1
|
van der Ham K, Laven JSE, Tay CT, Mousa A, Teede H, Louwers YV. Anti-müllerian hormone as a diagnostic biomarker for polycystic ovary syndrome and polycystic ovarian morphology: a systematic review and meta-analysis. Fertil Steril 2024; 122:727-739. [PMID: 38944177 DOI: 10.1016/j.fertnstert.2024.05.163] [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: 03/06/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 07/01/2024]
Abstract
IMPORTANCE As part of the 2023 international evidence-based polycystic ovary syndrome (PCOS) guideline, this meta-analysis investigated the inclusion of Anti-Müllerian hormone (AMH) levels in the diagnostic criteria for PCOS. OBJECTIVE To answer the following three questions: 1) Are AMH levels effective in diagnosing PCOS in adult women? 2) Are AMH levels effective in diagnosing PCOS in adolescents? Are AMH levels effective in diagnosing polycystic ovarian morphology (PCOM)? DATA SOURCES Searches were conducted in six databases until July 31, 2023. STUDY SELECTION AND SYNTHESIS Eligible studies were those conducted in humans, published in English, and reporting sensitivity, specificity, and/or area under the curve values. Extracted data included study population, age, body mass index, AMH assay, cut-off value of AMH levels, sensitivity, specificity, and area under the curve values. The risk of bias was assessed using the quality assessment of diagnostic accuracy studies tool. A random effects model was used to test diagnostic accuracy. MAIN OUTCOMES Pooled sensitivity and specificity to use AMH levels for PCOS diagnosis in adults as well as adolescents and for detecting PCOM in adults. RESULTS Eighty-two studies were included. The adult AMH-PCOS meta-analyses (n = 68) showed a pooled sensitivity and specificity of 0.79 (95% confidence interval [CI], 0.76-0.82; I2 = 86%) and 0.87 (95% CI, 0.84-0.89; I2 = 91%). The adolescent AMH-PCOS meta-analysis (n = 11) showed a pooled sensitivity and specificity of 0.66 (95% CI, 0.58-0.73; I2 = 74%) and 0.78 (95% CI, 0.71-0.83; I2 = 45%). The adult AMH-PCOM meta-analysis (n = 7) showed a pooled sensitivity and specificity of 0.79 (95% CI, 0.72-0.85; I2 = 94%) and 0.87 (95% CI, 0.78-0.93; I2 = 94%). CONCLUSION AND RELEVANCE: This study investigated the most profound change in the 2023 international evidence-based PCOS guideline, which now recommends AMH levels for defining PCOM in adults in accordance with the diagnostic algorithm. Antimüllerian hormone levels alone are insufficient for PCOS diagnosis and are nonspecific for PCOM in adolescents. Multiple factors influence AMH levels and cause heterogeneity as well as limitations in this study. Consequently, no international cut-off value could be recommended, emphasizing the need for research on more individualized cut-off values.
Collapse
Affiliation(s)
- Kim van der Ham
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, the Netherlands.
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Chau Thien Tay
- Monash Centre for Health Research and Implementation (MCHRI), Monash University, Melbourne, Victoria, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation (MCHRI), Monash University, Melbourne, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation (MCHRI), Monash University, Melbourne, Victoria, Australia
| | - Yvonne V Louwers
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| |
Collapse
|
2
|
Shah D, Jirge PR. Anti-Mullerian Hormone and Fertility Treatment Decisions in Polycystic Ovary Syndrome: A Literature Review. J Hum Reprod Sci 2024; 17:16-24. [PMID: 38665612 PMCID: PMC11041323 DOI: 10.4103/jhrs.jhrs_153_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/20/2024] [Accepted: 01/21/2024] [Indexed: 04/28/2024] Open
Abstract
Anti-Mullerian hormone is a robust marker of ovarian reserve and ovarian response in in vitro fertilisation (IVF). However, its role extends beyond improving the safety of IVF by aiding in choosing appropriate protocols and dosing. This review looks at the value of pre-treatment anti-Mullerian hormone (AMH) value in choosing the appropriate modality of treatment and its predictive ability for the outcomes of such treatment. It briefly addresses the factors that may modulate AMH levels and make clinical decision-making challenging.
Collapse
Affiliation(s)
- Duru Shah
- Gynaecworld, The Centre for Women’s Health and Fertility, Mumbai, Maharashtra, India
| | - Padma Rekha Jirge
- Sushrut Assisted Conception Clinic, Shreyas Hospital, Kolhapur, Maharashtra, India
| |
Collapse
|
3
|
Sumji S, Bhat A, Rashid A, Bashir R, Wani IA, Vasudevan V, Sehar T, Ganie MA. Efficacy of serum anti-mullerian hormone (AMH) levels for prediction of polycystic ovary syndrome (PCOS) and its association with clinical, biochemical and hormonal parameters. Indian J Clin Biochem 2023; 38:457-465. [PMID: 37746534 PMCID: PMC10516813 DOI: 10.1007/s12291-022-01058-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/06/2022] [Indexed: 10/14/2022]
Abstract
Anti-mullerian hormone (AMH) has been proposed to add significance to diagnosis of PCOS in case of ambiguity. However, variable cutoffs of AHM among PCOS women have been reported. Using case-control design, this study investigated the diagnostic threshold of serum AMH levels among age matched 113 PCOS and 75 normo-ovulatory women and its correlation with clinical, hormonal and ultrasonographic parameters.PCOS was defined as per Rotterdam criteria 2003. Results depicted the mean serum AMH level to be significantly higher in PCOS group (7.84 ± 3.67vs. 3.23 ± 1.56 ng/mL) than controls. The AMH levels were positively(p = 0.001) associated with ovarian volume (r = 0.521) as well as number of ovarian follicles(r = 0.461). Further, serum AMH levels showed a positive correlation with luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio (r = 0.206, p = 0.02), but no correlation significant with age, BMI,FG score and testosterone levels. As per receiver operating characteristic (ROC) curve, cut-off was worked out to be 3.76 ng/ml with 86.7% sensitivity and 62.7% specificity. The mean level of AMH were highest among PCOS women with phenotype A (12.67 ± 3.46 ng/ml) with least among PCOS women displaying phenotype B(7.28 ± 1.60 ng/ml) where there is absence of PCOM. In conclusion, serum AMH levels are highly predictive of PCOM and high LH/FSH ratio among PCOS women and may be a potent diagnostic marker of ovarian dysfunction either alone or in conjunction with other tools. Supplementary Information The online version contains supplementary material available at 10.1007/s12291-022-01058-4.
Collapse
Affiliation(s)
- Sajad Sumji
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
| | - Abid Bhat
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
| | - Aafia Rashid
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
- Department of Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
| | - Rohina Bashir
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
- Department of Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
| | - Imtiyaz A Wani
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
- Department of Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
| | - Vishnu Vasudevan
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
| | - Tajali Sehar
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
- Department of Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
| | - Mohd. Ashraf Ganie
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir India
- Department of Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, 190011 Srinagar, India
| |
Collapse
|
4
|
Geng X, He Z, Bao Z, Di W, Gu Z. Aberrant HPO Axis Alterations and Autoimmune Abnormalities in PCOS Patients with DOR: A Retrospective Analysis. J Clin Med 2023; 12:5212. [PMID: 37629254 PMCID: PMC10455465 DOI: 10.3390/jcm12165212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND There is a group of polycystic ovary syndrome (PCOS) patients in clinic who have diminished ovarian reserve (DOR) in combination. This study was designed to evaluate the differences in glucolipid metabolism, hypothalamic-pituitary-ovarian (HPO) axis-related parameters, and autoimmune antibodies in PCOS patients with and without DOR. METHODS A total of 2307 PCOS patients, including 1757 patients with PCOS alone and 550 patients who have both PCOS and DOR, were enrolled in this retrospective study. Parameters of glucolipid metabolism, HPO axis-related parameters, and autoimmune antibodies were measured and analyzed. RESULTS The prevalence of DOR among all patients with PCOS was 23.84%. Many HPO axis-related parameters, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and prolactin (PRL) were significantly different in PCOS with DOR compared with PCOS without DOR. The FSH levels were positively correlated with LH, testosterone (T), and androstenedione (AD) levels, but had no association with glucolipid metabolism after adjusting for body mass index (BMI). Moreover, anti-ovarian antibody (AOAb) and anti-21-OH antibody (21-OHAb) levels were significantly elevated in PCOS patients with DOR. CONCLUSIONS PCOS patients with DOR showed more chaotic HPO axis hormone levels and elevated autoimmune antibodies, suggesting that autoimmune factors may be the cause of DOR in women with PCOS.
Collapse
Affiliation(s)
- Xueying Geng
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
- Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200135, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai 200135, China
| | - Zhihong He
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Zhouzhou Bao
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Wen Di
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
- Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Zhuowei Gu
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
- Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| |
Collapse
|
5
|
Timur HT, Cimrin D, Gursoy Doruk O, Dogan OE. Determining the age group-based cut-off values of serum anti-Mullerian hormone concentrations to diagnose polycystic ovary syndrome. Curr Med Res Opin 2023; 39:855-863. [PMID: 37074782 DOI: 10.1080/03007995.2023.2204768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To determine the cut-off values of the serum anti-Müllerian hormone (AMH) concentration for different age groups (21-25, 26-30, 31-35 years) to diagnose polycystic ovary syndrome (PCOS). METHODS In total, 187 women aged 21-35 years were included in this descriptive study. Patients diagnosed with PCOS according to the Rotterdam Criteria formed the PCOS group (n = 93), whereas those without symptoms related to PCOS formed the control group (n = 94). Follicular phase serum hormone concentrations were evaluated during the endocrinological assessment of patients with PCOS. Serum levels of estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, total testosterone, dehydroepiandrosterone sulfate, sex hormone-binding globulin, androstenedione, and AMH were measured. The free androgen index and LH/FSH ratio were calculated. Cut-off values of serum AMH concentrations for the age groups were measured using receiver operating characteristic curve analysis. RESULTS The prevalence rates of frank, ovulatory, normoandrogenic, and non-polycystic ovary PCOS were 69.9, 10.8, 10.8, and 8.6%, respectively. Serum AMH concentrations >5.56 ng/mL were associated with PCOS in the 21-25-year-old group. The cut-off value was 4.01 ng/mL in the 26-30-year-old group, whereas it was 3.42 ng/mL in the oldest age group. The correlation between the antral follicle count (AFC) and serum AMH level was strong for each age group. CONCLUSIONS The serum AMH concentration is a valuable parameter for assessing patients with symptoms indicative of PCOS. We recommend measuring serum AMH levels to support the diagnosis or to use them instead of the AFC for the Rotterdam criteria.
Collapse
Affiliation(s)
- Hikmet Tunc Timur
- Obstetrics and Gynecology Clinic, Urla State Hospital, Urla, Izmir, Turkey
| | - Dilek Cimrin
- Deparment of Biochemistry, Dokuz Eylul University School of Medicine, Balcova, Izmir, Turkey
| | - Ozlem Gursoy Doruk
- Deparment of Biochemistry, Dokuz Eylul University School of Medicine, Balcova, Izmir, Turkey
| | - Omer Erbil Dogan
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Balcova, Izmir, Turkey
| |
Collapse
|
6
|
Anti-Müllerian hormone is a predictor of medium-term cumulative live birth following in vitro fertilization/intracytoplasmic sperm injection: A retrospective study. Eur J Obstet Gynecol Reprod Biol 2022; 272:220-225. [PMID: 35395615 DOI: 10.1016/j.ejogrb.2022.03.043] [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: 07/09/2021] [Revised: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aims to examine the capacity of anti-Müllerian hormone (AMH) to predict cumulative live birth rate (CLBR) following IVF/ICSI within 36 months since start of treatment. STUDY DESIGN This is a cohort study of women seeking IVF/ICSI fertility treatment in a private Australian IVF clinic in a single calendar year. Live births were monitored over three years following start date of IVF/ICSI. The impact of serum AMH level on the CLBR was assessed using Cox's proportional hazard models, and its incremental values in the prediction of CLBR were evaluated. RESULTS The CLBRs were significantly higher in women with AMH levels in the highest (>44.5 pmol/L; 87.0%, 95% CI 79.2% - 95.1%) and in the middle two quartiles (between 11.5 and 44.5 pmol/L; 81.0%, 95% CI 74.2% - 87.6%), compared with AMH levels below the 25th percentile (≤11.5 pmol/L; 63.2%, 95% CI 53.2% - 74.5%). Approximately half of the women with AMH in the lowest quartile conceived a live birth within 12 months of starting IVF compared with two-thirds of the women in the upper three quartiles. After adjusting for confounders, AMH remained a significant, albeit slight predictor of CLBR with a fall of 3 pmol/L equating to an 1% decrease in CLBR. The AMH's added values into the prediction of live birth were slight, indicated by a net reclassification improvement of 13.8%. The value is lower than that of maternal age (35.1%). CONCLUSIONS Serum AMH level was a significant slight predictor of CLBR following IVF/ICSI. AMH should not be used to exclude women from IVF/ICSI however, women with low AMH should be counselled on the likelihood of taking longer to achieve a live birth than individuals with normal AMH levels.
Collapse
|
7
|
Anand S, Kumar A, Prasad A, Trivedi K. Updated meta-analysis on the diagnostic accuracy of serum anti-Mullerian hormone in poly cystic ovary syndrome involving 13 509 subjects. J Obstet Gynaecol Res 2022; 48:2162-2174. [PMID: 35394100 DOI: 10.1111/jog.15233] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
Abstract
AIM To determine the diagnostic accuracy of anti-Mullerian hormone (AMH) in the diagnosis of polycystic ovary syndrome (PCOS). METHODS Two independent reviewers searched the electronic databases and search engines using PubMed, Cochrane library, and Google Scholar systematically to retrieve relevant articles published from inception to September 2021. The diagnostic efficacy of AMH was computed using the random-effects model in terms of pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence interval (CI). A meta-regression and subgroup analysis were performed to check for any source which could explain possible heterogeneity. Risk of bias assessment was conducted using the QUADAS-2 tool recommended by Cochrane Library. RESULTS This meta-analysis included a total of 41 studies involving 13 509 subjects. We observed promising pooled sensitivity 0.78 (95% CI 0.74 to 0.81), specificity 0.87 (95% CI 0.84 to 0.90), and diagnostic odds ratio (DOR) 24 (95% CI 15 to 37), for AMH in detecting PCOS and discriminatory power (summary receiver operating characteristic [SROC] curves, 0.89 [95% CI 0.86-0.92]). The most prominent bias was noted in the patient selection and index test assessment. CONCLUSIONS With the findings of this current meta-analysis, we conclude serum AMH to be a promising biomarker for the diagnosis of PCOS, however, substantial heterogeneity among studies needs individual patient data analysis in order to identify an optimal cut-off value and homogenous findings. REGISTRATION NUMBER AND GUIDELINES This meta-analysis was performed according to constructed protocol registered in the PROSPERO database with registration number CRD42021246910.
Collapse
Affiliation(s)
- Shikha Anand
- Department of Obstetrics and Gynecology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Amit Kumar
- Department of Laboratory Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Anupa Prasad
- Department of Biochemistry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Kiran Trivedi
- Department of Obstetrics and Gynecology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| |
Collapse
|
8
|
Reliability of AMH and AFC measurements and their correlation: a large multicenter study. J Assist Reprod Genet 2022; 39:1045-1053. [PMID: 35243569 PMCID: PMC9107554 DOI: 10.1007/s10815-022-02449-5] [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: 07/30/2021] [Accepted: 02/28/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Anti-Müllerian hormone (AMH) and antral follicle count (AFC) are correlated with the ovarian response, but their reliability and reproducibility are questionable. This large multicenter study describes their distribution, inter-cycle and inter-center variability, and their correlation. METHODS A total of 25,854 IVF cycles among 15,219 patients were selected in 12 ART centers. Statistical distribution of AMH and AFC was studied by using the Kolmogorov-Smirnov test and Shapiro goodness of fit test. The reproducibility of AFC and AMH was measured using a mixed model regressing the logarithmic transformation of AFC with age. RESULTS The distribution of AMH and AFC was characterized by a wide dispersion of values, twice more important for AFC, and a logarithmic distribution. The faster decline in AMH than in AFC with age suggests that their correlation changes with age. AMH and AFC showed a very low proportion of concordance in the range of expected poor responders according to Bologna cutoffs. The heterogeneity for AMH and AFC across centers was small, but much larger across patients within each center. Concerning the patients with several successive cycles, the reproducibility for AMH seemed much better than for AFC. Comparing respective performances of AMH and AFC for the prediction of ovarian response depended on the local conditions for measuring these indicators and on the reproducibility of results improved over time. CONCLUSION Distribution of AMH and AFC was characterized by the wide dispersion of values, and a logarithmic distribution. Establishing cutoffs or a direct relationship AMH/AFC without considering age seems hazardous. Correlation between AMH and AFC was very poor in the range of poor responders.
Collapse
|
9
|
Prevalence threshold of screening tests in obstetrics and gynecology. Eur J Obstet Gynecol Reprod Biol 2021; 259:191-195. [PMID: 33711775 DOI: 10.1016/j.ejogrb.2021.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We define the prevalence threshold as the prevalence level below which a test's positive predictive value (PPV) declines most sharply relative to disease prevalence - and thus the rate of false positive results/false discovery rate increases most rapidly. The objective of this study is to determine the prevalence threshold of various screening tests used in obstetrics and gynecology among low-risk women in modern clinical practice. METHODS We searched Medline, EMBASE, Google Scholar, Scopus, ISI Web of Science, Cochrane database, and PubMed to obtain the sensitivity and specificity estimates for the following screening tests: 50 g-oral glucose tolerance test (GDM-50 g), non-invasive prenatal testing (NIPT), combined first trimester screening (FTS), vagino-rectal swab for group B streptococcus (GBS) in pregnancy, cervical cytology (Pap) and HPV testing, mammography and manual breast exam, urinary PCR and cervical-vaginal swab testing for gonorrhoea and chlamydia as well as AMH for the diagnosis of PCOS. We used these estimates to calculate disease-specific prevalence thresholds, comparing them to the actual estimates of disease prevalence. RESULTS The prevalence thresholds and average estimates of disease prevalence (shown in brackets) are as follows: GDM-50 g 31 % (6%), NIPT 7% (0.2 %), combined FTS 19.5 % (0.2 %), GBS swab 18 % (15-45 %), Pap 21 % (0.2 %), HPV 27 % (0.2 %), mammography 25 % (12.5 %), breast exam 25 % (12.5 %), gonorrhoea -chlamydia 6-13 % (4.2-4.7 %), AMH for PCOS 32 % (10 %). CONCLUSION The prevalence thresholds of various screening tests used in obstetrics and gynecology are well above the estimated disease prevalence. This implies that when undertaking population-level screening a significant proportion of positive screening tests obtained are likely false-positives. Attempts at individualizing pre-test probability when undertaking population-level screening are needed in order to best interpret the results of screening tests.
Collapse
|
10
|
Zhu X, Ni Y, Cheng M, Chen Q, Zhang A. Evaluation of a fluorescence flow cytometry reagent for anti-Müllerian hormone detection. Acta Biochim Biophys Sin (Shanghai) 2020; 52:1427-1429. [PMID: 33249447 DOI: 10.1093/abbs/gmaa122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Xiaobin Zhu
- Reproductive Medical Center, Department of Obstetrics and Gynecology of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Ying Ni
- Reproductive Medical Center, Department of Obstetrics and Gynecology of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Meiyu Cheng
- Reproductive Medical Center, Department of Obstetrics and Gynecology of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Qian Chen
- Reproductive Medical Center, Department of Obstetrics and Gynecology of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Aijun Zhang
- Reproductive Medical Center, Department of Obstetrics and Gynecology of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
- Department of Histo-Embryology, Genetics and Developmental Biology, Shanghai Key Laboratory of Reproductive Medicine, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| |
Collapse
|
11
|
Bansal P, Sardana K, Arora P, Khurana A, Garga UC, Sharma L. A prospective study of anti-mullerian hormone and other ovarian and adrenal hormones in adult female acne. Dermatol Ther 2020; 33:e13974. [PMID: 33185003 DOI: 10.1111/dth.13974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/18/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Abstract
Polycystic ovarian syndrome (PCOS) diagnosis in adult female acne (AFA) is tough owing to unreliable ultrasonography in virgins or obese females and inconsistent hyperandrogenemia. We analyzed hormones in AFA and established a diagnostic cut-off value of anti-mullerian hormone (AMH) for PCOS. Female acne patients aged ≥25 years were assessed with total testosterone (TT), sex hormone binding globulin (SHBG), free androgen index (FAI), AMH, 17-hydroxyprogesterone (17-OHP), dehydroepiandrosterone sulfate (DHEAS), follicle stimulating hormone (FSH), and luteinizing hormone (LH). Rotterdam's criteria defined PCOS. AMH was measured (Access AMH assay) to calculate the diagnostic cut off value using receiver operating characteristic (ROC) curve. Of 120 cases, 25.83% had PCOS. This group had significant clinical hyperandrogenism, truncal and adolescent acne, polycystic ovarian morphology (PCOM), and raised hormones (AMH, TT, FAI, LH, and LH/FSH). AMH levels were significantly higher in the PCOS group (6.91 ± 3.85 ng/mL) and positively correlated with TT, FAI, 17OHP, LH, and LH/FSH ratio. AMH at >5.1 ng/mL (sensitivity-70.97% and specificity-82.02%) predicted PCOS and correlated with PCOM. AMH (>5.1 ng/mL) is useful for diagnosing PCOS and surrogate for hyperandrogenemia and PCOM. Its correlation with hormones in non PCOS AFA highlights its sensitivity to diagnose endocrinological derangements.
Collapse
Affiliation(s)
- Prekshi Bansal
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Pooja Arora
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Ananta Khurana
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Umesh Chandra Garga
- Department of Radiodiagnosis, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Lokesh Sharma
- Department of Biochemistry, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| |
Collapse
|
12
|
Lv PP, Jin M, Rao JP, Chen J, Wang LQ, Huang CC, Yang SQ, Yao QP, Feng L, Shen JM, Feng C. Role of anti-Müllerian hormone and testosterone in follicular growth: a cross-sectional study. BMC Endocr Disord 2020; 20:101. [PMID: 32641160 PMCID: PMC7341602 DOI: 10.1186/s12902-020-00569-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/08/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Anti-Müllerian hormone (AMH) is now considered the best serum biomarker of ovarian reserve, while basal sex hormones are classic markers used for assessing ovarian reserve. The interaction between AMH and sex hormones are complicated and not sufficiently addressed. In this study, we took diminished ovarian reserve (DOR) and polycystic ovarian syndrome (PCOS) as two extremes of ovarian reserve (deficient and excessive respectively) to investigate the role of AMH and sex hormones in follicular growth. METHODS A retrospective cross-sectional survey was performed. The patients assessed AMH and basal sex hormones in the Second Hospital of Zhejiang University from April 2016 to March 2019 were involved in this study. Serum AMH and sex hormone concentrations were tested with electrochemiluminescence method. Stepwise linear regression and binary logistic regression was used to determine the predictors of AMH level and to explore the involved factors determining DOR and PCOS. RESULTS In the present study, we found that age and follicle-stimulating hormone (FSH) were main negative correlation factors, and luteinizing hormone (LH) and testosterone (T) were main positive factors of AMH. In DOR group, age, FSH and estradiol (E2) increased and T decreased, while in PCOS group, LH and T increased. Binary logistic regression found that age, weight, FSH, E2, and T were the significant factors which independently predicted the likelihood of DOR, and that age, body mass index (BMI), AMH, LH, and T predicted the likelihood of PCOS. CONCLUSIONS Our study demonstrated that age, FSH, and T were factors that most closely correlated with AMH level, and T was involved in both DOR and PCOS. Since DOR and PCOS are manifested with insufficient AMH and excessive AMH respectively, it is suggested that total testosterone correlated with AMH closely and plays an important role in follicular growth. More attention should be given to testosterone level during controlled ovarian hyperstimulation (COH) process.
Collapse
Affiliation(s)
- Ping-Ping Lv
- The Women's Hospital of Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
| | - Min Jin
- The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Jin-Peng Rao
- The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Jian Chen
- The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Li-Quan Wang
- The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Chang-Chang Huang
- The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Song-Qing Yang
- The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Qiu-Ping Yao
- The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Lei Feng
- The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, 310006, Zhejiang, China
| | - Jin-Ming Shen
- The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, 310006, Zhejiang, China
| | - Chun Feng
- The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
| |
Collapse
|
13
|
Yang Y, Cheung HH, Zhang C, Wu J, Chan WY. Melatonin as Potential Targets for Delaying Ovarian Aging. Curr Drug Targets 2020; 20:16-28. [PMID: 30156157 DOI: 10.2174/1389450119666180828144843] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/02/2018] [Accepted: 08/15/2018] [Indexed: 12/21/2022]
Abstract
In previous studies, oxidative stress damage has been solely considered to be the mechanism of ovarian aging, and several antioxidants have been used to delay ovarian aging. But recently, more reports have found that endoplasmic reticulum stress, autophagy, sirtuins, mitochondrial dysfunction, telomeres, gene mutation, premature ovarian failure, and polycystic ovary syndrome are all closely related to ovarian aging, and these factors all interact with oxidative stress. These novel insights on ovarian aging are summarized in this review. Furthermore, as a pleiotropic molecule, melatonin is an important antioxidant and used as drugs for several diseases treatment. Melatonin regulates not only oxidative stress, but also the various molecules, and normal and pathological processes interact with ovarian functions and aging. Hence, the mechanism of ovarian aging and the extensive role of melatonin in the ovarian aging process are described herein. This systematic review supply new insights into ovarian aging and the use of melatonin to delay its onset, further supply a novel drug of melatonin for ovarian aging treatment.
Collapse
Affiliation(s)
- Yanzhou Yang
- Key Laboratory of Fertility Preservation and Maintenance, Ministry of Education, Key Laboratory of Reproduction and Genetics in Ningxia, Ningxia Medical University, Yinchuan, Ningxia, 75004, China
| | - Hoi-Hung Cheung
- Chinese University of Hong Kong - Shandong University Joint Laboratory for Reproductive Genetics, School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, SAR, Hong Kong
| | - Cheng Zhang
- College of Life Science, Capital Normal University, Beijing 100048, China
| | - Ji Wu
- Key Laboratory of Fertility Preservation and Maintenance, Ministry of Education, Key Laboratory of Reproduction and Genetics in Ningxia, Ningxia Medical University, Yinchuan, Ningxia, 75004, China.,Renji Hospital, Key Laboratory for the Genetics of Developmental & Neuropsychiatric Disorders (Ministry of Education), Bio-X Institutes, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Wai-Yee Chan
- Chinese University of Hong Kong - Shandong University Joint Laboratory for Reproductive Genetics, School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, SAR, Hong Kong
| |
Collapse
|
14
|
Ovarian reserve testing in the prediction of recurrent pregnancy loss. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.670091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
15
|
Teede H, Misso M, Tassone EC, Dewailly D, Ng EH, Azziz R, Norman RJ, Andersen M, Franks S, Hoeger K, Hutchison S, Oberfield S, Shah D, Hohmann F, Ottey S, Dabadghao P, Laven JSE. Anti-Müllerian Hormone in PCOS: A Review Informing International Guidelines. Trends Endocrinol Metab 2019; 30:467-478. [PMID: 31160167 DOI: 10.1016/j.tem.2019.04.006] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/16/2019] [Accepted: 04/22/2019] [Indexed: 12/27/2022]
Abstract
Polycystic ovary syndrome (PCOS) affects 8-13% of women. The Rotterdam diagnostic criteria include polycystic ovarian morphology (PCOM) on ultrasound, but given recognized challenges, serum anti-Müllerian hormone (AMH) is proposed as an alternative. To inform international PCOS guidelines, a systematic review was completed. Key identified gaps include large international studies in well-defined populations across the lifespan, clustering of AMH with PCOS features, relationships to long-term health outcomes, and improved quality, assay standardization, and sample handling, all needed to determine cut offs. Here we identify research priorities to address these gaps and enhance AMH utility in PCOS. Once issues are addressed, AMH levels could replace more costly and less accessible ultrasound in PCOS diagnosis.
Collapse
Affiliation(s)
- Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Locked Bag 29, Clayton, VIC 3168, Australia.
| | - Marie Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Locked Bag 29, Clayton, VIC 3168, Australia
| | - Eliza C Tassone
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Locked Bag 29, Clayton, VIC 3168, Australia
| | | | - Ernest Hy Ng
- Department of Obstetrics and Gynaecology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ricardo Azziz
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, SUNY, Albany, NY 12144, USA
| | - Robert J Norman
- Robinson Research Institute, University of Adelaide and Fertility SA, Adelaide, SA, Australia
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Clinical Institute, University of Southern Denmark, 5000 Odense C, Denmark
| | - Stephen Franks
- Imperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Hospital, London W12 0NN, UK
| | - Kathleen Hoeger
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Rochester, Rochester, NY 14642, USA
| | - Samantha Hutchison
- Diabetes and Endocrine Units, Monash Health, Clayton, VIC 3168, Australia
| | - Sharon Oberfield
- Department of Pediatrics, Division of Endocrinology, Diabetes, and Metabolism, Columbia University Medical Center, New York, NY 10032, USA
| | - Duru Shah
- Gynaecworld, Center for Women's Health and Fertility, Maharashtra 400036, India
| | - Femke Hohmann
- Huisartsenpraktijk Hohmann & De Vet, Rotterdam 3061, The Netherlands
| | - Sasha Ottey
- PCOS Challenge, Inc., 931 Monroe Drive, NE Suite A-470 Atlanta, GA 30308, USA
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, India
| | - Joop S E Laven
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
16
|
Johnson CY, Tanz LJ, Lawson CC, Howards PP, Bertone-Johnson ER, Eliassen AH, Schernhammer ES, Rich-Edwards JW. Anti-Müllerian hormone levels in nurses working night shifts. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2019; 75:136-143. [PMID: 30945620 PMCID: PMC6776712 DOI: 10.1080/19338244.2019.1577210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Our objective was to examine associations between night shift work and serum anti-Müllerian hormone (AMH) levels. We analyzed 1,537 blood samples from premenopausal female nurses in the Nurses' Health Study II, assayed for AMH. Rotating or permanent night shifts worked in the two weeks before blood collection and years of rotating night shift work were obtained via questionnaire. We found no associations between recent night shifts or rotating night shift work and AMH. The median difference in AMH was 0.3 (95% CI: -0.4, 0.8) ng/mL for ≥5 versus 0 recent night shifts and -0.1 (95% CI: -0.4, 0.3) ng/mL for ≥6 versus 0 years of rotating night shift work. Although we found no associations between night shift work and AMH, this does not preclude associations between night shift work and fertility operating through other mechanisms.
Collapse
Affiliation(s)
- Candice Y Johnson
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Lauren J Tanz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christina C Lawson
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Eva S Schernhammer
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Connor Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
17
|
Mahajan N, Kaur J. Establishing an Anti-Müllerian Hormone Cutoff for Diagnosis of Polycystic Ovarian Syndrome in Women of Reproductive Age-Bearing Indian Ethnicity Using the Automated Anti-Müllerian Hormone Assay. J Hum Reprod Sci 2019; 12:104-113. [PMID: 31293324 PMCID: PMC6594116 DOI: 10.4103/jhrs.jhrs_149_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Context: Polycystic ovary syndrome diagnosed by Rotterdam criteria, is the most common cause of anovulatory infertility. The criteria of polycystic ovarian morphology (PCOM) are subject to operator variability and technological advances. Serum anti-Müllerian hormone (AMH) level has been proposed as a more reliable alternative to antral follicle count. There is a paucity of data on use of AMH for diagnosis of PCOS in Indian women. Aim and Objectives: The aim of this study is to determine a cutoff level for AMH that could facilitate diagnosis of PCOS and its phenotypes in women of Indian origin using the automated (Roche) assay and to compare the competence of oocytes in PCOS and non-PCOS women undergoing in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI). Materials and Methodology: A total of 367 women undergoing treatment at our fertility center between February 2017 and August 2017 were prospectively enrolled in this study. Of these, 133 were diagnosed with PCOS, 69 had isolated PCOM, and 165 (controls) had normal ovaries on ultrasound examination. Serum AMH levels were assessed using the fully automated Roche Elecsys® immunoassay. Gonadotropin-releasing hormone antagonist protocol was used for IVF-ICSI in all patients. Statistical Analysis Used: Quantitative variables were compared using the Mann–Whitney test. Qualitative variables were correlated using the Chi-square test. P < 0.05 was considered to be statistically significant. Results: Mean AMH concentrations in women with PCOS was higher (7.56 ± 4.36 ng/mL) in comparison to PCOM and controls. Serum AMH concentration >5.03 ng/mL could facilitate diagnosis of PCOS (area under the curve = 0.826); sensitivity –70.68%, specificity of 79.91%. There was no difference in the ratio of mature to total oocytes retrieved in the three groups (P > 0.05). Mean number of mature oocytes was lower in controls than PCOS and PCOM (P < 0.001). Conclusions: Serum AMH concentration >5.03 ng/mL could be used as cutoff value for the diagnosis of PCOS in women of Indian origin.
Collapse
Affiliation(s)
- Nalini Mahajan
- Department of Reproductive Medicine, Mother and Child Hospital, Delhi, India
| | - Jasneet Kaur
- Department of Reproductive Medicine, Mother and Child Hospital, Delhi, India
| |
Collapse
|
18
|
Aydoğmuş H, Kelekçi S, Elmalı F, Aydoğmuş S. Can we use serum Anti-Mullerian hormone to differentiate the diagnosis between polycystic ovary syndrome patients and healthy women with polycystic ovarian morphology and regular menstrual cycles. Saudi Med J 2018; 39:1011-1016. [PMID: 30284584 PMCID: PMC6201027 DOI: 10.15537/smj.2018.10.23413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: To compare Anti-Mullerian hormone (AMH) concentrations between polycystic ovary syndrome (PCOS) patients and healthy women who have polycystic ovarian morphology (PCOM) with regular menstrual cycles, and to determine a diagnostic cutoff value for PCOS women during reproductive period. Methods: This study was carried out between February 2013 and October 2017 at the Department of Obstetrics and Gynecology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, Izmir, Turkey. Seventy PCOS patients and 70 PCOM women with normal menstrual cycles were included in the study. Blood samples of the subjects were obtained following an 8-hour fast for AMH and biochemical assessments, serum gonadotropin, and androgen measurements. Results: The mean serum AMH levels of PCOS patients were found to be higher than PCOM women with normal menstrual cycles (p<0.01). The optimal serum AMH cutoff value for PCOS diagnosis was determined as 3.51 ng/ml (sensitivity 72.8%, specificity 75.7%). Conclusion: Serum AMH concentrations are significantly higher in PCOS patients independent from the ovarian morphology and number of follicles per ovary. Positive and negative predictive values of AMH in PCOS diagnosis were found to be 75% and 73.6%, respectively, with a cutoff value of 3.51 ng/mL.
Collapse
Affiliation(s)
- Hüseyin Aydoğmuş
- Department of Gynecology and Obstetrics, İzmir Katip Çelebi University Atatürk Research and Training Hospital,İzmir, Turkey. E-mail.
| | | | | | | |
Collapse
|
19
|
Accuracy of anti-Müllerian hormone and total follicles count to diagnose polycystic ovary syndrome in reproductive women. Taiwan J Obstet Gynecol 2018; 57:499-506. [DOI: 10.1016/j.tjog.2018.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 11/18/2022] Open
|
20
|
Stracquadanio M, Ciotta L, Palumbo MA. Relationship between serum anti-Mullerian hormone and intrafollicular AMH levels in PCOS women. Gynecol Endocrinol 2018; 34:223-228. [PMID: 28944702 DOI: 10.1080/09513590.2017.1381838] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Polycystic ovary syndrome is a complex disease characterized by various endocrine disorders that are the potential cause of anovulation and hyperandrogenism. Anti-Müllerian hormone expression is suspected to be overexpressed in PCOS granulosa cells. AMH acts as a regulator of folliculogenesis: it is produced by the granulosa cells of follicles from the stage of the primary follicle to the initial formation of the antrum. Serum and intrafollicular AMH levels are elevated in patients with PCOS due to increased number of small follicles and an increased secretion within each of these small follicles. This excess of AMH is strongly suspected to play a role in the characteristic follicular arrest of PCOS, through a negative action on aromatase expression and on FSH action. Value above 5 ng/ml or 35 pmol/l might be considered as a diagnostic criterion for PCOS. The aim of our study is to demonstrate the presence of higher AMH serum levels and higher AMH intrafollicular fluid level of PCOS patients, undergone to IVF cycles, compared to normovulatory patients. The results clearly indicate that blood and intrafollicular AMH levels are significantly higher in PCOS women comparing to the normovulatory population. Serum AMH level appears to be a good predictive marker for the risk ovarian hyperstimulation syndrome: thus, its evaluation should be recommended before starting a controlled ovarian stimulation for IVF.
Collapse
Affiliation(s)
- M Stracquadanio
- a Institute of Obstetric and Gynecological Pathology , Santo Bambino Hospital, University of Catania , Catania , Italy
| | - L Ciotta
- a Institute of Obstetric and Gynecological Pathology , Santo Bambino Hospital, University of Catania , Catania , Italy
| | - M A Palumbo
- a Institute of Obstetric and Gynecological Pathology , Santo Bambino Hospital, University of Catania , Catania , Italy
| |
Collapse
|
21
|
Sathyapalan T, Al-Qaissi A, Kilpatrick ES, Dargham SR, Atkin SL. Anti-Müllerian hormone measurement for the diagnosis of polycystic ovary syndrome. Clin Endocrinol (Oxf) 2018; 88:258-262. [PMID: 29144548 DOI: 10.1111/cen.13517] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/11/2017] [Accepted: 11/09/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Anti-Müllerian hormone (AMH) is derived from the small antral follicles, and an elevated level has been suggested to add value to the Rotterdam criteria for the diagnosis of PCOS in cases of diagnostic uncertainty. Therefore, the role of AMH in the classical phenotype of PCOS was defined within a Caucasian population. DESIGN This was a cross-sectional study. PATIENTS Sixty Five women without PCOS and 110 women with PCOS fulfilling all 3 diagnostic Rotterdam criteria. MEASUREMENTS The main outcomes were the utility of serum AMH for the diagnosis of PCOS and its relationship to the metabolic parameters. RESULTS Anti-Müllerian hormone was increased in PCOS compared to controls (P < .001). Areas under the receiver operator curve showed AMH to be predictive of PCOS (0.76) using a cut-off AMH of 46 pmol/L, which is derived from the 95th percentile of the controls that gave a 41% sensitivity and 86% specificity; an AMH cut-off of 35 pmol/L gave a 55% sensitivity and 79% specificity. Age- and BMI-adjusted multiple logistic regression showed that AMH was more predictive of PCOS independently of either serum testosterone (T) (OR = 4.04; 95% CI 1.42-11.11; P = .007) or free androgen index (FAI) (OR = 3.90; 95% CI 1.40-10.83; P = .009). CONCLUSION Whilst an elevated AMH has poor sensitivity, it is fourfold more likely to be associated with a diagnosis of PCOS, and supplementary to biochemical parameters will make a positive diagnosis of PCOS in 22% of patients when neither serum testosterone nor FAI is elevated.
Collapse
Affiliation(s)
| | - Ahmed Al-Qaissi
- Department of Diabetes and Endocrinology, University of Hull, Hull, UK
| | | | - Soha R Dargham
- Infectious Disease Epidemiology Group, Weill Cornell Medicine, Doha, Qatar
| | | |
Collapse
|
22
|
Daney de Marcillac F, Pinton A, Guillaume A, Sagot P, Pirrello O, Rongieres C. What are the likely IVF/ICSI outcomes if there is a discrepancy between serum AMH and FSH levels? A multicenter retrospective study. J Gynecol Obstet Hum Reprod 2017; 46:629-635. [PMID: 28843783 DOI: 10.1016/j.jogoh.2017.08.001] [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: 01/14/2017] [Revised: 07/25/2017] [Accepted: 08/18/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The principal outcome was to assess the ovarian response to controlled hyperstimulation during in vitro fertilization (IVF) with or without micro-injection (ICSI) in patients whom ovarian reserve testing revealed a discrepancy between the serum levels of FSH and AMH. The secondary outcome was to determine whether AMH and FSH profiles could predict the IVF/ICSI response. STUDY DESIGN This was a multicenter, retrospective study analysing all controlled ovarian hyperstimulation cycles with attempted fresh embryo transfer(s) carried out during IVF/ICSI treatment and in which the AMH level had been assayed between January 01, 2008 and December 31, 2011. This enabled us to form 2 control groups (NOR, normal ovarian reserve: normal AMH and FSH and DOR, diminished ovarian reserve: diminished AMH, increased FSH) and 2 study groups (DAMH: diminished AMH, normal FSH and NAMH: normal AMH, increased FSH). The principal assessment criterion was quantitative ovarian response to stimulation defined by the mean number of oocytes punctured, the secondary assessment criterion the qualitative response to stimulation defined by the pregnancy rate per cycle. RESULTS We were able to analyse 1803 stimulation cycles. The mean number of oocytes punctured was significantly reduced in the DAMH and DOR groups compared to the NAMH and NOR groups (5.2±3.9 and 4.1±3.3 vs. 11.5±7 and 9.5±5.6, respectively [P<0.01]). The pregnancy rate per initiated cycle was significantly reduced in the DAMH and DOR groups compared to the NAMH and NOR groups (20% and 24% vs. 32 and 35%, respectively [P<0.01]). Live birth rates did not differ between the groups however. Multivariate analysis with logistic regression revealed that AMH, FSH and age independently had an effect on the number of oocytes punctured, although the effect exerted by AMH seemed to be preponderant (OR: 2.75: 95%CI [2.39-3.19]). AMH appeared to be the sole factor independently predictive of pregnancy per cycle. CONCLUSION The serum AMH level appears to provide an additional item of discriminatory information, which should not be overlooked. Ovarian reserve work-up should include routine AMH assay.
Collapse
Affiliation(s)
| | - A Pinton
- Department of reproductive medicine, CMCO, 67130 Schiltigheim, France
| | - A Guillaume
- Department of reproductive medicine, CMCO, 67130 Schiltigheim, France
| | - P Sagot
- Department of reproductive medicine, CHU Dijon-Bourgogne, 21079 Dijon, France
| | - O Pirrello
- Department of reproductive medicine, CMCO, 67130 Schiltigheim, France
| | - C Rongieres
- Department of reproductive medicine, CMCO, 67130 Schiltigheim, France
| |
Collapse
|
23
|
Song DK, Oh JY, Lee H, Sung YA. Differentiation between polycystic ovary syndrome and polycystic ovarian morphology by means of an anti-Müllerian hormone cutoff value. Korean J Intern Med 2017; 32:690-698. [PMID: 27899014 PMCID: PMC5511935 DOI: 10.3904/kjim.2016.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/22/2016] [Accepted: 05/29/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Although increased serum anti-Müllerian hormone (AMH) level has been suggested to be a surrogate marker of polycystic ovarian morphology (PCOM), its association with polycystic ovary syndrome (PCOS) is controversial, and its diagnostic value has not been determined. We aimed to observe the relationship between the AMH level and PCOS phenotypes and to determine the optimal cutoff value of AMH for the diagnosis of PCOS in young Korean women. METHODS We recruited 207 women with PCOS (120 with PCOM and 87 without PCOM) and 220 regular cycling women with normoandrogenemia (100 with PCOM and 120 without PCOM). Subjects underwent testing at a single outpatient visit. Serum AMH level was measured. RESULTS Women with PCOS had higher serum AMH levels than did regular cycling women with normoandrogenemia (p < 0.05). Women with PCOM had higher serum AMH levels than women without PCOM, regardless of PCOS status (p < 0.05). The optimal AMH cutoff value for the diagnosis of PCOS was 10.0 ng/mL (71% sensitivity, 93% specificity). Serum AMH was an independent determinant of total testosterone after adjustment for age, body mass index, and the number of menses/year (β = 0.31, p < 0.01). An association between AMH and hyperandrogenism was only observed in women with PCOS, and it was independent of the presence of PCOM. CONCLUSION The serum AMH level can be useful for the diagnosis of PCOS at any age less than 40 years, and the optimal cutoff value for the diagnosis of PCOS identified in this study of young Korean women was 10.0 ng/mL.
Collapse
Affiliation(s)
- Do Kyeong Song
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
- Correspondence to Do Kyeong Song, M.D. Department of Internal Medicine, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea Tel: +82-2-2650-6158 Fax: +82-2-2650-5235 E-mail:
| | - Jee-Young Oh
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyejin Lee
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yeon-Ah Sung
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| |
Collapse
|
24
|
Anti-Mullerian hormone concentrations in individual follicular fluids within one stimulated IVF cycle resemble blood serum values. J Assist Reprod Genet 2017; 34:1115-1120. [PMID: 28324271 PMCID: PMC5581778 DOI: 10.1007/s10815-017-0908-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/07/2017] [Indexed: 11/11/2022] Open
Abstract
Purpose Anti-Mullerian hormone (AMH) is commonly known as the most potent marker for ovarian reserve due to its decline as female age increases. While serum AMH (sAMH) levels have been intensively investigated, there is less data regarding AMH concentrations in follicular fluid (FF), since FF has usually been designated as waste product during oocyte collection in assisted reproductive technologies. This pilot study investigated follicle AMH concentrations (fAMH) of several follicles per ovary, individually collected with the Steiner-Tan needle, and compared them to sAMH concentrations in women undergoing IVF treatment. We hypothesized that there is no difference of fAMH concentrations in individual follicles and that these concentrations resemble the sAMH value of the patient. Methods Patients were stimulated with a gonadotropin-releasing hormone antagonist ovarian hyperstimulation protocol. On the day of oocyte retrieval, serum samples and FF from all individual follicles from one stimulated IVF cycle were collected and individually analyzed for AMH concentrations. Results Intracyclic mean fAMH values (nfollicle = 2–14) were significantly correlated to sAHM values (ρ = 0.85, p < 0.001) and showed a trend to be negatively associated with age (ρ = −0.43, p = 0.06). Mean intrapatient fAMH concentrations differed significantly (p < 0.001). Furthermore, significant correlations of sAMH with individual fAMH values of the first five follicles of each patient were observed. Conclusions In conclusion, our results clearly showed that individual fAMH concentrations reflected sAMH values and that fAMH concentrations did not significantly differ within one patient. In future studies, it will be interesting to correlate individual fAMH values to the respective embryo development and overall pregnancy outcome in order to improve IVF treatments and to refrain from embryo overproduction.
Collapse
|
25
|
Montano GA, Robeck TR, Steinman KJ, O'Brien JK. Circulating anti-Müllerian hormone concentrations in relation to age and season in male and female beluga (Delphinapterus leucas). Reprod Fertil Dev 2017; 29:1642-1652. [DOI: 10.1071/rd15537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 08/07/2016] [Indexed: 12/31/2022] Open
Abstract
The present study aimed to describe serum anti-Müllerian hormone (AMH) patterns of ex situ male and female beluga to examine the influence of age (divided into 5-year categories) or sexual maturation and reproductive season. In males aged 5–9 years, AMH concentrations were significantly (P < 0.05) higher than those in all age categories exceeding 15 years and were not influenced by season (P = 0.57). AMH concentrations in females peaked in the 5–9-year age category during the breeding season and decreased (P < 0.05) after 9 years of age. Aged females displayed lower (P < 0.05) AMH concentrations than immature and mature animals and immature females secreted higher concentrations than mature animals (P = 0.03). For mature females, seasonal differences (P = 0.02) in AMH concentrations were detected, with females in the breeding season displaying higher AMH concentrations than in the non-breeding season. This is the first time AMH has been characterised in a cetacean species and the first potential hormonal evidence of reproductive senescence in beluga. Further research is required to determine if this hormone can be used as a predictor of fertility for the species.
Collapse
|
26
|
Pearson K, Long M, Prasad J, Wu YY, Bonifacio M. Assessment of the Access AMH assay as an automated, high-performance replacement for the AMH Generation II manual ELISA. Reprod Biol Endocrinol 2016; 14:8. [PMID: 26879773 PMCID: PMC4754992 DOI: 10.1186/s12958-016-0143-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/08/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The manual Generation II (Gen II) ELISA method used to measure Anti-Müllerian Hormone (AMH) from Beckman Coulter has recently been superseded by a fully automated AMH immunoassay. The aim of this study was to evaluate the performance of the Access AMH assay and directly compare it to the modified Gen II ELISA method. A secondary aim was to verify that the fertile age-related AMH range previously established using the Gen II ELISA could be used to interpret results from the new automated Access assay. METHODS The precision, stability, linearity, measurement range and detection limits were determined using recombinant AMH and patient serum samples. Different diluents and their effects on AMH concentration were compared. A correlation study was performed on patient samples to compare the Access AMH assay to the ELISA method on the Access2 and DxI800 analysers. The fertile AMH range was verified by comparing the 10th, 50th and 90th percentile values from both methods obtained from 489 natural conception pregnant women. RESULTS The Access AMH assay showed good performance across the measuring range for both intra-assay (CV 1.41-3.30 %) and inter-assay (CV 3.04-5.76 %) precision and acceptable sample stability. Dilution of the high concentration samples with the recommended diluent resulted in a small but significant downward shift in values. The assay was linear over the range of values recommended by the manufacturer, allowing for accurate reporting within the reported range. The two assay types were highly correlated (R(2) = 0.9822 and 0.9832 for Access2 and DxI800, respectively), and the differences observed between the Access2 and DxI800 analysers were within clinically acceptable ranges, indicating that the methods are interchangeable. Furthermore, we demonstrated that results from the published reference range for the Gen II ELISA correlate with those from the automated Access AMH assay. CONCLUSION Here, we verified the published performance of the Access AMH assay and showed excellent correlation with the Gen II ELISA method. Moreover, we validated this correlation by confirming that the results from a fertile AMH reference range established using the preceding Gen II ELISA are interchangeable with the new automated Access AMH assay.
Collapse
Affiliation(s)
- Kylie Pearson
- Genea-Canberra, 17B/2 King Street, Deakin, ACT 2600, Australia.
| | - Matthew Long
- Genea-Sydney City, Level 3/321 Kent Street, Sydney, NSW, 2000, Australia
| | - Josephine Prasad
- Genea-Sydney City, Level 3/321 Kent Street, Sydney, NSW, 2000, Australia
| | - Ye Ying Wu
- Genea-South West, 173-175 Bigge Street, Liverpool, NSW, 2170, Australia
| | - Michael Bonifacio
- Genea-Sydney City, Level 3/321 Kent Street, Sydney, NSW, 2000, Australia
| |
Collapse
|