eur J Obstet Gynecol Reprod Biol 2015; 195:88-93. [DOI: 10.1016/j.ejogrb.2015.09.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/26/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
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Sabek EAS, Saleh OI, Ahmed HA. Ultrasound in evaluating ovarian reserve, is it reliable? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril 2015; 103:e9-e17. [DOI: 10.1016/j.fertnstert.2014.12.093] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 11/21/2022]
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Nelson SM, Klein BM, Arce JC. Comparison of antimüllerian hormone levels and antral follicle count as predictor of ovarian response to controlled ovarian stimulation in good-prognosis patients at individual fertility clinics in two multicenter trials. Fertil Steril 2015; 103:923-930.e1. [PMID: 25624196 DOI: 10.1016/j.fertnstert.2014.12.114] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/10/2014] [Accepted: 12/15/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare antimüllerian hormone (AMH) and antral follicle count (AFC) as predictors of ovarian response to controlled ovarian stimulation at individual fertility clinics. DESIGN Retrospective analysis of individual study center data in two multicenter trials. Centers that provided >10 patients were included in the analysis. SETTING A total of 19 (n = 519 patients) and 18 study centers (n = 686 patients) participating in a long GnRH agonist trial (MERIT) and a GnRH antagonist trial (MEGASET), respectively. PATIENT(S) Infertile women of good prognosis. INTERVENTION(S) Long GnRH agonist or GnRH antagonist cycles. MAIN OUTCOME MEASURE(S) Correlation between AMH and AFC, and oocyte yield by each study center for each trial. RESULTS(S) Antimüllerian hormone was more strongly correlated with oocyte yield than AFC: r = 0.56 vs. r = 0.28 in the GnRH agonist cohort, and r = 0.55 vs. r = 0.33 in the GnRH antagonist cohort. The correlation was numerically higher for AMH than for AFC at a significantly higher proportion of study centers: 17 (89%) and 15 (83%) centers in the long GnRH agonist and GnRH antagonist trial, respectively. Assessment of the relative capacity of AMH and AFC for predicting oocyte yield demonstrated that AMH dominated the model: AMH, R(2) = 0.29 and 0.23; AFC: R(2) = 0.07 and 0.07; AMH + AFC: R(2) = 0.30 and 0.23 for long GnRH agonist and GnRH antagonist trials, respectively. CONCLUSIONS(S) Antimüllerian hormone was a stronger predictor of ovarian response to gonadotropin therapy than AFC at the study center level in both randomized trials utilizing GnRH agonist and GnRH antagonist protocols. Antral follicle count provided no added predictive value beyond AMH.
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Affiliation(s)
- Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Bjarke M Klein
- Global Biometrics, Ferring Pharmaceuticals, Copenhagen, Denmark
| | - Joan-Carles Arce
- Reproductive Health, Ferring Pharmaceuticals A/S, Copenhagen, Denmark.
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Iliodromiti S, Anderson RA, Nelson SM. Technical and performance characteristics of anti-Müllerian hormone and antral follicle count as biomarkers of ovarian response. Hum Reprod Update 2014; 21:698-710. [PMID: 25489055 DOI: 10.1093/humupd/dmu062] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/07/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Stratified (individualized) medicine has been recognized as a key priority for policy makers and healthcare providers. The main principle of individualized care depends on utilizing patients' characteristics and biomarkers to predict prognosis, tailor intended treatment and predict treatment outcomes. In reproductive medicine a wide variety of biomarkers have been proposed as predictors of ovarian response; of these, anti-Müllerian hormone (AMH) and antral follicle count (AFC) are purported as exhibiting the most favourable analytical and performance characteristics. Previously AFC and AMH have been considered essentially interchangeable; however, recent trial data have questioned this postulation. The aim of this review is to present an analysis of the strengths and weaknesses of these biomarkers as predictors of ovarian response, using both physiological and technical perspectives. METHODS We have conducted a systematic search of the most recent (to May 2014) relevant literature and summarized the existing evidence. Articles written in a language other than English without an available English translation were excluded. RESULTS Both AMH values and AFC can be influenced by comparable technical, physiological and exogenous factors. AMH displays some variation within and between cycles, consistent with its physiological role in follicle development, and there are growing data on the impact of pharmacological treatments and pathological conditions but cycle-independent measurement is appropriate for clinical purposes. A range of issues with manual AMH assays may be resolving with the development of fully automated assays. Despite described standardization of its measurement technique, AFC is subject to marked inter- and intra-operator variability and the effects of external influences are likely to be comparable. Outwith some highly specialist centres, the intracyclic variation in AFC requires its measurement between Day 2 and 4 of the cycle. Observational studies suggest comparable performance characteristics for AMH and AFC in predicting poor and high ovarian response, but recent RCTs suggest markedly better performance for AMH. CONCLUSIONS The performance characteristics of both AMH and AFC for the prediction of ovarian response to exogenous gonadotrophins have been inflated by single site observational cohorts, resulting in the viewpoint that AMH and AFC exhibit equivalent performance characteristics. Large scale multicentre RCTs, with centralized assay performance, have demonstrated that AMH is substantially the more accurate and robust biomarker, probably reflecting difficulties with standardization of AFC determination. While AFC retains some advantages, particularly immediacy and accessibility, international standardization of AMH combined with a stable automated assay is likely to enhance its performance as the biomarker of choice in predicting the ovarian response in assisted conception.
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Affiliation(s)
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow G31 2ER, UK
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Song T, Kim WY, Lee KW, Kim KH. Effect on ovarian reserve of hemostasis by bipolar coagulation versus suture during laparoendoscopic single-site cystectomy for ovarian endometriomas. J Minim Invasive Gynecol 2014; 22:415-20. [PMID: 25460517 DOI: 10.1016/j.jmig.2014.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVE To compare the postoperative decrease in ovarian reserve between hemostasis by bipolar coagulation and suture during laparoendoscopic single-site cystectomy (LESS-C) for ovarian endometriomas. DESIGN Prospective comparative study (Canadian Task Force Classification II-1). SETTING University hospital. PATIENTS One hundred twenty-five patients with ovarian endometriomas. INTERVENTIONS Patients with endometrioma were managed by hemostasis with either bipolar coagulation (n = 62) or suturing (n = 63) during LESS-C. We evaluated the impact of surgery on ovarian reserve using serum anti-Müllerian hormone (AMH) levels, which were measured before surgery and 3 months after surgery in all patients. MEASUREMENT AND MAIN RESULTS Baseline characteristics such as age, bilaterality of endometriomas, and preoperative AMH levels were similar between the 2 study groups. There were also no differences between the 2 groups in surgical outcomes, such as operative time, operative blood loss, or operative complications. In both study groups, postoperative AMH levels were lower than preoperative AMH levels (p < .001). The decline rate of AMH levels was significantly greater in the bipolar coagulation group than in the suture group (42.2% [interquartile range, 16.5%-53.0%] and 24.6% [interquartile range, 11.6%-37.0%], respectively, p = .001). CONCLUSION Hemostasis by bipolar coagulation after stripping of the endometrioma during LESS-C reduces ovarian reserve more than suturing does, as determined by serial AMH levels. Therefore, suturing may be a better hemostatic choice after stripping ovarian endometriomas.
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Affiliation(s)
- Taejong Song
- Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Obstetrics & Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea.
| | - Woo Young Kim
- Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyo Won Lee
- Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kye Hyun Kim
- Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Song T, Lee SH, Kim WY. Additional benefit of hemostatic sealant in preservation of ovarian reserve during laparoscopic ovarian cystectomy: a multi-center, randomized controlled trial. Hum Reprod 2014; 29:1659-65. [DOI: 10.1093/humrep/deu125] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Kofinas JD, Elias RT. Follicle-stimulating hormone/luteinizing hormone ratio as an independent predictor of response to controlled ovarian stimulation. ACTA ACUST UNITED AC 2014; 10:505-9. [PMID: 24807379 DOI: 10.2217/whe.14.31] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM To determine whether a follicle-stimulating hormone (FSH)/luteinizing hormone (LH) ratio over 3 in the setting of a normal FSH (<12 IU/l) is associated with a higher rate of failed controlled ovarian stimulation cycles. DESIGN Retrospective cohort. MATERIALS & METHODS A total of 676 patients were identified; 198 patients had a FSH/LH ratio >3 and 477 patients had a FSH/LH ratio <3. Exclusion criteria included: age >40 years; estradiol (E2) prime protocols; E2 at start >70 pg/ml; and FSH at start >12 IU/l. The main outcome measure was cycle cancellation. RESULTS An elevated FSH/LH ratio >3 was more likely to result in the individual's cycle cancelled (15 vs 5.24%; p = 0.0001). The total gonadotropin dosage was greater in the higher ratio versus lower ratio group (2636 vs 2242 IU; significant). Peak E2 was significantly lower in the FSH/LH >3 group (peak E2: 1635 vs 1942 pg/ml). CONCLUSION The value of the FSH/LH ratio in patients with normal FSH levels, may have a role in determining the appropriate stimulation protocol and predict cycle cancellations.
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Affiliation(s)
- Jason D Kofinas
- Department of Obstetrics & Gynecology, New York Presbyterian Hospital, 525 East 68th Street New York, NY 10021, USA.
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Lukaszuk K, Liss J, Kunicki M, Jakiel G, Wasniewski T, Woclawek-Potocka I, Pastuszek E. Anti-Müllerian hormone (AMH) is a strong predictor of live birth in women undergoing assisted reproductive technology. Reprod Biol 2014; 14:176-81. [PMID: 25152514 DOI: 10.1016/j.repbio.2014.03.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 03/20/2014] [Accepted: 03/26/2014] [Indexed: 12/28/2022]
Abstract
In the present study, we evaluated the clinical value of the following parameters: basal anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), inhibin B and antral follicle count (AFC) in predicting live birth outcomes. The study involved 603 women undergoing in vitro fertilization (IVF) using the long protocol for controlled ovarian hyperstimulation (COH). Serum levels of AMH, FSH and inhibin B as well as AFC were measured on the first three days of the menstrual cycle prior to the beginning of stimulation. AMH was the only independent parameter that correlated with the chance of live birth. We found that live birth rates of 46.2% (patient age <35 years), 44.7% (35-37 years), 32.1% (38-39) and 15.3% (>39) were associated with concentrations of AMH>1.4 ng/ml. For the AMH range 0.6-1.4 ng/ml, the live birth rates were 29.3%, 12.5%, 5.6% and 2.7%, respectively, and for AMH concentrations below 0.6 ng/ml the rates were 7.1%, 8.3%, 0% and 5.8%, respectively. Independently of other parameters affecting the chance of live birth, the success rate was the highest when the AMH level was >2 ng/ml, significantly lower when the AMH concentration was about 1 ng/ml, and 0% when the AMH concentration was ∼0.1 ng/ml. In conclusion, this is the first report to demonstrate that AMH level correlated better than age, FSH or inhibin B concentrations or AFC with live birth outcome. Therefore, the basal serum concentration of AMH may become a new, substantial prognostic factor regarding live birth above and beyond other currently available predictors of IVF outcome.
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Affiliation(s)
- Krzysztof Lukaszuk
- INVICTA Fertility and Reproductive Center, Gdansk, Poland; Department of Nursing, Medical University, Gdansk, Poland; INVICTA Fertility and Reproductive Clinic, Warsaw, Poland; Department of Gynaecology and Obstetrics, Warmia and Masuria University, Olsztyn, Poland.
| | - Joanna Liss
- INVICTA Fertility and Reproductive Center, Gdansk, Poland
| | - Michal Kunicki
- INVICTA Fertility and Reproductive Clinic, Warsaw, Poland
| | - Grzegorz Jakiel
- Department of Obstetrics and Gynaecology, The Medical Center of Postgraduate Education, Warsaw, Poland
| | - Tomasz Wasniewski
- Department of Gynaecology and Obstetrics, Warmia and Masuria University, Olsztyn, Poland
| | - Izabela Woclawek-Potocka
- Department of Reproductive Immunology and Pathology, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Ewa Pastuszek
- INVICTA Fertility and Reproductive Center, Gdansk, Poland; Department of Nursing, Medical University, Gdansk, Poland
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Arthur R, Kachura J, Liu G, Chan C, Shapiro H. Laparoscopic Myomectomy Versus Uterine Artery Embolization: Long-Term Impact on Markers of Ovarian Reserve. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:240-247. [DOI: 10.1016/s1701-2163(15)30632-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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La Marca A, Sunkara SK. Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: from theory to practice. Hum Reprod Update 2013; 20:124-40. [PMID: 24077980 DOI: 10.1093/humupd/dmt037] [Citation(s) in RCA: 339] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The main objective of individualization of treatment in IVF is to offer every single woman the best treatment tailored to her own unique characteristics, thus maximizing the chances of pregnancy and eliminating the iatrogenic and avoidable risks resulting from ovarian stimulation. Personalization of treatment in IVF should be based on the prediction of ovarian response for every individual. The starting point is to identify if a woman is likely to have a normal, poor or a hyper response and choose the ideal treatment protocol tailored to this prediction. The objective of this review is to summarize the predictive ability of ovarian reserve markers, such as antral follicle count (AFC) and anti-Mullerian hormone (AMH), and the therapeutic strategies that have been proposed in IVF after this prediction. METHODS A systematic review of the existing literature was performed by searching Medline, EMBASE, Cochrane library and Web of Science for publications in the English language related to AFC, AMH and their incorporation into controlled ovarian stimulation (COS) protocols in IVF. Literature available to May 2013 was included. RESULTS The search generated 305 citations of which 41 and 25 studies, respectively, reporting the ability of AMH and AFC to predict response to COS were included in this review. The literature review demonstrated that AFC and AMH, the most sensitive markers of ovarian reserve identified to date, are ideal in planning personalized COS protocols. These sensitive markers permit prediction of the whole spectrum of ovarian response with reliable accuracy and clinicians may use either of the two markers as they can be considered interchangeable. Following the categorization of expected ovarian response to stimulation clinicians can adopt tailored therapeutic strategies for each patient. Current scientific trend suggests the elective use of the GnRH antagonist based regimen for hyper-responders, and probably also poor responders, as likely to be beneficial. The selection of the appropriate and individualized gonadotrophin dose is also of paramount importance for effective COS and subsequent IVF outcomes. CONCLUSION Personalized IVF offers several benefits; it enables clinicians to give women more accurate information on their prognosis thus facilitating counselling especially in cases of extremes of ovarian response. The deployment of therapeutic strategies based on selective use of GnRH analogues and the fine tuning of the gonadotrophin dose on the basis of potential ovarian response in every single woman can allow for a safer and more effective IVF practice.
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Affiliation(s)
- Antonio La Marca
- Mother-Infant Department, Institute of Obstetrics and Gynaecology, University of Modena and Reggio Emilia, 41100 Modena, Italy
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Brugo Olmedo S, De Vincentiis S, De Martino E, Bedecarrás P, Blanco AM, Freire A, Buffone MG, Rey RA. Prediction of reproductive outcomes according to different serum anti-Müllerian hormone levels in females undergoing intracystoplasmic sperm injection. PLoS One 2013; 8:e75685. [PMID: 24069435 PMCID: PMC3775779 DOI: 10.1371/journal.pone.0075685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 08/19/2013] [Indexed: 11/18/2022] Open
Abstract
Background and aim of the study Serum anti-Müllerian hormone (AMH) is a reliable marker of ovarian reserve, and it has been shown to be correlated with reproductive outcomes in grouped analyses. However, practical data is scarce for the physician and the patients to predict these outcomes in an individual couple according to serum AMH measured prior to assisted reproduction technology (ART) procedures. Study Design To address this question, we performed an analytic observational study including 145 females undergoing intracytoplasmic sperm injection (ICSI) in a single center. Results were analyzed according to serum AMH; subgroup analyses were performed by grouping patients according to patient’s age and FSH levels. Results The risk of cycle cancelation decreased from 64% in patients with serum AMH ≤3 pmol/L (0.42 ng/mL) to 21% with AMH ≥15 pmol/L (2.10 ng/mL). Cycle cancelation occurred in approximately two-thirds of the patients with AMH ≤ 3 pmol/L irrespective of the FSH level. However, with higher AMH values the risk of cycle cancelation decreased more significantly in patients with normal FSH. The rate of good response increased from almost null in patients with AMH ≤3 pmol/L to 61% in those with AMH ≥15 pmol/L. The positive correlation between good response and AMH was also significant, but with lower absolute rates, when patients were grouped according to their age or FSH levels. Pregnancy rate increased moderately, but significantly, from 31% with AMH ≤3 pmol/L to 35% with AMH ≥15 pmol/L. Conclusions We provide estimates of reproductive outcomes according to individualized values of serum AMH, in general and in subgroups according to patient’s age or serum FSH, which are helpful for the clinician and the couple in their decision making about starting an assisted reproductive treatment.
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Affiliation(s)
| | | | | | - Patricia Bedecarrás
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE)CONICET – FEI – División de Endocrinología, Hospital de Niños R. Gutiérrez, Buenos Aires, Argentina
| | - Ana María Blanco
- Centro de Estudios Bioquímicos, Andrológicos y Ginecológicos, Buenos Aires, Argentina
| | - Analía Freire
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE)CONICET – FEI – División de Endocrinología, Hospital de Niños R. Gutiérrez, Buenos Aires, Argentina
| | - Mariano G. Buffone
- Centro Médico, Seremas, Buenos Aires, Argentina
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Rodolfo A. Rey
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE)CONICET – FEI – División de Endocrinología, Hospital de Niños R. Gutiérrez, Buenos Aires, Argentina
- * E-mail:
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Broer SL, Dólleman M, van Disseldorp J, Broeze KA, Opmeer BC, Bossuyt PMM, Eijkemans MJC, Mol BW, Broekmans FJM. Prediction of an excessive response in in vitro fertilization from patient characteristics and ovarian reserve tests and comparison in subgroups: an individual patient data meta-analysis. Fertil Steril 2013; 100:420-9.e7. [PMID: 23721718 DOI: 10.1016/j.fertnstert.2013.04.024] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/12/2013] [Accepted: 04/12/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate whether ovarian reserve tests (ORTs) add prognostic value to patient characteristics, such as female age, in the prediction of excessive response to ovarian hyperstimulation in patients undergoing IVF, and whether their performance differs across clinical subgroups. DESIGN Authors of studies reporting on basal FSH, antimüllerian hormone (AMH), or antral follicle count (AFC) in relation to ovarian response to ovarian hyperstimulation were invited to share original data. Random intercept logistic regression models were used to estimate added value of ORTs on patient characteristics, while accounting for between-study heterogeneity. Receiver operating characteristic regression analyses were performed to study the effect of patient characteristics on ORT accuracy. SETTING In vitro fertilization clinics. PATIENT(S) A total of 4,786 women for the main analysis, with a subgroup of 1,023 women with information on all three ORTs. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Excessive response prediction. RESULT(S) We included 57 studies reporting on 32 databases. Female age had an area under the receiver operating characteristic curve of 0.61 for excessive response prediction. Antral follicle count and AMH significantly added prognostic value to this. A model with female age, AFC, and AMH had an area under the receiver operating characteristic curve of 0.85. The combination of AMH and AFC, without age, had similar accuracy. Subgroup analysis indicated that FSH performed significantly worse in predicting excessive response in higher age groups, AFC did significantly better, and AMH performed the same. CONCLUSION(S) We demonstrate that AFC and AMH add value to female age in the prediction of excessive response and that, for AFC and FSH, the discriminatory performance is affected by female age.
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Affiliation(s)
- Simone L Broer
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht, the Netherlands
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Ni L, Sadiq S, Mao Y, Cui Y, Wang W, Liu J. Influence of various tubal surgeries to serum antimullerian hormone level and outcome of the subsequent IVF-ET treatment. Gynecol Endocrinol 2013; 29:345-9. [PMID: 23339657 DOI: 10.3109/09513590.2012.743004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the influence of various tubal surgeries to ovarian reserve via serum level of antimullerian hormone (AMH) and the subsequent in vitro fertilization and embryo transplantation (IVF-ET) outcome in patients with simple tubal infertility. STUDY DESIGN A prospective cohort study was conducted on 134 IVF cycles undegone by 26 and 34 cases with bilateral and unilateral salpingectomy, respectively, 23 cases with bilateral oviducts interrupted in the proximal and 51 cases with bilateral oviducts obstruction without intervention as controls. RESULTS Serum AMH displayed its great superiority to traditional markers of ovarian reserve in correspondence with antral follicles count and decisive effect for the number of oocytes retrieved after stimulation in each group. No significant differences on ovarian reserve and responsiveness or IVF-ET outcome existed among four groups comparable on essential characteristics, except for numerically higher clinical pregnancy rate and live birth rate after various tubal surgeries versus no intervention for bilateral oviducts obstruction. Especially, bilateral salpingectomy precursed the statistically highest implantation rate (51.0% versus 28.0%, 39.1%, 30.4%) and numerically best IVF outcome. CONCLUSION Tubal surgical procedures have some beneficial effect for improving IVF outcome without significant impact on ovarian reserve or responsiveness. Bilateral salpingectomy appears to be an appropriate procedure before IVF treatment for bilateral salpingitis, especially hydrosalpinx.
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Affiliation(s)
- Lili Ni
- Center of Clinical Reproduction, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Anti-Müllerian hormone as an independent predictor of twin versus singleton pregnancy in fresh cycles. Reprod Biomed Online 2013; 26:360-7. [DOI: 10.1016/j.rbmo.2012.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 12/05/2012] [Accepted: 12/06/2012] [Indexed: 11/19/2022]
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Singh N, Bahadur A, Malhotra N, Kalaivani M, Mittal S. Prospective analysis of ovarian reserve markers as determinant in response to controlled ovarian stimulation in women undergoing IVF cycles in low resource setting in India. Arch Gynecol Obstet 2013; 288:697-703. [PMID: 23529683 DOI: 10.1007/s00404-013-2802-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 03/12/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The objective of this study was to determine whether ovarian reserve markers can predict ovarian response in women undergoing their first cycle of assisted reproduction. MATERIALS AND METHODS This prospective observational study included 292 infertile patients undergoing their first IVF trial in the Assisted Reproductive Unit in a tertiary care hospital. Day 2 follicle stimulating hormone (FSH), Inhibin B, anti-Mullerian hormone (AMH), antral follicle count (AFC) and ovarian volume was measured before commencement of controlled ovarian hyperstimulation. The main outcome measures were oocytes retrieved and this was correlated with ovarian reserve markers. RESULTS The mean age was 31.8 (±4.4) years and mean duration of infertility 8.2 (±3.9) years. The correlation between oocytes retrieved and age, day 2 FSH, Inhibin B, AMH, AFC and volume of the ovary was calculated. A negative correlation was found with age (r = -0.22, p < 0.001) and day 2 FSH (r = -0.35, p < 0.001). A positive correlation was seen with AMH (r = 0.15, p = 0.022), AFC (r = 0.48, p < 0.05) and volume (r = 0.17, p = 0.009). In the bivariate analysis, 1 year increase in age was found to decrease the oocytes retrieved count by 0.37 with a significant p value. The independent significant factors found in multiple linear regression analysis were day 2 FSH and AFC. DISCUSSION The present study concludes that day 2 FSH and AFC are promising biomarkers for ovarian reserve in predicting ovarian response to gonadotropin stimulation in IVF patients.
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Affiliation(s)
- Neeta Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Mutlu MF, Erdem M, Erdem A, Yildiz S, Mutlu I, Arisoy O, Oktem M. Antral follicle count determines poor ovarian response better than anti-Müllerian hormone but age is the only predictor for live birth in in vitro fertilization cycles. J Assist Reprod Genet 2013; 30:657-65. [PMID: 23508679 DOI: 10.1007/s10815-013-9975-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/06/2013] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To determine the predictive value of serum anti-müllerian hormone (AMH) concentrations and antral follicle counts (AFC), on ovarian response and live birth rates after IVF and compare with age and basal FSH. METHODS Basal levels of AMH, FSH and antral follicle count were measured in 192 patients prior to IVF treatment. The predictive value of these parameters were evaluated in terms of retrieved oocyte number and live birth rates. RESULTS Poor responders in IVF were older, had lower AFC and AMH but higher basal FSH levels. In multivariate analysis AFC was the best and only independent parameter among other parameters and AMH was better than age and basal FSH to predict poor response to ovarian stimulation. Addition of AMH, basal FSH, age and total gonadotropin dose to AFC did not improve its prognostic reliability. Area under curve (AUC) for each parameter according to ROC analysis also revealed that AFC performed better in poor response prediction compared with AMH, basal FSH and age. The cut-off point for mean AMH and AFC in discriminating the best between poor and normal ovarian response cycles was 0.94 ng/mL (with a sensitivity of 70% and a specificity of 86%) and 5.5 (with a sensitivity of 91% and a specificity of 91%), respectively. However, age was the only independent predictor of live birth in IVF as compared to hormonal and ultrasound indices of ovarian reserve. CONCLUSION AFC is better than AMH to predict poor ovarian response. Although AMH and AFC could be used to predict ovarian response they had limited value in live birth prediction. The only significant predictor of the probability of achieving a live birth was age.
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Affiliation(s)
- Mehmet Firat Mutlu
- Department of Obstetrics & Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey.
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Lin WQ, Yao LN, Zhang DX, Zhang W, Yang XJ, Yu R. The predictive value of anti-Mullerian hormone on embryo quality, blastocyst development, and pregnancy rate following in vitro fertilization-embryo transfer (IVF-ET). J Assist Reprod Genet 2013; 30:649-55. [PMID: 23504440 DOI: 10.1007/s10815-013-9973-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 03/04/2013] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The objective of this study was to investigate the predictive value of anti-Mullerian hormone (AMH) on fertilization rate (FR), blastocyst development, embryo quality, the outcome of the pregnancy and the live birth rate (LBR) following in vitro fertilization-embryo transfer (IVF-ET)/intracytoplasmic sperm injection (ICSI). METHOD In this prospective study outcomes were followed in 83 women undergoing cycles of IVF/ICSI within a university hospital. Basal serum AMH, follicle stimulating hormone (FSH), luteinizing hormone (LH) and antral follicle count (AFC) were measured on Day 3. Serum AMH (Gn6 AMH ) level was measured on Day 6 after the administration of gonadotrophin (Gn). AMH was measured in follicle fluid (FF AMH) on the day of ovum pick-up (dOPU). The numbers of retrieved and fertilized oocytes, good quality embryos and blastocysts were counted. Secondary outcome variables included clinical pregnancy rate (CPR) and LBR. RESULTS Spearman correlation analysis indicated that the numbers of oocytes, good quality embryos and blastocysts were associated with AMH (P < 0.05) and that LBR was correlated with FF AMH (r = 0.495, P < 0.05). No associations were found between FR and AMH (P > 0.05). Receiver operating characteristic analysis showed that the sensitivity of FF AMH at predicting CPR was 91.2%; the specificity was 86.5% and ROC(AUC) was 0.893 (P < 0.0001). CONCLUSION AMH parameters were correlated with good quality embryos and blastocysts, but only FF AMH showed a significant correlation with LBR and CPR.
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Affiliation(s)
- Wen-Qin Lin
- Reproductive Medcine Center, the First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
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Lukaszuk K, Kunicki M, Liss J, Lukaszuk M, Jakiel G. Use of ovarian reserve parameters for predicting live births in women undergoing in vitro fertilization. Eur J Obstet Gynecol Reprod Biol 2013; 168:173-7. [PMID: 23485092 DOI: 10.1016/j.ejogrb.2013.01.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 01/20/2013] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine common clinical determinants, including patient age; levels of anti-Müllerian hormone (AMH), inhibin B, and follicle-stimulating hormone (FSH); antral follicle count (AFC); and number of oocytes retrieved, to predict live births in women undergoing in vitro fertilization. STUDY DESIGN Women undergoing cycles of intracytoplasmic sperm injection (ICSI) for the first time were reviewed retrospectively, and serum levels of AMH, inhibin B, and FSH, as well as AFC (days 1 and 4 of pre-ICSI menstrual period) and patient age were analyzed as determinants of live birth rates. RESULTS Of the patients studied, 35.71% (891/2495) became pregnant, with live births achieved in 32.20% (806/2495) of cycles initiated and in 46.37% (806/1738) of embryo transfers. Clinical pregnancy rate was 35.71% (891/2495) for cycles initiated and 51.26% (891/2318) for embryo transfers. Univariate analysis revealed that the odds of live birth significantly decreased with increasing age, declining AMH or inhibin B concentrations, and fewer oocytes retrieved. At AMH levels greater than 5.7 ng/ml, the odds of live birth were 3.18 times greater than for AMH levels less than 1.9 ng/ml [95% confidence interval (CI), 1.89-5.43]. Using multivariate logistic regression, only AMH (OR = 1.89; 95% CI, 1.00-3.60; p < 0.05) and AFC (OR = 1.86; 95% CI, 1.02-3.40; p < 0.05) showed statistically significant associations with live birth. Area under the curve for ROC (ROC(AUC)) indicated that AMH (AUC = 0.60) surpassed AFC (AUC = 0.59), number of oocytes retrieved (AUC = 0.59), inhibin B (AUC = 0.55), FSH (ROC(AUC) = 0.54) and chronological age (ROC(AUC) = 0.53) in predicting live birth. CONCLUSIONS In this assessment of various indices (i.e., age; levels of AMH, inhibin B, and FSH; AFC; and quantity of oocytes retrieved) for predicting live births for IVF patients, AMH, AFC and the quantity of oocytes retrieved constituted the most reliable determinants.
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Association of Abnormal Ovarian Reserve Parameters With a Higher Incidence of Aneuploid Blastocysts. Obstet Gynecol 2013; 121:71-7. [DOI: 10.1097/aog.0b013e318278eeda] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
ABSTRACT
Diminished ovarian reserve predicts diminished ovarian response to stimulation but does not predict cycle fecundity. It has been recently defined by ESHRE, the Bologna's criteria, according to which at least two of the following three features should be present: (1) Age >40 years/any other risk factor for DOR, (2) abnormal ovarian reserve test, i.e. antral follicle count, AMH, (3) poor ovarian response in a previous stimulated cycle, i.e. less than three follicles after standard gonadotropin stimulation. Poor response to maximal stimulation on two previous occasions also defines DOR.
The treatment options are limited. Avoiding the GnRH agonist long protocol and stimulation with microdose flare or antagonist protocol yields better results. Adjuvant therapy with LH, DHEAS and growth hormone shows some benefit in improving the oocyte yield. It is advisable to perform ICSI for all obtained oocytes and some advocate assisted hatching. Pregnancy rates are, however, poor and often these patients require ovum donation. Developing tests that will diagnose DOR in a low-risk population will allow women to plan their reproductive careers early.
How to cite this article
Kaur M, Arora M. Diminished Ovarian Reserve, Causes, Assessment and Management. Int J Infertility Fetal Med 2013;4(2):45-55.
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Broer SL, van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC, Bossuyt P, Eijkemans MJ, Mol BWJ, Broekmans FJ, Broer S, van Disseldorp J, Broeze K, Dolleman M, Opmeer B, Anderson R, Ashrafi M, Bancsi L, Caroppo LE, Copperman A, Ebner T, Eldar Geva M, Erdem M, Greenblatt E, Jayaprakasan K, Fenning R, Klinkert E, Kwee J, Lambalk C, La Marca A, McIlveen M, Merce L, Muttukrishna S, Nelson S, Ng H, Popovic-Todorovic B, Smeenk J, Tomás C, Van der Linden P, van Rooij I, Vladimirov I, Bossuyt P, Eijkemans M, Mol B, Frank B. Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach. Hum Reprod Update 2013. [DOI: 10.1093/humupd/dms041] [Citation(s) in RCA: 302] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Simone L. Broer
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Jeroen van Disseldorp
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Kimiko A. Broeze
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Madeleine Dolleman
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Brent C. Opmeer
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Patrick Bossuyt
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Marinus J.C. Eijkemans
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Ben-Willem J. Mol
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Frank J.M. Broekmans
- Department of Reproductive Medicine, University Medical Center Utrecht, Room F05.126, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands
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Lee JE, Lee JR, Jee BC, Suh CS, Kim KC, Lee WD, Kim SH. Clinical application of anti-Müllerian hormone as a predictor of controlled ovarian hyperstimulation outcome. Clin Exp Reprod Med 2012; 39:176-81. [PMID: 23346529 PMCID: PMC3548077 DOI: 10.5653/cerm.2012.39.4.176] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 10/29/2012] [Accepted: 11/08/2012] [Indexed: 11/17/2022] Open
Abstract
Objective In 2009 anti-Müllerian hormone (AMH) assay was approved for clinical use in Korea. This study was performed to determine the reference values of AMH for predicting ovarian response to controlled ovarian hyperstimulation (COH) using the clinical assay data. Methods One hundred sixty-two women who underwent COH cycles were included in this study. We collected data on age, basal AMH and FSH levels, total dose of gonadotropins, stimulation duration, and numbers of oocytes retrieved and fertilized. Blood samples were obtained on cycle day 3 before gonadotropin administration started. Serum AMH levels were measured at a centralized clinical laboratory center. The correlation between the AMH level and COH outcomes and cut-off values for poor and high response after COH was analyzed. Results Concentration of AMH was significantly correlated with the number of oocytes retrieved (OPU; r=0.700, p<0.001). The mean±SE serum AMH levels for poor (OPU≤3), normal (4≤OPU≤19), and high (OPU≥20) response were 0.94±0.15 ng/mL, 2.79±0.21 ng/mL, and 6.94±0.90 ng/mL, respectively. The cut-off level, sensitivity and specificity for poor and high response were 1.08 ng/mL, 85.8%, and 78.6%; and 3.57 ng/mL, 94.4%, and 83.3%, respectively. Conclusion Our data present clinical reference values of the serum AMH level for ovarian response in Korean women. The serum AMH level could be a clinically useful predictor of ovarian response to COH.
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Affiliation(s)
- Jae Eun Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Bhide P, Gudi A, Shah A, Timms P, Grayson K, Homburg R. Anti-Müllerian hormone as a predictor of pregnancy following IVF. Reprod Biomed Online 2012; 26:247-52. [PMID: 23352101 DOI: 10.1016/j.rbmo.2012.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 11/23/2012] [Accepted: 11/27/2012] [Indexed: 11/19/2022]
Abstract
This single-centre retrospective observational study was performed at a university IVF centre. The aim was to examine the predictive power of AMH concentrations for clinical pregnancy rate (CPR) and establish a cut-off concentration of AMH below which no pregnancies were achieved. Data from 820 women with one treatment cycle each were analysed. There was a significant difference in CPR (24.4% and 40.0%; P<0.01) between the lowest and highest quartiles of AMH. This study failed to establish a cut-off concentration of AMH below which there were no clinical pregnancies as several pregnancies were achieved despite an AMH less than 1pmol/l. Log AMH showed a strong positive correlation with number of oocytes retrieved (r=0.522; P<0.001). Log AMH and overall CPR were weakly correlated (r=0.112, P<0.001), but this was not maintained when controlled for the number of oocytes. Age was a stronger independent predictor of CPR than AMH. In conclusion, although an excellent marker of ovarian response, AMH is only a weak predictor of clinical pregnancy. With AMH below the third percentile, CPR was 15%. However AMH is very useful for patient counselling and assessment when used in conjunction with age.
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Affiliation(s)
- Priya Bhide
- Homerton University Hospital, Homerton Row, London E9 6SR, UK.
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GRYNNERUP ANNAGARCIAALIX, LINDHARD ANETTE, SØRENSEN STEEN. The role of anti-Müllerian hormone in female fertility and infertility - an overview. Acta Obstet Gynecol Scand 2012; 91:1252-60. [DOI: 10.1111/j.1600-0412.2012.01471.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril 2012; 98:1407-15. [PMID: 23095141 DOI: 10.1016/j.fertnstert.2012.09.036] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 09/21/2012] [Indexed: 11/18/2022]
Abstract
Currently, there is no uniformly accepted definition of decreased ovarian reserve (DOR), as the term may refer to three related but distinctly different outcomes: oocyte quality, oocyte quantity, or reproductive potential. Available evidence concerning the performance of ovarian reserve tests is limited by small sample sizes, heterogeneity among study design, analyses and outcomes, and the lack of validated outcome measures.
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Mutlu MF, Erdem A. Evaluation of ovarian reserve in infertile patients. J Turk Ger Gynecol Assoc 2012; 13:196-203. [PMID: 24592038 DOI: 10.5152/jtgga.2012.28] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 08/13/2012] [Indexed: 11/22/2022] Open
Abstract
Diminished ovarian reserve is a more common occurrence as more women postpone childbearing in modern societies due to social and demographic trends. Diminished ovarian reserve is one of the primary reasons for poor ART outcome. Due to high costs, side effects and heavy burden on patients on ART treatments, patient selection and counseling for prognosis is an important aspect before starting ART. Proper prediction of ovarian reserve before initiation of the treatment can decrease cycle cancellations, help clinicians to establish alternative treatment options (i.e.oocyte donation) for poor prognosis patients. However, indicators of ovarian reserve are not fully successful in predicting the outcome of the treatment. In this review, our aim was to discuss the efficacy of ovarian reserve tests on predicting poor ovarian response and treatment outcome in ART patients.
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Affiliation(s)
- Mehmet Fırat Mutlu
- Department of Gynecology and Obstetrics, HRS Ankara Women Hospital, Ankara, Turkey
| | - Ahmet Erdem
- Department of Gynecology and Obstetrics, Faculty of Medicine, Gazi University, Ankara, Turkey
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McDade TW, Woodruff TK, Huang YY, Funk WE, Prewitt M, Kondapalli L, Gracia CR. Quantification of anti-Müllerian hormone (AMH) in dried blood spots: validation of a minimally invasive method for assessing ovarian reserve. Hum Reprod 2012; 27:2503-8. [PMID: 22674205 DOI: 10.1093/humrep/des194] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Biological markers of ovarian reserve have the potential to advance research on fecundability, infertility and reproductive aging. Anti-Müllerian hormone (AMH) has emerged as a clinically useful measure of ovarian reserve, but the requirement for venous blood is an obstacle to application in non-clinical settings. This paper validates a new method for quantifying AMH in dried blood spot (DBS) samples--drops of whole blood collected on filter paper following a simple finger stick. METHODS Matched serum and DBS samples were obtained from n=101 women of reproductive age, and AMH values were compared using regression analyses and scatter plots. The precision, reliability, linearity, recovery and lower detection limit of the DBS assay were evaluated, as well as the stability of AMH in DBS across a range of storage conditions. RESULTS There was a strong agreement between AMH concentrations measured in DBS and serum samples across the entire assay range. Analysis of within-assay (percent coefficient of variation, 4.7-6.5%) and between-assay (3.5-7.2%) variability indicated a high level of assay precision and reliability, respectively. The minimum detectable dose of AMH was 0.065 ng/ml. Concentrations of AMH remained stable in DBS samples stored for 2 weeks at room temperature, and for 4 weeks when refrigerated. CONCLUSIONS The DBS assay performs at a level that is comparable to serum-based methods, with the advantage of lower burdens and costs associated with blood collection that may be advantageous for research in clinical as well as non-clinical settings on the causes and consequences of variation in ovarian reserve.
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Affiliation(s)
- Thomas W McDade
- Department of Anthropology, Northwestern University, Evanston, IL 60208, USA.
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[Low circulating anti-Müllerian hormone and normal follicle stimulating hormone levels: which prognosis in an IVF program?]. ACTA ACUST UNITED AC 2012; 40:411-8. [PMID: 22521986 DOI: 10.1016/j.gyobfe.2012.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 09/27/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the results of controlled ovarian hyperstimulation (COH) for IVF in patients with low anti-Müllerian hormone (AMH) and normal basal follicle stimulating hormone (FSH) and Estradiol levels (≤50 pg/mL). PATIENTS AND METHODS A retrospective cohort study including 704 patients for whom AMH and FSH levels (measured between days 3 and 5 of the menstrual cycle) were available, is performed in the IVF center at the Sèvres Hospital (France). Three groups are designed and analyzed: group 1 with AMH less or equal to 2 ng/mL and FSH less or equal to 10 mUI/mL (study group), Group 2 with AMH greater than 2 ng/mL and FSH less or equal to 10 mUI/mL (control group) and Group 3 with AMH less or equal to 2 ng/mL and FSH greater than 10 mUI/mL (group with decreased ovarian reserve). RESULTS IVF outcome for patients from the study group is significantly worse than that of the second but not than that of the third group. In the first group, the number of retrieved oocytes, the number of total obtained embryos, the clinical pregnancy rate and the live birth rate are significantly lower than in the second group; moreover, there are more cancelled cycles because of poor response in the first group. There is no difference with the third group. DISCUSSION AND CONCLUSIONS This study shows that women with a low baseline AMH have a similar response to COH to the poor responders patients with a decreased ovarian reserve revealed by an elevated FSH level. Thus, when a woman undergoing IVF cycle presents a low AMH, she might be considered as a poor responder patient regardless of the FSH level and, although the clinical pregnancy rate is not so disappointing (18%), the couple should be informed of a higher risk of cycle cancellation.
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