1
|
Mahabamunuge J, Wang S, Rifas-Shiman SL, Faleschini S, Fitz VW, Shifren J, Chavarro JE, Oken E, Hivert MF. Associations of anti-Müllerian hormone levels among women in their mid-30s with menopausal symptoms ~14 years later. Menopause 2024; 31:505-511. [PMID: 38688466 PMCID: PMC11126356 DOI: 10.1097/gme.0000000000002360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The aim of this study was to examine associations of anti-Müllerian hormone (AMH) levels in gravid women in their mid-30s with menopausal symptoms ~14 years later and age at natural menopause. METHODS In this prospective analysis, 474 participants in Project Viva, a longitudinal cohort, were enrolled during pregnancy between 1999 and 2002. AMH levels were determined using plasma samples collected 3 years postpartum. Participants completed the Menopause Rating Scale (MRS) and self-reported age at and reason for menopause at the 17 years postpartum visit (Mid-Life Visit). Primary outcomes were individual MRS item responses and total MRS score. To examine associations between AMH levels and menopausal outcomes, we performed linear and logistic regressions, and survival analyses, adjusting for confounding variables. RESULTS Mean (SD) AMH level was 2.80 (2.74) ng/mL, measured at 38.2 (3.9) years. At the Mid-Life Visit, mean (SD) age was 52.3 (3.9) years and total MRS score was 8.0 (5.7). During follow-up, 50% had experienced natural menopause, and self-reported mean (SD) age at natural menopause was 50.4 (3.6) years. AMH in the lowest tertile (mean [SD]: 0.47 [0.32] ng/mL) was associated with higher odds of moderate to severe vaginal dryness (adjusted odds ratio: 2.58; 95% CI: 1.16 to 5.73), a lower MRS psychological subscale (adjusted β: -0.71; 95% CI: -1.35 to -0.07), and earlier attainment of natural menopause (adjusted hazards ratio: 7.1; 95% CI: 4.6 to 11.0) compared with AMH in the highest tertile (mean [SD]: 6.01 [2.37] ng/mL). CONCLUSIONS Lower AMH in the mid-30s was associated with earlier menopause and increased odds of vaginal dryness but fewer psychological symptoms ~14 years later.
Collapse
Affiliation(s)
- Jasmin Mahabamunuge
- New York Medical College, School of Medicine, Valhalla, NY, USA
- Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Siwen Wang
- Department of Nutrition Harvard T.H. Chan School of Public Health, Boston, MA, US
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Sabrina Faleschini
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Victoria W Fitz
- Department of Obstetrics, Gynecology, & Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Jan Shifren
- Department of Obstetrics, Gynecology, & Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Jorge E. Chavarro
- Department of Nutrition Harvard T.H. Chan School of Public Health, Boston, MA, US
| | - Emily Oken
- Department of Nutrition Harvard T.H. Chan School of Public Health, Boston, MA, US
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
2
|
Shingshetty L, Cameron NJ, Mclernon DJ, Bhattacharya S. Predictors of success after in vitro fertilization. Fertil Steril 2024; 121:742-751. [PMID: 38492930 DOI: 10.1016/j.fertnstert.2024.03.003] [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: 01/16/2024] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/18/2024]
Abstract
The last few decades have witnessed a rise in the global uptake of in vitro fertilization (IVF) treatment. To ensure optimal use of this technology, it is important for patients and clinicians to have access to tools that can provide accurate estimates of treatment success and understand the contribution of key clinical and laboratory parameters that influence the chance of conception after IVF treatment. The focus of this review was to identify key predictors of IVF treatment success and assess their impact in terms of live birth rates. We have identified 11 predictors that consistently feature in currently available prediction models, including age, duration of infertility, ethnicity, body mass index, antral follicle count, previous pregnancy history, cause of infertility, sperm parameters, number of oocytes collected, morphology of transferred embryos, and day of embryo transfer.
Collapse
Affiliation(s)
- Laxmi Shingshetty
- Aberdeen Centre for Reproductive Medicine, NHS Grampian, Aberdeen, Aberdeenshire, United Kingdom; School of Medicine, Nutrition Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Aberdeenshire, United Kingdom.
| | - Natalie J Cameron
- School of Medicine, Nutrition Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Aberdeenshire, United Kingdom; Aberdeen Maternity Hospital, NHS Grampian and University of Aberdeen, Aberdeen, Aberdeenshire, United Kingdom
| | - David J Mclernon
- Medical Statistics Team, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Aberdeenshire, United Kingdom
| | - Siladitya Bhattacharya
- School of Medicine, Nutrition Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Aberdeenshire, United Kingdom
| |
Collapse
|
3
|
Setti AS, Braga DPDAF, Guilherme P, Iaconelli A, Borges E. Serum anti-Müllerian hormone concentrations are related to embryo development: lessons from time-lapse imaging. ZYGOTE 2023; 31:570-576. [PMID: 37743564 DOI: 10.1017/s0967199423000370] [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] [Indexed: 09/26/2023]
Abstract
Our objective was to study whether serum anti-Müllerian hormone (AMH) concentrations were associated with embryo morphokinetic events. This retrospective cohort study was performed in a private university-affiliated in vitro fertilization centre between March 2019 and December 2020 and included 902 oocytes cultured in a time-lapse imaging incubator, obtained from 114 intracytoplasmic sperm injection cycles performed. The relationship between AMH concentrations and morphokinetic events was investigated by considering the clustering of data (multiple embryos/patient). Evaluated kinetic markers were time to pronuclei appearance (tPNa) and fading (tPNf), time to two (t2), three (t3), four (t4), five (t5), six (t6), seven (t7), and eight cells (t8), (tSB) and time to the start of blastulation (tSB) and to blastulation (tB). Significant inverse relationships were observed between serum AMH concentrations and tPNf, t3, t4, t5, t6, t7, t8, and tB. The AMH was positively correlated with the KIDScore and implantation rate. Increased serum AMH concentrations correlated with faster embryo development. The clinical implications of this effect on embryo development warrant further investigation.
Collapse
Affiliation(s)
- Amanda Souza Setti
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
| | - Daniela Paes de Almeida Ferreira Braga
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
| | - Patricia Guilherme
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
| | - Assumpto Iaconelli
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
| | - Edson Borges
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
| |
Collapse
|
4
|
Pelayo C, Ciampi E, Soler B, Uribe-San-Martín R, Reyes A, García L, Del-Canto A, Gutierrez-Carquin L, Barrerra-Hormazabal A, Jürgensen-Heinrich L, Guzman-Cárcamo I, Carvajal A, Troncoso C, Carvajal R, Cárcamo C. Frequency of diminished ovarian reserve in women with multiple sclerosis in Chile: An exploratory study. Mult Scler Relat Disord 2023; 79:105012. [PMID: 37797392 DOI: 10.1016/j.msard.2023.105012] [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: 04/08/2023] [Revised: 08/11/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Multiple Sclerosis (MS) is a chronic disease affecting around 2.8 million people worldwide. Two-thirds are women, and the mean age at diagnosis is about 30 years old. Social trends are moving towards older age at first pregnancy, both in women with and without MS. OBJECTIVES To determine the frequency of diminished ovarian reserve (DOR) through anti-Mullerian Hormone (AMH) measurement in women with MS at fertile age and Healthy Females (HF) in Chile. METHODS Case-control, multicentric, cross-sectional study including relapsing-remitting people with MS (pwMS) between 18 and 40 years and sex and age-matched HF. We obtained a blood sample to determine AMH levels. We defined DOR as AMH <1.5 ng/mL and very-low AMH levels as <0.5 ng/mL. Also, we performed questions regarding reproductive decision-making. RESULTS We included 79 sex and age-matched HF and 92 pwMS, median age 32(19-40) years, median disease duration 6 (1-17)years, median EDSS 1.0 (0-6), 95% were receiving disease-modifying therapy (DMT), 70% high-efficacy DMT and 37% with a treatment that contraindicates pregnancy. DOR was observed in 24% (n = 22) of the pwMS, compared to 14% (n = 11) of the HF (p = 0.09), while very-low AMH levels were observed in 7.6% (n = 7) of pwMS and none of the HF (p = 0.0166). We observed an inverse correlation between age and AMH levels. Age was the only significant risk factor for low AMH levels in pwMS (OR 1.14 95%CI(1.00-1-31), p = 0.04), including smoking, body mass index (BMI), hormonal contraception, autoimmune comorbidity, high/low-moderate efficacy DMT, and active disease as covariables. We did not find statistically significant differences in age at diagnosis, BMI, disease duration, EDSS, autoimmune comorbidity, use of hormonal contraception, or percentage of active disease between MS women with normal vs DOR. Over 70% of pwMS desired to become pregnant in the future, while 60% considered that the diagnosis of MS was a limitation for pregnancy planning. CONCLUSIONS No differences in DOR, measured by levels of AMH, were observed between pwMS MS and HF in Chile. As expected, AMH levels were correlated only with ageing. This information may be evaluated early during the disease course to help patients and neurologists with fertility counselling and family planning considerations regarding DMT use.
Collapse
Affiliation(s)
- Carolina Pelayo
- Neurology Department, Pontifical Catholic University of Chile, Chile
| | - Ethel Ciampi
- Neurology Department, Pontifical Catholic University of Chile, Chile; Neurology Service, Sótero Del Río Hospital, Chile.
| | - Bernardita Soler
- Neurology Department, Pontifical Catholic University of Chile, Chile; Neurology Service, Sótero Del Río Hospital, Chile
| | - Reinaldo Uribe-San-Martín
- Neurology Department, Pontifical Catholic University of Chile, Chile; Neurology Service, Sótero Del Río Hospital, Chile
| | - Ana Reyes
- Neurology Department, Pontifical Catholic University of Chile, Chile
| | - Lorena García
- Neurology Department, Pontifical Catholic University of Chile, Chile; Neurology Service, Sótero Del Río Hospital, Chile
| | - Adolfo Del-Canto
- Neurology Department, Pontifical Catholic University of Chile, Chile
| | | | | | | | | | | | | | | | - Claudia Cárcamo
- Neurology Department, Pontifical Catholic University of Chile, Chile
| |
Collapse
|
5
|
Woolner AM, Bhattacharya S. Intergenerational trends in reproduction: Infertility and pregnancy loss. Best Pract Res Clin Obstet Gynaecol 2023; 86:102305. [PMID: 36639284 DOI: 10.1016/j.bpobgyn.2022.102305] [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: 08/31/2022] [Revised: 11/25/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
This review article summarises the evidence for intergenerational trends observed to date within infertility and pregnancy loss. There appears to be evidence of intergenerational trends between mothers and daughters for the age at menopause, endometriosis, polycystic ovarian syndrome (PCOS), male factor infertility and miscarriage. At present, there is no evidence for a predisposition to stillbirth between mothers and daughters. One study found an association with familial predisposition for ectopic pregnancy. Very few studies have considered the potential for paternal transmission of risk of infertility or pregnancy loss. The majority of studies to date have significant limitations because of their observational design, risk of recall bias and risk of confounding. Therefore, high-quality well-designed research, with multi-centre collaboration and utilisation of registry-based data sources and individual patient data, is needed to understand whether infertility and pregnancy loss may have heritable factors. Epidemiological findings need to be followed up and investigated with translational research to determine the possible causalities as well as any implications for clinical practice.
Collapse
Affiliation(s)
- Andrea Mf Woolner
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom.
| | - Siladitya Bhattacharya
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom.
| |
Collapse
|
6
|
Using a Modified Polysaccharide as a Hemostatic Agent Results in Less Reduction of the Ovarian Reserve after Laparoscopic Surgery of Ovarian Tumors-Prospective Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010014. [PMID: 36676638 PMCID: PMC9866198 DOI: 10.3390/medicina59010014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: The study investigated whether the method of achieving hemostasis affects the ovarian reserve in patients undergoing laparoscopic surgery due to ovarian tumors or cysts. Materials and Methods: Patients with unilateral tumors or ovarian cysts, who qualified for laparoscopic tumor enucleation, were randomly selected to receive modified polysaccharides or bipolar coagulation. Ovarian reserve was analyzed by anti-Mullerian hormone (AMH) level. Results: The study included 38 patients: 19 patients in the modified polysaccharide group and 19 in the bipolar coagulation group. Patients after bipolar coagulation treatment had statistically significantly lower AMH 6 months after surgery compared to the group treated with modified starch. The levels of AMH in the study and control groups were 3.96 +/- 2.12 vs. 2.51 +/- 1.39 ng/mL, respectively; p = 0.018. A statistically significant decrease in AMH was also demonstrated in the bipolar coagulation group as compared to the preoperative assessment (p = 0.049). There was no statistically significant decrease in AMH in the group of patients treated with the modified starch. Conclusions: Using a modified polysaccharide during laparoscopic cystectomy is effective and has a positive effect on the ovarian reserve compared to the use of bipolar coagulation. Both the AMH level 6 months after surgery and the percentage decrease in AMH were more favorable in the group of patients treated with modified starch.
Collapse
|
7
|
Gouvea TM, Cota E Souza LA, Lima AA. Correlation of serum anti-Mullerian hormone with hormonal and environmental parameters in Brazilian climacteric women. Sci Rep 2022; 12:12065. [PMID: 35835777 PMCID: PMC9283385 DOI: 10.1038/s41598-022-15429-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/23/2022] [Indexed: 11/09/2022] Open
Abstract
This study aimed to identify the correlation among anti-Mullerian Hormone serum levels and 25-OH-D, obesity, metabolic syndrome (MetS), and sexual hormones in climacteric women classified according to stages of reproductive aging (SRA). A cross-sectional study was conducted with a total of 177 Brazilian climacteric women between 40 and 64 years old. Concentrations of AMH were measured using the Access 2 Immunoassay System. A multiple linear regression analysis was used to identify the relationship among AMH, 25-OH-D, obesity, MetS, sexual hormones, sociodemographic and lifestyle factors. AMH levels decreased with increased age (B = - 0.059; p < 0.001), and reproductive aging (B = - 0.483; p < 0.001). Obesity indicators, lifestyle characters, 25-OH-D levels and MetS were not significantly associated with AMH serum concentration. Negative correlation was found for FSH (B = - 0.009; p < 0.001) and LH (B = - 0.006; p = 0.004); positive correlation for E2 (B = 0.001; p = 0.011), DHEAS (B = 0.003; p < 0.001) and SHBG (B = 0.003; p = 0.005). In the model adjusted for SRA, FSH levels (p < 0.001) and DHEAS (p = 0.014) were associated with AMH. Although, with the adjustment for age, only FSH remained with a significant association (p = 0.001). Of the other analytes, none was associated with AMH, regardless of the model fit. Our findings confirm that serum AMH level decreased with age and FSH levels, but there is no correlation between AMH with obesity, 25-OH-D, MetS or other sexual hormones in Brazilian climacteric women.
Collapse
Affiliation(s)
- Thiago Magalhães Gouvea
- Programa de Pós-Graduação em Ciências Farmacêuticas (CiPharma), Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, CEP 35400-000, Brazil.
| | - Laura Alves Cota E Souza
- Programa de Pós-Graduação em Ciências Farmacêuticas (CiPharma), Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, CEP 35400-000, Brazil
| | - Angélica Alves Lima
- Programa de Pós-Graduação em Ciências Farmacêuticas (CiPharma), Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, CEP 35400-000, Brazil.,Departamento de Análises Clínicas (DEACL), Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| |
Collapse
|
8
|
Sayme N, Kljajic M, Krebs T, Maas DHA. The impact of anti-Müllerian hormone (AMH) on multiple pronuclei (PN) presence and oocyte maturity in ICSI treatments. Gynecol Endocrinol 2020; 36:646-649. [PMID: 31878804 DOI: 10.1080/09513590.2019.1706080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
This prospective study was designed to investigate whether anti-Müllerian hormone (AMH) levels are associated with the presence of multiple pronuclei in zygotes as well as with the ovarian response, fertilization rate and pregnancy outcome in ICSI cycles. A total of 413 patients undergoing ICSI cycles were included in the study. The assessment included 3084 MII oocytes. Serum AMH measurements were performed at the first initial presence of the patient. The outcome measures were the presence of multiple pronuclei (PN), a number of retrieved oocytes, number of mature/immature oocytes, fertilization rate and clinical pregnancy. Obtained results showed a statistically significant correlation between AMH levels and maternal age, the number of follicles, the number of cumulus-oocyte complexes, mature and immature oocyte, fertilization rate and pregnancy rate. Linear regression analysis showed that AMH significantly correlates with the presence of multiple pronuclei in the zygote. The further analysis confirmed that the number of zygotes with the presence of multiple pronuclei increased when AMH levels were higher. This is the first examination of the prognostic value of the serum AMH on the presence of multiple pronuclei in the zygote and our data in the preliminary study suggest that AMH levels could be used as a predictive marker.
Collapse
Affiliation(s)
- Nabil Sayme
- IVF/Gynecology, Team Kinderwunsch Hannover, Hannover, Germany
| | - Marija Kljajic
- Gynecology/IVF, Universitatsklinikum des Saarlandes und Medizinische Fakultat der Universitat des Saarlandes, Homburg, Germany
| | - Thomas Krebs
- IVF/Gynecology, Team Kinderwunsch Hannover, Hannover, Germany
| | - Dieter H A Maas
- IVF/Gynecology, Team Kinderwunsch Hannover, Hannover, Germany
| |
Collapse
|
9
|
Guo R, Pankhurst MW. Accelerated ovarian reserve depletion in female anti-Müllerian hormone knockout mice has no effect on lifetime fertility†. Biol Reprod 2019; 102:915-922. [DOI: 10.1093/biolre/ioz227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/12/2019] [Accepted: 12/12/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Anti-Müllerian hormone (AMH) inhibits the activation of primordial follicles in the ovary. This causes an increased rate of ovarian reserve depletion in Amh−/− mice. The depletion of the ovarian reserve is responsible for the onset of menopause but age-related infertility occurs in advance of ovarian reserve depletion. To determine whether accelerated loss of primordial follicles leads to earlier onset infertility, Amh−/− and Amh+/+ females were paired with Amh+/+ stud males and birth rates were recorded across the females’ reproductive lifespan. The number of primordial follicles remaining in the ovaries of Amh−/− and Amh+/+ females were quantified in two cohorts at 11–12 and 12–13 months of age. As expected, the ovarian reserve in the Amh−/− females became depleted approximately 1 month earlier than Amh+/+ females. However, no difference was observed in the cumulative number of births over the lifespan, nor were there any differences in mean littersize at any age. It is possible that the reproductive lifespan of mice is too short for sufficient divergence of primordial follicles numbers to cause differences in Amh−/− and Amh+/+ female fertility. An alternative explanation contradicts current thinking; the function of AMH may be unrelated to the longevity of the reproductive lifespan in female mice.
Collapse
Affiliation(s)
- Ruikang Guo
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Michael W Pankhurst
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| |
Collapse
|
10
|
Vahedpour Z, Abedzadeh-Kalahroudi M, Sehat M, Allamezadeh-Davani S. The effects of salpingectomy on the serum level of anti-Müllerian hormone: A single-blind randomized controlled trial. J Gynecol Obstet Hum Reprod 2019; 49:101658. [PMID: 31786349 DOI: 10.1016/j.jogoh.2019.101658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/09/2019] [Accepted: 11/23/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Concerns exist over the effects of salpingectomy on ovarian function. This study aimed to assess the effects of salpingectomy on the serum level of anti-Müllerian hormone. MATERIALS AND METHODS This single-blind randomized controlled trial was conducted in 2017-2018 on 86 candidates for hysterectomy. Participants were randomly allocated to undergo either hysterectomy without salpingectomy (control group) or hysterectomy with salpingectomy (intervention group). Serum anti-Müllerian hormone level was measured both before and three months after surgery. Data were analyzed through the Mann-Whitney U test, the Chi-square test, the analysis of covariance, and the linear regression analysis. RESULTS The mean value of Serum anti-Müllerian hormone level did not significantly change in the study groups (P>0.05). After removing the effects of confounders, study groups did not significantly differ from each other respecting the posttest mean value of serum anti-Müllerian hormone level (P=0.868). CONCLUSION Salpingectomy does not significantly affect serum anti-Müllerian hormone level and ovarian function.
Collapse
Affiliation(s)
- Zahra Vahedpour
- Autoimmune Research Center, Kashan University of Medical Sciences, Kashan, Iran.
| | | | - Mojtaba Sehat
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran.
| | | |
Collapse
|
11
|
Anti-Müllerian Hormone and Its Predictive Utility in Assisted Reproductive Technologies Outcomes. Clin Obstet Gynecol 2019; 62:238-256. [DOI: 10.1097/grf.0000000000000436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Beydoun HA, Hossain S, Beydoun MA, Weiss J, Zonderman AB, Eid SM. Anti-Müllerian Hormone Levels and Cardiometabolic Disturbances by Weight Status Among Men in the 1999 to 2004 National Health and Nutrition Examination Survey. J Endocr Soc 2019; 3:921-936. [PMID: 31020056 PMCID: PMC6469951 DOI: 10.1210/js.2018-00414] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/12/2019] [Indexed: 12/27/2022] Open
Abstract
Context Serum anti-Müllerian hormone level (AMH) and body mass index may be jointly associated with cardiometabolic risk. Objectives Examine the contribution of AMH to cardiometabolic disturbances by weight status among US adult men. Design Cross-sectional analysis using data from the 1999 to 2004 waves of the National Health and Nutrition Examination Survey. Setting Multistage probability sampling of the noninstitutionalized US population. Participants US men aged ≥18 years. Final analytic sample sizes ranged from 517 to 1063 participants. Main Outcome and Exposure Measures Cardiometabolic disturbances (metabolic syndrome and its components, insulin resistance, diabetes, and chronic inflammation) and AMH were obtained from trained staff and nurses in a mobile examination center or during in-home visits. Results AMH was directly associated with insulin resistance among obese men [OR 1.08 (95% CI 1.00, 1.15); P = 0.046; N = 146], whereas AMH was inversely associated with waist circumference (WC) among obese men [OR 0.95 (95% CI 0.91, 0.99); P = 0.049; N = 146]. An inverse relationship was also observed between categorical AMH and diabetes status [medium vs low AMH; OR 0.19 (95% CI 0.043, 0.84); P = 0.030; N = 145] among obese men, with a strong inverse relationship also detected among overweight men [high vs low AMH; OR 0.011 (95% CI 0.0004, 0.27); P = 0.007; N = 193]. An inverse relationship between continuous AMH and diabetes [OR 0.75 (95% CI: 0.59, 0.93); P = 0.011; N = 193] was also detected among overweight men. Conclusions AMH was associated with specific cardiometabolic risk factors, including WC, diabetes status, and insulin resistance, in overweight and obese US men.
Collapse
Affiliation(s)
- Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | - Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health Intramural Research Program, Baltimore, Maryland
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health Intramural Research Program, Baltimore, Maryland
| | - Jordan Weiss
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health Intramural Research Program, Baltimore, Maryland
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health Intramural Research Program, Baltimore, Maryland
| | - Shaker M Eid
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| |
Collapse
|
13
|
Żelaźniewicz A, Bielawski T, Nowak J, Pawłowski B. Body symmetry and reproductive hormone levels in women. Women Health 2018; 59:391-405. [PMID: 29979937 DOI: 10.1080/03630242.2018.1492499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Fluctuating asymmetry (FA), a morphological marker of developmental stability, may be related to an individual's biological condition, e.g., health or fertility. The aim of this study was to test if the level of a woman's FA was related to her fertility and reproductive potential as measured by reproductive hormone levels. Fifty-three healthy, non-pregnant, naturally cycling women (mean age = 23.42, SD = 1.85 years), participated in the study, conducted in Wrocław (Poland) in May 2015. Early-follicular phase serum levels of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) were measured. FA was calculated based on anthropometric measures of six bilateral body traits, and the composite FA index was used in statistical analyses. No relationship was observed between FA and the levels of FSH, LH, and AMH (p > .05), controlled for potential confounders. However, the level of E2 was positively correlated with FA (p < .05). Thus, in young women, FA was not related to hormones levels related to ovarian reserve, but more symmetrical women had lower E2 levels. As FA is an index of developmental stability, environmental, and genetic stress, the results of the study confirm previous research suggesting that developmental conditions may be related to women's endogenous estrogen levels.
Collapse
Affiliation(s)
| | - Tomasz Bielawski
- a Department of Human Biology , University of Wrocław , Wrocław , Poland
| | - Judyta Nowak
- a Department of Human Biology , University of Wrocław , Wrocław , Poland
| | - Bogusław Pawłowski
- a Department of Human Biology , University of Wrocław , Wrocław , Poland
| |
Collapse
|
14
|
Individualized predictions of time to menopause using multiple measurements of antimüllerian hormone. Menopause 2018; 23:839-45. [PMID: 27326817 DOI: 10.1097/gme.0000000000000642] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The ability of antimüllerian hormone (AMH) to predict age at menopause has been reported in several studies, and a decrease in AMH level has been found to increase the probability of menopause. The rate of decline varies among women, and there is also a variability of decline between women's cycles. As a result, individualized evaluation is required to accurately predict time of menopause. To this end, we have used the AMH trajectories of individual women to predict each one's age at menopause. METHODS From a cohort study, 266 women (ages 20-50 y) who had regular and predictable menstrual cycles at the initiation of the study were randomly selected from among 1,265 women for multiple AMH measurements. Participants were visited at approximately 3-year intervals and followed for an average of 6.5 years. Individual likelihood of menopause was predicted by fitting the shared random-effects joint model to the baseline covariates and the specific AMH trajectory of each woman. RESULTS In total, 23.7% of the women reached menopause during the follow-up period. The estimated mean (SD) AMH concentration at the time of menopause was 0.05 ng/mL (0.06 ng/mL), compared with 1.36 ng/mL (1.85 ng/mL) for those with a regular menstrual cycle at their last assessment. The decline rate in the AMH level varied among age groups, and age was a significant prognostic factor for AMH level (P < 0.001). Adjusting for age and body mass index, each woman had her own specific AMH trajectory. Lower AMH and older age had significant effects on the onset of menopause. Individualized prediction of time to menopause was obtained from the fitted model. CONCLUSIONS Longitudinal measurements of AMH will enable physicians to individualize the prediction of menopause, thereby facilitating counseling on the timing of childbearing or medical management of health issues associated with menopause.
Collapse
|
15
|
Bungum L, Tagevi J, Jokubkiene L, Bungum M, Giwercman A, Macklon N, Andersen CY, Klausen TW, Tørring N, Kumar A, Skouby SO. The Impact of the Biological Variability or Assay Performance on AMH Measurements: A Prospective Cohort Study With AMH Tested on Three Analytical Assay-Platforms. Front Endocrinol (Lausanne) 2018; 9:603. [PMID: 30459709 PMCID: PMC6232665 DOI: 10.3389/fendo.2018.00603] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/21/2018] [Indexed: 12/28/2022] Open
Abstract
This study examined longitudinal, age-related and intra-individual variation in Anti-Müllerian Hormone (AMH) in regular menstruating women and correlated the hormonal levels to the antral follicle count (AFC). The impact of variations on an algorithm for calculation of follitropin-dose for ovarian stimulation were also tested. The study was carried out at a fertility clinic of a tertiary university hospital and had a prospective trial design. Twenty-six healthy women not receiving infertility treatment aged 22 to 50 years participated. Blood sampling for hormonal analysis was done every fifth day throughout three consecutive menstrual cycles, AFC was determined with 3-dimentional ultrasound and AMH measured by different assays from Beckman Coulter, Roche and Ansh Labs. Outcome measures were maximum and minimum difference in absolute and relative terms for each study subject during the test-period, coefficient of variation (Cv) for AMH for each cycle and cycle-day and correlation between AMH and AFC. The impact from variable AMH levels on an algorithm calculating follitrophin-delta dose in ovarian stimulation was explored. A significant longitudinal age-independent variation in AMH-levels and coefficient of variation in cycles and cycle days was found. A strong correlation between AMH-levels and AFC was confirmed and a case of significant divergence between assays was seen. Variations in AMH had a significant impact on an algorithm calculated dosage of gonadotrophins in ovarian stimulation. The finding of a substantial longitudinal variation in AMH question one recording being sufficient in quantifying gonadotrophins for ovarian stimulation, decision making and prognostication related to infertility treatment and counseling. Occasionally, commercial assays may fail to recognize specific AMH cleavage-products.
Collapse
Affiliation(s)
- Leif Bungum
- Department of Obstetrics and Gynecology, Herlev Gentofte Hospital, Herlev, Denmark
- *Correspondence: Leif Bungum
| | - Julia Tagevi
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Ligita Jokubkiene
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmø, Sweden
| | - Mona Bungum
- Reproductive Medicine Centre, Skanes University Hospital, Malmø, Sweden
| | | | - Nick Macklon
- Obsterics and Gynecology, Denmark and London Women's Clinic, Zealand University Hospital, London, United Kingdom
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Niels Tørring
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Ajay Kumar
- Ansh Labs LLC, Medical Center Blvd, Webster, IA, United States
| | - Sven Olaf Skouby
- Department of Obstetrics and Gynecology, Herlev Gentofte Hospital, Herlev, Denmark
| |
Collapse
|
16
|
Podfigurna A, Lukaszuk K, Czyzyk A, Kunicki M, Maciejewska-Jeske M, Jakiel G, Meczekalski B. Testing ovarian reserve in pre-menopausal women: why, whom and how? Maturitas 2017; 109:112-117. [PMID: 29292013 DOI: 10.1016/j.maturitas.2017.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/08/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022]
Abstract
Numerous social and environmental factors (environmental hazards, social factors such as education and career, higher economic status desired before the decision is made to have children) influence a women's decision to postpone pregnancy until late reproductive age. In turn, age is related to a fall in ovarian reserve. The main goal of testing ovarian reserve is the identification of women with so-called diminished ovarian reserve (DOR). Additionally, it provides assistance in the counselling of women who are planning to use assisted reproductive techniques (ART). This review examines current methods of testing ovarian reserve and their application. The most useful methods of assessing ovarian reserve are ultrasonographic count of ovarian antral follicles (AFC) and serum tests of both the anti-Müllerian hormone (AMH) level and the third-day level of follicle stimulating hormone (FSH). However, there are limitations to the currently used methods of testing ovarian reserve, especially in relation to their specificity and sensitivity. It is also difficult to predict egg quality based on these tests. The value of screening programmes of ovarian reserve is yet to be determined.
Collapse
Affiliation(s)
- Agnieszka Podfigurna
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Lukaszuk
- INVICTA Fertility and Reproductive Center, Gdańsk, Poland; INVICTA Fertility and Reproductive Center, Warsaw, Poland; Department of Gynecological Endocrinology, Medical University of Warsaw, Warsaw, Poland; Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdańsk, Poland
| | - Adam Czyzyk
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Michal Kunicki
- INVICTA Fertility and Reproductive Center, Warsaw, Poland
| | | | - Grzegorz Jakiel
- INVICTA Fertility and Reproductive Center, Warsaw, Poland; Department of Obstetrics and Gynecology, Center of Postgraduate Education, Warsaw, Poland
| | - Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland.
| |
Collapse
|
17
|
Borges E, Braga DPAF, Setti A, Figueira RDC, Iaconelli A. The predictive value of serum concentrations of anti-Müllerian hormone for oocyte quality, fertilization, and implantation. JBRA Assist Reprod 2017; 21:176-182. [PMID: 28837024 PMCID: PMC5574637 DOI: 10.5935/1518-0557.20170035] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective This study aimed to identify a possible correlation between serum levels of
anti-Müllerian hormone (AMH) and oocyte quality, embryo developmental
competence, and implantation potential. Methods 4488 oocytes obtained from 408 patients undergoing ICSI cycles were
evaluated. Oocyte dimorphisms, embryo quality on days two and three,
blastocyst formation competence, fertilization rates, implantation rates,
and pregnancy rates were correlated with serum levels of AMH using Pearson's
correlation coefficient and regression analysis. Results A positive correlation was observed between serum levels of AMH and number of
retrieved oocytes (CC: 0.600, p<0.001), fertilization
rate (CC:0.595, p=0.048), and number of obtained embryos
(CC:0.495, p<0.001). AMH did not affect the quality of
cleavage stage embryos or the chance of blastocyst formation. However, AMH
levels affected oocyte quality (OR:0.75, CI 0.44-0.96,
p<0.001), and implantation (CC:0,116,
p=0.031) and pregnancy (OR:1.22, CI:1.03-1.53,
p<0.001) rates. Conclusion Serum levels of AMH are a useful predictor of ovarian response to COS, oocyte
quality, and fertilization. However, AMH levels may also compromise clinical
outcomes; lower AMH levels did not impair embryo development.
Collapse
Affiliation(s)
- Edson Borges
- Fertility Medical Group, São Paulo, SP - Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Assistida, São Paulo, SP - Brazil
| | - Daniela P A F Braga
- Fertility Medical Group, São Paulo, SP - Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Assistida, São Paulo, SP - Brazil.,Disciplina de Urologia, Área de Reprodução Humana, Departamento de Cirurgia, Universidade Federal de São Paulo, São Paulo, SP - Brazil
| | - Amanda Setti
- Fertility Medical Group, São Paulo, SP - Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Assistida, São Paulo, SP - Brazil
| | | | - Assumpto Iaconelli
- Fertility Medical Group, São Paulo, SP - Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Assistida, São Paulo, SP - Brazil
| |
Collapse
|
18
|
Tal R, Seifer DB. Ovarian reserve testing: a user's guide. Am J Obstet Gynecol 2017; 217:129-140. [PMID: 28235465 DOI: 10.1016/j.ajog.2017.02.027] [Citation(s) in RCA: 232] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/08/2017] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
Ovarian reserve is a complex clinical phenomenon influenced by age, genetics, and environmental variables. Although it is challenging to predict the rate of an individual's ovarian reserve decline, clinicians are often asked for advice about fertility potential and/or recommendations regarding the pursuit of fertility treatment options. The purpose of this review is to summarize the state-of-the-art of ovarian reserve testing, providing a guide for the obstetrician/gynecologist generalist and reproductive endocrinologist. The ideal ovarian reserve test should be convenient, be reproducible, display little if any intracycle and intercycle variability, and demonstrate high specificity to minimize the risk of wrongly diagnosing women as having diminished ovarian reserve and accurately identify those at greatest risk of developing ovarian hyperstimulation prior to fertility treatment. Evaluation of ovarian reserve can help to identify patients who will have poor response or hyperresponse to ovarian stimulation for assisted reproductive technology. Ovarian reserve testing should allow individualization of treatment protocols to achieve optimal response while minimizing safety risks. Ovarian reserve testing may inform patients regarding their reproductive lifespan and menopausal timing as well as aid in the counselling and selection of treatment for female cancer patients of reproductive age who receive gonadotoxic therapy. In addition, it may aid in establishing the diagnosis of polycystic ovary syndrome and provide insight into its severity. While there is currently no perfect ovarian reserve test, both antral follicular count and antimüllerian hormone have good predictive value and are superior to day-3 follicle-stimulating hormone. The convenience of untimed sampling, age-specific values, availability of an automated platform, and potential standardization of antimüllerian hormone assay make this test the preferred biomarker for the evaluation of ovarian reserve in women.
Collapse
|
19
|
Özcan P, Fiçicioğlu C, Ateş S, Can MG, Kaspar Ç, Akçin O, Yesiladali M. The cutoff values of serum AMH levels and starting recFSH doses for the individualization of IVF treatment strategies. Gynecol Endocrinol 2017; 33:467-471. [PMID: 28277814 DOI: 10.1080/09513590.2017.1294154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The main purpose of our study is to categorize starting doses of recombinant follicle-stimulating hormone (recFSH) based on various cutoff values of anti-Mullerian hormone (AMH) and to determine the effectiveness of serum AMH levels in the prediction of poor ovarian response. MATERIAL AND METHODS Prospective data analysis was conducted at IVF center. A total of 323 patients were included. All patients were divided into four groups according to the patients' serum AMH concentrations: Group 1 (AMH < 1 ng/ml; 450 IU/day n = 157); Group 2 (AMH 1-2 ng/ml; 375 IU/day, n = 55); Group 3 (AMH 2-3 ng/ml; 225 IU/day, n = 48); and Group 4 (AMH > 3 ng/ml; 150 IU/day, n = 63). Collected data included age, total gonadotropin dosage, duration of stimulations, the total number of oocytes retrieved, ovarian response, cancelation rate, and cPRs. RESULTS As serum AMH levels increased, there were significant decreases in the starting recFSH dose and total gonadotropin dosage, and a significant increase in the total number of oocytes retrieved. There was a significant trend toward increasing cycle cancelation rates and decreasing cPRs with decreasing serum AMH levels. Although there were no significant differences with regard to the proportion of cycles with hypo-response between all groups. A result of ≤0.83 was considered the cutoff value of AMH to predict a hypo-response to ovarian stimulation. CONCLUSIONS AMH is a useful marker in selecting the starting dose of recFSH and prediction of poor ovarian response. Our protocol may allow clinicians to modulate the starting dose of recFSH according to these cutoff values for serum AMH levels.
Collapse
Affiliation(s)
- Pinar Özcan
- a Department of Obstetrics and Gynecology , Bezmialem University Faculty of Medicine , İstanbul , Turkey
- b Department of Obstetrics , Gynecology and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA
| | - Cem Fiçicioğlu
- c Department of Obstetrics and Gynecology , Yeditepe University, Faculty of Medicine , Istanbul , Turkey
| | - Seda Ateş
- a Department of Obstetrics and Gynecology , Bezmialem University Faculty of Medicine , İstanbul , Turkey
| | - Meltem Güner Can
- d Department of Anesthesiology , Acibadem University, Faculty of Medicine , Istanbul , Turkey , and
| | - Çiğdem Kaspar
- e Department of Medical Informatics , Yeditepe University, Faculty of Medicine , Istanbul , Turkey
| | - Oya Akçin
- c Department of Obstetrics and Gynecology , Yeditepe University, Faculty of Medicine , Istanbul , Turkey
| | - Mert Yesiladali
- c Department of Obstetrics and Gynecology , Yeditepe University, Faculty of Medicine , Istanbul , Turkey
| |
Collapse
|
20
|
Gorkem U, Kucukler FK, Togrul C, Gungor T. Anti-Müllerian hormone exhibits a great variation in infertile women with different ovarian reserve patterns. Aust N Z J Obstet Gynaecol 2017; 57:464-468. [PMID: 28419409 DOI: 10.1111/ajo.12625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/13/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Several conflicting studies with results on the biological variability of serum anti-Müllerian hormone (AMH) levels have been reported. Most of the studies have not focused on whether the level of AMH fluctuations shows variability by a baseline ovarian follicular reserve. AIM To reveal whether intracyclic variation in AMH levels occurs among women with adequate, high and diminished ovarian reserve patterns. STUDY DESIGN In this prospective cross-sectional study, 171 infertile women between the ages of 18 and 42 years were recruited. All participants were divided into three types of ovarian reserve patterns (adequate, high and diminished). Serum samples were tested for levels of follicular AMH (F-AMH), luteal AMH (L-AMH), estradiol (E2), and follicle stimulating hormone (FSH) and progesterone. RESULTS The median age of the 171 participating women was 28 (18-42) years. The three ovarian reserve groups had similar body mass index (BMI) and E2 (P = 0.797 and P = 0.135, respectively). The serum AMH levels of all women and the three ovarian reserve groups in the follicular phase were higher compared to those in the luteal phase (P < 0.001). There were strong positive correlations between follicular and luteal AMH levels in adequate, high and diminished reserve groups (Spearman r = 0.864, P < 0.001 vs r = 0.899, P < 0.001 vs r = 0.863, P < 0.001, respectively). CONCLUSION Serum AMH levels were higher during the follicular phase than the luteal phase in women with adequate, high and diminished ovarian patterns. Since the highest AMH levels are demonstrated during the follicular phase, the optimal time to measure AMH concentration might be during the follicular phase.
Collapse
Affiliation(s)
- Umit Gorkem
- Department of Obstetrics and Gynaecology, Hitit University Faculty of Medicine, Corum, Turkey
| | - Ferit Kerim Kucukler
- Department of Endocrinology, Hitit University Faculty of Medicine, Corum, Turkey
| | - Cihan Togrul
- Department of Obstetrics and Gynaecology, Hitit University Faculty of Medicine, Corum, Turkey
| | - Tayfun Gungor
- Department of Obstetrics and Gynaecology, Hitit University Faculty of Medicine, Corum, Turkey
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Szmidt NAK, Bhattacharya S, Maheshwari A. Does poor ovarian response to gonadotrophins predict early menopause? A retrospective cohort study with minimum of 10-year follow-up. HUM FERTIL 2016; 19:212-9. [PMID: 27549023 DOI: 10.1080/14647273.2016.1221149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
One in 10 women reach menopause before they are 45 years of age, and 1 in 100 before 40. In most cases, poor ovarian response to gonadotrophins is a result of poor ovarian reserve. An early menopause is associated with long-term health risks. Identifying women at risk may allow appropriate measures to be instigated early. Women aged <40 years treated in the Aberdeen Fertility Centre between 1998 and 2002 were identified. Those with poor response to an age appropriate dose of gonadotrophins (obtaining ≤3 eggs or had cycle cancelled) after exclusion of hypothalamic insufficiency, or whose cycle was cancelled due to poor response were age matched with good responders (6-15 eggs). In this retrospective cohort study, women who have had IVF at least 10 years ago (157 poor responders and 314 good responders) were sent a postal questionnaire to determine age at menopause. A total of 219 women (64 poor responders, 155 good responders) returned their questionnaires. Poor responders were more likely to have premature menopause (3% vs. 0%; p = .024). A higher proportion of poor responders experienced early menopause (11% vs. 3%; p = .044). Despite being the first study with a 10-year follow-up, this study is limited to one centre and has a small number of women reaching premature menopause. Poor response to gonadotrophins in the context of IVF treatment is a marker of reduced ovarian reserve and is associated with early menopause. Results of this study underline the need for larger studies with long-term follow-up.
Collapse
Affiliation(s)
| | | | - Abha Maheshwari
- c Reproductive Medicine & Surgery , Aberdeen Fertility Centre, NHS Grampian , Aberdeen , UK
| |
Collapse
|
23
|
Hadlow N, Brown SJ, Habib A, Wardrop R, Joseph J, Gillett M, Maguire R, Conradie J. Quantifying the intraindividual variation of antimüllerian hormone in the ovarian cycle. Fertil Steril 2016; 106:1230-1237. [PMID: 27351446 DOI: 10.1016/j.fertnstert.2016.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/19/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To quantify intraindividual variability of antimüllerian hormone (AMH) as analytical and biological coefficients of variation and assess the effects of variation on clinical classification. DESIGN Retrospective cohort study. SETTING Not applicable. PATIENT(S) Thirty-eight women referred by general practitioners. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Total intraindividual variability (CVW), analytical (CVA) and biological variability (CVI) for each woman and for AMH ranges: low (<5 pmol/L), reduced (5-10), moderate (>10-30) and high (>30 pmol/L), with calculation of proportion of women crossing clinical cutoffs and expected variability around each cutoff. RESULT(S) Cycling women (n = 38) contributed 238 blood samples (average 6 samples each). The average total intraindividual AMH variability was 20% (range: 2.1% to 73%). Biological variation was 19% (range: 0 to 71%) and at least twice the analytical variation of 6.9% (range: 4.5% to 16%). Reclassification rates were highest in women with low (33%) or reduced AMH (67%) levels. Expected variations around the 5, 10, and 30 pmol/L cutoffs were 3-7, 7-13, and 20-40 pmol/L, respectively. In a woman with mean AMH in the 10-30 pmol/L range, the span of results that could occur was 7-40 pmol/L. CONCLUSION(S) Total variation in AMH was 20%, and the majority of this was biological. Changes in AMH resulted in reclassification in 29% of women and occurred most frequently in those with low and reduced AMH. In cycling women, the variability in AMH should be considered by clinicians, especially if a result is close to a clinical cutoff.
Collapse
Affiliation(s)
- Narelle Hadlow
- Department of Biochemistry, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia; Western Diagnostic Pathology, Myaree, Western Australia, Australia.
| | - Suzanne J Brown
- Department of Endocrinology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Afsana Habib
- Western Diagnostic Pathology, Myaree, Western Australia, Australia
| | - Robert Wardrop
- Department of Biochemistry, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - John Joseph
- Department of Biochemistry, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Melissa Gillett
- Western Diagnostic Pathology, Myaree, Western Australia, Australia
| | - Rhonda Maguire
- Department of Biochemistry, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Johan Conradie
- Western Diagnostic Pathology, Myaree, Western Australia, Australia
| |
Collapse
|
24
|
Tsoulis MW, Chang PE, Moore CJ, Chan KA, Gohir W, Petrik JJ, Vickers MH, Connor KL, Sloboda DM. Maternal High-Fat Diet-Induced Loss of Fetal Oocytes Is Associated with Compromised Follicle Growth in Adult Rat Offspring. Biol Reprod 2016; 94:94. [PMID: 26962114 PMCID: PMC4861169 DOI: 10.1095/biolreprod.115.135004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 02/25/2016] [Indexed: 11/12/2022] Open
Abstract
Maternal obesity predisposes offspring to metabolic and reproductive dysfunction. We have shown previously that female rat offspring born to mothers fed a high-fat (HF) diet throughout pregnancy and lactation enter puberty early and display aberrant reproductive cyclicity. The mechanisms driving this reproductive phenotype are currently unknown thus we investigated whether changes in ovarian function were involved. Wistar rats were mated and randomized to: dams fed a control diet (CON) or dams fed a HF diet from conception until the end of lactation (HF). Ovaries were collected from fetuses at Embryonic Day (E) 20, and neonatal ovaries at Day 4 (P4), prepubertal ovaries at P27 and adult ovaries at P120. In a subset of offspring, the effects of a HF diet fed postweaning were evaluated. The present study shows that fetuses of mothers fed a HF diet had significantly fewer oocytes at E20, and in neonates, have reduced AMH signaling that may facilitate an increased number of assembled primordial follicles. Both prepubertally and in adulthood, ovaries show increased follicular atresia. As adults, offspring have reduced FSH responsiveness, low expression levels of estrogen receptor alpha (Eralpha), the oocyte-secreted factor, Gdf9, oocyte-specific RNA binding protein, Dazl, and high expression levels of the granulosa-cell derived factor, AMH, in antral follicles. Together, these data suggest that ovarian compromise in offspring born to HF-fed mothers may arise from changes already observable in the fetus and neonate and in the long term, associated with increased follicular atresia through adulthood.
Collapse
Affiliation(s)
- Michael W Tsoulis
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Pauline E Chang
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Caroline J Moore
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kaitlyn A Chan
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Wajiha Gohir
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - James J Petrik
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Mark H Vickers
- Liggins Institute and Gravida, National Centre for Growth and Development, University of Auckland, Aukland, New Zealand
| | - Kristin L Connor
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Deborah M Sloboda
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
25
|
A new concept of minimally invasive laparoscopic surgery utilizing the vaginal route to prevent iatrogenic spillage of dermoid cysts: The bathtub method. Gynecol Minim Invasive Ther 2016. [DOI: 10.1016/j.gmit.2015.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
26
|
Young K, Fisher J, Kirkman M. Endometriosis and fertility: women's accounts of healthcare. Hum Reprod 2016; 31:554-62. [PMID: 26759140 DOI: 10.1093/humrep/dev337] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 12/15/2015] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What do women with endometriosis recall being told about their fertility by their healthcare providers? SUMMARY ANSWER Women recalled being given varied information and advice, and gave examples of empathic and individualized care from doctors but also reported opportunities for enhancing clinical practice. WHAT IS KNOWN ALREADY There is evidence of an association between endometriosis and infertility. However, the strength of this association and the mechanisms that underlie it are not yet known nor are the implications for optimum healthcare. STUDY DESIGN, SIZE, DURATION This study used in-depth cross-sectional qualitative research methods. PARTICIPANTS/MATERIALS, SETTING, METHODS Women aged at least 18 years who lived in Victoria, Australia, and who had been surgically diagnosed with endometriosis were invited to participate in in-depth interviews about their experience of endometriosis. Twenty-six women of diverse backgrounds and experiences of endometriosis were interviewed from January to September 2014. Interviews were transcribed and analysed thematically using a data-driven approach. MAIN RESULTS AND THE ROLE OF CHANCE All women encountered medical professionals who were aware of the association between endometriosis and infertility, and who were proactive in ensuring fertility was addressed within endometriosis care. Women recalled being given varied, often conflicting, information about the consequences for their fertility of an endometriosis diagnosis. While some recounted positive experiences with the way their doctor communicated with them about endometriosis and fertility, all women reported adverse experiences such as receiving insufficient or inappropriate information or having their doctor prioritize their fertility over other aspects of their care, including quality of life and symptom relief, without first consulting them. LIMITATIONS, REASONS FOR CAUTION The perspectives of the women's doctors were not sought. The findings may not translate to settings that differ from a predominantly Anglo-Saxon country with both universal public and private healthcare systems. WIDER IMPLICATIONS OF THE FINDINGS Women's fertility needs and priorities differ for many reasons; there can be no 'one size fits all' approach to care. Women may benefit most from endometriosis care in which they are first asked about their fertility needs and preferences and in which medical uncertainty is acknowledged. STUDY FUNDING/COMPETING INTERESTS K.Y. receives a scholarship from the National Health and Medical Research Council and Australian Rotary Health. J.F. is supported by a Monash Professional Fellowship and the Jean Hailes Professional Fellowship which is funded by Perpetual Trustees Pty Ltd. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.
Collapse
Affiliation(s)
- K Young
- The Jean Hailes Research Unit, Monash University, 1st Floor, 549 St Kilda Rd, Melbourne, Victoria 3004, Australia
| | - J Fisher
- The Jean Hailes Research Unit, Monash University, 1st Floor, 549 St Kilda Rd, Melbourne, Victoria 3004, Australia
| | - M Kirkman
- The Jean Hailes Research Unit, Monash University, 1st Floor, 549 St Kilda Rd, Melbourne, Victoria 3004, Australia
| |
Collapse
|
27
|
Iwase A, Osuka S, Nakamura T, Kato N, Takikawa S, Goto M, Kikkawa F. Usefulness of the Ultrasensitive Anti-Müllerian Hormone Assay for Predicting True Ovarian Reserve. Reprod Sci 2015; 23:756-60. [PMID: 26614267 DOI: 10.1177/1933719115618284] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Serum concentration of anti-Müllerian hormone (AMH) is a useful marker for ovarian reserve. Measurement of AMH in clinical practice has gained widespread use to predict parameters such as the ovarian response, menopause, and recovery after chemotherapy. However, undetectable AMH levels assayed by conventional enzyme-linked immunosorbent assay (ELISA) kits fail to predict depletion of follicles because of low sensitivity of the kits. We investigated whether a recently developed ultrasensitive ELISA kit, picoAMH, would be more effective at detecting very low AMH levels in association with menstrual status. We analyzed 68 women with undetectable serum AMH levels using an ELISA kit, AMH Gen II. The AMH concentration of the same samples was detected in 36 samples using picoAMH; 32 samples were within the standard range, and 4 samples were out of the standard range but still detectable. Thirty-two women whose AMH levels were undetectable using the picoAMH all showed amenorrhea. We also found a significant correlation between the classes of serum AMH levels (undetectable, detectable under the limit of quantification, and measurable within the assay range) and menstrual status. Five of the 6 amenorrheic women with detectable AMH eventually achieved follicle growth. The present study demonstrated that very low AMH levels detectable using picoAMH correspond well to current and future ovulation status. This suggests that serum AMH levels can be useful for the assessment of ovarian reserve and follow-up of women with a declined ovarian reserve.
Collapse
Affiliation(s)
- Akira Iwase
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan Department of Maternal and Perinatal Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Satoko Osuka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan Department of Maternal and Perinatal Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Nao Kato
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sachiko Takikawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
28
|
Iwase A, Nakamura T, Osuka S, Takikawa S, Goto M, Kikkawa F. Anti-Müllerian hormone as a marker of ovarian reserve: What have we learned, and what should we know? Reprod Med Biol 2015; 15:127-136. [PMID: 29259429 DOI: 10.1007/s12522-015-0227-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 11/06/2015] [Indexed: 01/05/2023] Open
Abstract
Ovarian reserve reflects the quality and quantity of available oocytes. This reserve has become indispensable for the better understanding of reproductive potential. Measurement of the serum anti-Müllerian hormone (AMH) level allows quantitative evaluation of ovarian reserve. It has been applied to a wide range of clinical conditions, and it is well established that the measurement of serum AMH levels is more useful than qualitative evaluation based on the menstrual cycle. AMH levels are monitored during infertility treatments; in patients undergoing medically assisted reproductive technology; and in the diagnosis of ovarian failure, polycystic ovarian syndrome, and granulosa cell tumor. It is also useful in the evaluation of iatrogenic ovarian damage. Population-based studies have indicated a potential role for serum AMH in the planning of reproductive health management. While AMH is currently the best measure of ovarian reserve, its predictive value for future live births remains controversial. Furthermore, there is a serious practical issue in the interpretation of test results, as currently available assay kits use different assay ranges and coefficients of variation due to the absence of an international reference standard. The pros and cons of the serum AMH level as a definitive measure of ovarian reserve merits further review in order to guide future research.
Collapse
Affiliation(s)
- Akira Iwase
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
- Department of Maternal and Perinatal Medicine Nagoya University Hospital 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| | - Tomoko Nakamura
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| | - Satoko Osuka
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| | - Sachiko Takikawa
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| |
Collapse
|
29
|
Chiang HJ, Lin PY, Huang FJ, Kung FT, Lin YJ, Sung PH, Lan KC. The impact of previous ovarian surgery on ovarian reserve in patients with endometriosis. BMC WOMENS HEALTH 2015; 15:74. [PMID: 26359251 PMCID: PMC4566490 DOI: 10.1186/s12905-015-0230-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 08/25/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND To investigate the impact of previous ovarian surgery on ovarian reserve in patients with endometriosis. METHODS A total of 829 female patients were recruited. Their medical records were reviewed retrospectively. Patients who had diagnoses of endometriosis or endometrioma were defined as the endometriosis group, and those without endometriosis were as the control group. We further divided these patients into four groups according to whether they had received ovarian surgeries before. Group 1: control group without previous surgery; Group 2: control group with previous surgery; Group 3: endometriosis group without previous surgery; Group 4: endometriosis group with previous surgery. The subgroups with endometrioma or not and different operative procedures were also analyzed. The parameters for comparison included age, body mass index, serum estradiol, follicle-stimulating hormone, luteinizing hormone, cancer antigen 125, and anti-Müllerian hormone (AMH) level. RESULTS The level of serum AMH was highest in group 1 and lowest in group 4. The decline was significant between group 1 and group 4 (p < 0.05). The serum AMH level was lower in group 4 than in group 3 but no significant difference. Serum estradiol level was significantly higher in group 3 than in group 2 (p < 0.05). Cancer antigen 125 levels were both significantly higher in group 3 and group 4 as compared with group 1 and group 2 (p < 0.05). CONCLUSIONS Performing repeated ovarian surgery in patients with recurrent endometriosis needs careful consideration and adequate patient counselling because of the predictable deteriorating ovarian reserve.
Collapse
Affiliation(s)
- Hsin-Ju Chiang
- Department of Obstetrics and Gynecology, No.123, DAPI Rd. Niaosng Dist, Kaohsiung City, 83301, Taiwan, R.O.C..
| | - Pin-Yao Lin
- Department of Obstetrics and Gynecology, No.123, DAPI Rd. Niaosng Dist, Kaohsiung City, 83301, Taiwan, R.O.C..
| | - Fu-Jen Huang
- Department of Obstetrics and Gynecology, No.123, DAPI Rd. Niaosng Dist, Kaohsiung City, 83301, Taiwan, R.O.C..
| | - Fu-Tsai Kung
- Department of Obstetrics and Gynecology, No.123, DAPI Rd. Niaosng Dist, Kaohsiung City, 83301, Taiwan, R.O.C..
| | - Yu-Ju Lin
- Department of Obstetrics and Gynecology, No.123, DAPI Rd. Niaosng Dist, Kaohsiung City, 83301, Taiwan, R.O.C..
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, DAPI Rd. Niaosng Dist, Kaohsiung City, 83301, Taiwan, R.O.C..
| | - Kuo-Chung Lan
- Department of Obstetrics and Gynecology, No.123, DAPI Rd. Niaosng Dist, Kaohsiung City, 83301, Taiwan, R.O.C..
| |
Collapse
|
30
|
Tremellen K, Zander-Fox D. Serum anti-Mullerian hormone assessment of ovarian reserve and polycystic ovary syndrome status over the reproductive lifespan. Aust N Z J Obstet Gynaecol 2015; 55:384-9. [PMID: 26230428 DOI: 10.1111/ajo.12366] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/16/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND To determine normal ranges for serum anti-Mullerian hormone (AMH) using the new automated Elecsys AMH assay platform, with a view to establishing values that signify premature loss of ovarian reserve, increased risk for an excessive response during IVF stimulation and a likely diagnosis of polycystic ovary syndrome (PCOS). MATERIALS AND METHODS Serum AMH was measured by the Elecsys automated electrochemiluminescence assay in 654 women undergoing gynaecological assessment. RESULTS Serum AMH levels peaked before 25 years of age, with mean AMH levels halving by 36 and falling to a quarter of their peak by 40 years of age. Overall, AMH results of 95% of patients with PCOS exceeded the 50th percentile for their age, with 72.1% having an AMH result in the top quartile for age. ROC analysis suggested that a serum AMH ≥36 pmol L(-1) is the best determinant of PCOS status (sensitivity 83.7% and specificity 82.3%). Serum AMH exhibited an excellent correlation with ultrasound-assessed antral follicle count (AFC) (r = 0.836, P < 0.0001), with a result of 20 pmol L(-1) corresponding to an AFC of 16 and, therefore, increased risk of ovarian hyperstimulation syndrome (OHSS) during IVF treatment. CONCLUSION Serum AMH is a sensitive marker of age-related decline in ovarian reserve status. A serum AMH result >36 pmol L(-1) , or above the 75th percentile for age, is highly suggestive of a diagnosis of PCOS. A serum AMH result below the 10th percentile for age suggests accelerated loss of ovarian reserve, while an AMH result exceeding 20 pmol L(-1) suggests an increased risk of OHSS during IVF treatment.
Collapse
Affiliation(s)
- Kelton Tremellen
- Repromed, Dulwich, South Australia, Australia.,Department of Obstetrics and Gynaecology, Flinders University, Bedford Park, South Australia, Australia
| | | |
Collapse
|
31
|
Torres-Rovira L, Gonzalez-Bulnes A, Succu S, Spezzigu A, Manca ME, Leoni GG, Sanna M, Pirino S, Gallus M, Naitana S, Berlinguer F. Predictive value of antral follicle count and anti-Müllerian hormone for follicle and oocyte developmental competence during the early prepubertal period in a sheep model. Reprod Fertil Dev 2015; 26:1094-106. [PMID: 24008140 DOI: 10.1071/rd13190] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/02/2013] [Indexed: 11/23/2022] Open
Abstract
Circulating anti-Müllerian hormone (AMH) and antral follicle count (AFC) are addressed as suitable markers of oocyte quantity and quality during adulthood. To investigate whether AFC and circulating AMH could predict follicle development and oocyte quality during the prepubertal period we used 40-day-old ewe lambs with high, intermediate and low AFC (≥30, 16-29 and≤15 follicles respectively). The analysis of the response to the exogenous FSH ovarian reserve test showed a positive correlation between AFC, AMH plasma levels, total follicle number and the number of large follicles (≥3mm) grown after exogenous FSH administration. The incorporation of abattoir-derived oocytes collected from ovaries with different AFC in an in vitro embryo production system showed that a high AFC can predict oocyte quality in prepubertal ovaries, reflecting an ovarian status suitable for follicular development. The histological quantification of the ovarian reserve evidenced that AFC was not predictive of differences in either the number of healthy follicles or the size of the primordial follicle pool in prepubertal ovaries. Further studies are needed to investigate the implication on the reproductive performance of the significant inter-individual differences found in the present study in AFC and circulating AMH in the early prepubertal period.
Collapse
Affiliation(s)
- Laura Torres-Rovira
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | | | - Sara Succu
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Antonio Spezzigu
- Embryo Sardegna, Technology, Reproduction and Fertility, 07034 Perfugas, Località Suiles (SS), Italy
| | - Maria E Manca
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Giovanni G Leoni
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Marina Sanna
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Salvatore Pirino
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Marilia Gallus
- Department of Animal Production, AGRIS Sardegna, Loc. Bonassai S.S. 291 Sassari-Fertilia -Km. 18,600, 07100 Sassari, Italy
| | - Salvatore Naitana
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Fiammetta Berlinguer
- Department of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| |
Collapse
|
32
|
Waimey KE, Smith BM, Confino R, Jeruss JS, Pavone ME. Understanding Fertility in Young Female Cancer Patients. J Womens Health (Larchmt) 2015; 24:812-8. [PMID: 26075731 DOI: 10.1089/jwh.2015.5194] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Young women diagnosed with cancer today have a greater chance of long-term survival than ever before. Successful survivorship for this group of patients includes maintaining a high quality of life after a cancer diagnosis and treatment; however, lifesaving treatments such as chemotherapy, radiation, and surgery can impact survivors by impairing reproductive and endocrine health. Studies demonstrate that future fertility is a concern for many women diagnosed with cancer, but physician knowledge and attitudinal barriers can still prevent females from receiving care. Today, fertility preservation is an option for girls and women facing a cancer diagnosis, and emerging research is providing clinicians with an increasing number of reproductive and hormonal management tools. Physicians can play an important role in fertility by working closely with oncologists, providing patients with information about fertility preservation options prior to the start of cancer treatment, monitoring reproductive capacity after treatment, and working with cancer survivors to explore potential avenues to parenthood.
Collapse
Affiliation(s)
- Kate E Waimey
- 1 Strategic Foundation Initiatives, University of Chicago , Chicago, Illinois
| | - Brigid M Smith
- 2 Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Rafael Confino
- 2 Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Jacqueline S Jeruss
- 3 Division of Surgical Oncology, Department of Surgery, University of Michigan , Ann Arbor, Michigan
| | - Mary Ellen Pavone
- 2 Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| |
Collapse
|
33
|
Thomas-Teinturier C, Allodji RS, Svetlova E, Frey MA, Oberlin O, Millischer AE, Epelboin S, Decanter C, Pacquement H, Tabone MD, Sudour-Bonnange H, Baruchel A, Lahlou N, De Vathaire F. Ovarian reserve after treatment with alkylating agents during childhood. Hum Reprod 2015; 30:1437-46. [DOI: 10.1093/humrep/dev060] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 02/23/2015] [Indexed: 11/13/2022] Open
|
34
|
Iwase A, Nakamura T, Nakahara T, Goto M, Kikkawa F. Assessment of ovarian reserve using anti-Müllerian hormone levels in benign gynecologic conditions and surgical interventions: a systematic narrative review. Reprod Biol Endocrinol 2014; 12:125. [PMID: 25510324 PMCID: PMC4274680 DOI: 10.1186/1477-7827-12-125] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/14/2014] [Indexed: 11/10/2022] Open
Abstract
The usefulness of anti-Müllerian hormone (AMH) for the quantitative evaluation of ovarian reserve has been established. Therefore, serum AMH has been recently applied to the assessment of ovarian reserve outside infertility treatment. We conducted a computer-based search, using keywords, through the PubMed database from inception until May 2014 and summarized available studies evaluating ovarian damage caused by gynecologic diseases, such as endometriosis and ovarian tumor, as well as surgical interventions, such as cystectomy and uterine artery embolization (UAE), to discuss the usefulness of serum AMH. Most of the studies demonstrated a decline of serum AMH levels after cystectomy for endometriomas. It is not conclusive whether electrocoagulation or suturing is preferable. The effects of other gynecologic diseases and interventions, such as hysterectomy and UAE, on ovarian reserve are controversial. Serum AMH levels should be considered in determining the indication and selection of operative methods for benign gynecologic conditions.
Collapse
Affiliation(s)
- Akira Iwase
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Department of Maternal and Perinatal Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Tomoko Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Tatsuo Nakahara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| |
Collapse
|
35
|
Ovarian reserve in breast cancer: assessment with anti-Müllerian hormone. Reprod Biomed Online 2014; 29:573-80. [DOI: 10.1016/j.rbmo.2014.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 06/19/2014] [Accepted: 07/01/2014] [Indexed: 11/20/2022]
|
36
|
AMH: An ovarian reserve biomarker in assisted reproduction. Clin Chim Acta 2014; 437:175-82. [DOI: 10.1016/j.cca.2014.07.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 07/18/2014] [Accepted: 07/23/2014] [Indexed: 11/22/2022]
|
37
|
Tremellen K, Savulescu J. Ovarian reserve screening: a scientific and ethical analysis. Hum Reprod 2014; 29:2606-14. [DOI: 10.1093/humrep/deu265] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
|
38
|
Iwase A, Nakamura T, Nakahara T, Goto M, Kikkawa F. Anti-Müllerian hormone and assessment of ovarian reserve after ovarian toxic treatment: a systematic narrative review. Reprod Sci 2014; 22:519-26. [PMID: 25228631 DOI: 10.1177/1933719114549856] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since serum anti-Müllerian hormone (AMH) levels enable quantitative evaluation of ovarian damage, we conducted a computer-based search, using key words, of all articles published in English through the PubMed database from inception until September 2013 to summarize available studies evaluating ovarian reserve after ovarian toxic interventions to discuss the usefulness of serum AMH levels. We found that most of the studies demonstrated a decline in serum AMH levels when compared to control or pretreatment levels, with levels dependent on the type of treatment modality. Measurement of serum AMH levels enables quantitative evaluation of ovarian damage caused by ovarian toxic interventions, such as chemotherapy and radiotherapy, instead of qualitative evaluation using menstrual condition or basal follicle-stimulating hormone levels. Serum AMH levels are becoming indispensable to assess the ovarian reserve of patients who desire preservation of ovarian function for fertility and endogenous sex steroid hormones.
Collapse
Affiliation(s)
- Akira Iwase
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan Department of Maternal and Perinatal Medicine, Nagoya University Hospital, Showa-ku, Nagoya, Japan
| | - Tomoko Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Tatsuo Nakahara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| |
Collapse
|
39
|
Aanesen A, Westerbotn M. Prospective study of a Swedish infertile cohort 2005-08: population characteristics, treatments and pregnancy rates. Fam Pract 2014; 31:290-7. [PMID: 24591683 DOI: 10.1093/fampra/cmu003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We here report on results from a prospective study comprising 380 infertile couples undergoing infertility work-up and various treatments for infertility in our clinic. The aim was to investigate the overall birth rate as a result of different treatments, as well as spontaneous pregnancies. METHODS Three hundred and eighty couples were consecutively included between December 2005 and May 2008. All couples underwent a fertility work-up, including hysterosalpingogram, hormonal characterization, clinical examination, screening for infectious diseases and semen analysis. The mean age of the women at the time of inclusion was 33.2 years. The mean duration of infertility prior to inclusion was 1.8 years. And 46.6% (n = 177) of the women had been pregnant prior to their first visit to the clinic and 30.0% (n = 114) had been pregnant earlier in their present relationship. RESULTS As of November 2010, 57.3% (n = 218) of the women had given birth to a child when they were lost to follow up by the study. Spontaneous conception was observed in 11.3% (n = 43) of the women, 14.5% (n = 64) conceived after intrauterine insemination (IUI), 4.2% (n = 16) conceived after ovarian hyperstimulation and ovulation induction (OH/OI) and 28.4% (n = 113) after in vitro fertilization. There were 280 pregnancies and 58 spontaneous abortions (22.3%) in the group. Mean anti-mullerian hormone significantly correlated with antral follicle count and age and was significantly higher in the subgroup that became pregnant after IUI. CONCLUSIONS Spontaneous pregnancies and IUI + OH/OI contributed significantly to the pregnancies observed in the total population. Predictive factors for pregnancy were anti-mullerian hormone in the group undergoing IUI treatment and in the age group ≥38-duration of infertility. Previous pregnancies, body mass index, estradiol, follicle stimulating hormone or having given birth prior to the infertility period were not predictive of pregnancy for the infertile couples in this study.
Collapse
|
40
|
Monniaux D, Clément F, Dalbiès-Tran R, Estienne A, Fabre S, Mansanet C, Monget P. The ovarian reserve of primordial follicles and the dynamic reserve of antral growing follicles: what is the link? Biol Reprod 2014; 90:85. [PMID: 24599291 DOI: 10.1095/biolreprod.113.117077] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The growing follicles develop from a reserve of primordial follicles constituted early in life. From this pre-established reserve, a second ovarian reserve is formed, which consists of gonadotropin-responsive small antral growing follicles and is a dynamic reserve for ovulation. Its size, evaluated by direct antral follicular count or endocrine markers, determines the success of assisted reproductive technologies in humans and embryo production biotechnologies in animals. Strong evidence indicates that these two reserves are functionally related. The size of both reserves appears to be highly variable between individuals of similar age, but the equilibrium size of the dynamic reserve in adults seems to be specific to each individual. The dynamics of both follicular reserves appears to result from the fine tuning of regulations involving two main pathways, the phosphatase and tensin homolog (PTEN)/phosphatidylinositol-3 kinase (PI3K)/3-phosphoinositide-dependent protein kinase-1 (PDPK1)/v-akt murine thymoma viral oncogene homolog 1 (AKT1) and the bone morphogenetic protein (BMP)/anti-Müllerian hormone (AMH)/SMAD signaling pathways. Mutations in genes encoding the ligands, receptors, or signaling effectors of these pathways can accelerate or modulate the exhaustion rate of the ovarian reserves, causing premature ovarian insufficiency (POI) or increase in reproductive longevity, respectively. With female aging, the decline in primordial follicle numbers parallels the decrease in the size of the dynamic reserve of small antral follicles and the deterioration of oocyte quality. Recent progress in our knowledge of signaling pathways and their environmental and hormonal control during adult and fetal life opens new perspectives to improve the management of the ovarian reserves.
Collapse
Affiliation(s)
- Danielle Monniaux
- Institut National de la Recherche Agronomique (INRA), UMR85 Physiologie de la Reproduction et des Comportements, Nouzilly, France
| | | | | | | | | | | | | |
Collapse
|
41
|
Eijkemans MJC, van Poppel F, Habbema DF, Smith KR, Leridon H, te Velde ER. Too old to have children? Lessons from natural fertility populations. Hum Reprod 2014; 29:1304-12. [PMID: 24676403 DOI: 10.1093/humrep/deu056] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is it possible to construct an age curve denoting the ages above which women are biologically too old to reproduce? SUMMARY ANSWER We constructed a curve based on the distribution of female age at last birth in natural fertility populations reflecting the ages above which women have become biologically too old to have children. WHAT IS KNOWN ALREADY The median age at last birth (ALB) for females is ∼40-41 years of age across a range of natural fertility populations. This suggests that there is a fairly universal pattern of age-related fertility decline. However, little is known about the distribution of female ALB and in the present era of modern birth control, it is impossible to assess the age-specific distribution of ALB. Reliable information is lacking that could benefit couples who envisage delaying childbearing. STUDY DESIGN, SIZE, DURATION This study is a review of high-quality historical data sets of natural fertility populations in which the distributions of female age at last birth were analysed. The studies selected used a retrospective cohort design where women were followed as they age through their reproductive years. PARTICIPANTS/MATERIALS, SETTING, METHODS Using a common set of eligibility criteria, large data files of natural fertility populations were prepared such that the analysis could be performed in parallel across all populations. Data on the ALB and confounding variables are presented as box and whisker plots denoting the 5th, 25th, 50th, 75th and 95th percentile distribution of the age at last birth for each population. The analysis includes the estimation of Kaplan-Meier curves for age at last birth of each population. The hazard curve for ALB was obtained by plotting the smoothed hazard curve of each population and taking the lowest hazard within a time period of at least 5 years. This lowest hazard curve was then transformed into a cumulative distribution function representing the composite curve of the end of biological fertility. This curve was based on the data from three of the six populations, having the lowest hazards of end of fertility. MAIN RESULTS AND THE ROLE OF CHANCE We selected six natural fertility populations comprising 58 051 eligible women. While these populations represent different historical time periods, the distribution of the ages at last birth is remarkably similar. The curve denoting the end of fertility indicates that <3% of women had their last birth at age 20 years meaning that almost 98% were able to have at least one child thereafter. The cumulative curve for the end of fertility slowly increases from 4.5% at age 25 years, 7% at age 30 years, 12% at age 35 years and 20% at age 38 years. Thereafter, it rises rapidly to about 50% at age 41, almost 90% at age 45 years and approaching 100% at age 50 years. LIMITATIONS, REASONS FOR CAUTION It may be argued that these historical fertility data do not apply to the present time; however, the age-dependent decline in fertility is similar to current populations and is consistent with the pattern seen in women treated by donor insemination. Furthermore, for reproductive ageing, we note that it is unlikely that such a conserved biological process with a high degree of heritability would have changed significantly within a century or two. WIDER IMPLICATIONS OF THE FINDINGS We argue that the age-specific ALB curve can be used to counsel couples who envisage having children in the future. Our findings challenge the unsubstantiated pessimism regarding the possibility of natural conception after age 35 years. STUDY FUNDING/COMPETING INTEREST(S) No external funding was either sought or obtained for this study. There are no conflicts of interest to be declared.
Collapse
Affiliation(s)
- Marinus J C Eijkemans
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | | | | | | | | |
Collapse
|
42
|
Aboulghar M, Saber W, Amin Y, Aboulghar MM, Serour G, Mansour R. Impact of antimüllerian hormone assays on the outcomes of in vitro fertilization: a prospective controlled study. Fertil Steril 2014; 101:134-7. [DOI: 10.1016/j.fertnstert.2013.09.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 09/19/2013] [Accepted: 09/20/2013] [Indexed: 11/15/2022]
|
43
|
Evaluation of serum anti-Mullerian hormone levels to assess the ovarian reserve in women with severe endometriosis. Eur J Obstet Gynecol Reprod Biol 2014; 172:62-4. [DOI: 10.1016/j.ejogrb.2013.10.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 08/01/2013] [Accepted: 10/02/2013] [Indexed: 11/17/2022]
|
44
|
Sikar Aktürk A, Abalı R, Yüksel MA, Güzel EÇ, Güzel S, Kıran R. The effects of isotretinoin on the ovarian reserve of females with acne. Gynecol Endocrinol 2014; 30:30-3. [PMID: 24256373 DOI: 10.3109/09513590.2013.860118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
There are some side effects of isotretinoin in many organs. However, a study investigating the effects of isotretinoin on the human ovarian reserve has not been reported previously. The study was conducted to investigate possible effects of isotretinoin on ovarian reserve. Serum anti-Müllerian hormone (AMH) levels were measured at the beginning and at the end of isotretinoin treatment in 22 patients with acne and in 22 women without. The mean AMH level before treatment was 5.77 ng/mL in the study group and 3.79 ng/mL in the control group (p = 0.008). Following treatment, the mean AMH level was 4.69 ng/mL in the study group. This mean AMH level after treatment was statistically lower than the AMH level before treatment (p = 0.012). There was no significant difference between the mean AMH level at the end of treatment and that of the control group (p = 0.20). The high level of pre-treatment AMH levels could be an evidence of hyperandrogenism in women with acne, even if they are not identified as having polycystic ovary syndrome (PCOS) or hyperandrogenism. Decrease in AMH levels following exposure to isotretinoin may suggest that it has a detrimental effect on the ovaries.
Collapse
Affiliation(s)
- Aysun Sikar Aktürk
- Department of Dermatology, Faculty of Medicine, Kocaeli University , Kocaeli , Turkey
| | | | | | | | | | | |
Collapse
|
45
|
d'Herbomez M, Bauters C, Cortet-Rudelli C, Dewailly D, Docao C, Wémeau JL. [Biomarkers in endocrinology]. Presse Med 2013; 43:40-56. [PMID: 24342177 DOI: 10.1016/j.lpm.2013.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 11/12/2013] [Indexed: 10/25/2022] Open
Abstract
TSH assay is the best parameter of the thyroid function. For adults, the normal interval of TSH concentrations range from 0.4 to 4 mUI/L. At the first trimester of pregnancy, TSH levels must be <2.5 mUI/L. Normal TSH levels increase with aging and obesity. The biological diagnosis relies on the identification of excessive secretion of the metanephrines which are more sensitive and specific than those of catecholamines. The concentrations of the free plasmatic metanephrines reflect the ongoing production of tumor. Plasma methoxytyramine is a novel biomarker of metastatic pheochromocytomas and paragangliomas. Serum IGF1 is a reliable measure of integrated GH concentrations in patients with acromegaly. Accurate assessment of IGF1 concentrations requires age and sex-matched control values. IGF1 is a sensitive tool for the diagnosis of acromegaly and efficacy of therapies. Serum AMH assay is more sensitive, more specific and more reproducible that counting of ovarian follicles by ultrasound. AMH level above 5 ng/mL (35 pmol/L) could be chosen as one of the diagnostic criteria for the polycystic ovary syndrome. In early or "incipiens" ovarian failure, the decrease in serum AMH is far ahead of the increase in FSH. Thyroglobulin (TG) and calcitonin (CT) are the sensitive and specific markers of respectively well-differentiated thyroid cancers of follicular origin and of the medullary thyroid cancers. The same tumour marker assay should be used to monitor a given patient. Chromogranin A (CgA) is a highly efficient biomarker for diagnosis and follow-up of various endocrine tumours. Despite the lack of international standardisation, some CgA assays are reliable.
Collapse
Affiliation(s)
- Michèle d'Herbomez
- Université de Lille II, 59800 Lille, France; CHRU de Lille, centre de biologie-pathologie-génétique, rue Émile-Laine, 59037 Lille cedex, France.
| | - Catherine Bauters
- Clinique d'endocrinologie Marc-Linquette, hôpital Huriez, 59037 Lille cedex, France
| | | | - Didier Dewailly
- Université de Lille II, 59800 Lille, France; Hôpital Jeanne-de-Flandre, service de gynécologie endocrinienne et médecine de la reproduction, 59037 Lille cedex, France
| | - Christine Docao
- Clinique d'endocrinologie Marc-Linquette, hôpital Huriez, 59037 Lille cedex, France
| | - Jean-Louis Wémeau
- Université de Lille II, 59800 Lille, France; Clinique d'endocrinologie Marc-Linquette, hôpital Huriez, 59037 Lille cedex, France
| |
Collapse
|
46
|
|
47
|
Weghofer A, Kim A, Barad DH, Gleicher N. Age at menarche: a predictor of diminished ovarian function? Fertil Steril 2013; 100:1039-43. [DOI: 10.1016/j.fertnstert.2013.05.042] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/14/2013] [Accepted: 05/28/2013] [Indexed: 11/16/2022]
|
48
|
Variation in antimüllerian hormone concentration during the menstrual cycle may change the clinical classification of the ovarian response. Fertil Steril 2013; 99:1791-7. [DOI: 10.1016/j.fertnstert.2013.01.132] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 12/21/2012] [Accepted: 01/21/2013] [Indexed: 11/17/2022]
|
49
|
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: 27] [Impact Index Per Article: 2.5] [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.
Collapse
|
50
|
Metzger ML, Meacham LR, Patterson B, Casillas JS, Constine LS, Hijiya N, Kenney LB, Leonard M, Lockart BA, Likes W, Green DM. Female reproductive health after childhood, adolescent, and young adult cancers: guidelines for the assessment and management of female reproductive complications. J Clin Oncol 2013; 31:1239-47. [PMID: 23382474 PMCID: PMC4500837 DOI: 10.1200/jco.2012.43.5511] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE As more young female patients with cancer survive their primary disease, concerns about reproductive health related to primary therapy gain relevance. Cancer therapy can often affect reproductive organs, leading to impaired pubertal development, hormonal regulation, fertility, and sexual function, affecting quality of life. METHODS The Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancer (COG-LTFU Guidelines) are evidence-based recommendations for screening and management of late effects of therapeutic exposures. The guidelines are updated every 2 years by a multidisciplinary panel based on current literature review and expert consensus. RESULTS This review summarizes the current task force recommendations for the assessment and management of female reproductive complications after treatment for childhood, adolescent, and young adult cancers. Experimental pretreatment as well as post-treatment fertility preservation strategies, including barriers and ethical considerations, which are not included in the COG-LTFU Guidelines, are also discussed. CONCLUSION Ongoing research will continue to inform COG-LTFU Guideline recommendations for follow-up care of female survivors of childhood cancer to improve their health and quality of life.
Collapse
|