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Xu X, Jiang Y, Du J, Sun H, Wang X, Zhang C. Development and validation of a prediction model for suboptimal ovarian response in polycystic ovary syndrome (PCOS) patients undergoing GnRH-antagonist protocol in IVF/ICSI cycles. J Ovarian Res 2024; 17:116. [PMID: 38807145 PMCID: PMC11134646 DOI: 10.1186/s13048-024-01437-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 05/11/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND PCOS patients with unexpectedly low oocyte yield following conventional ovarian stimulation are referred to as suboptimal responders. However, identifying suboptimal responders presents a significant challenge within reproductive medicine and limited research exists on the occurrence of suboptimal response. This analysis aimed to develop a predictive model of suboptimal response during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatments in PCOS patients. METHODS This retrospective study involved a cohort of 313 PCOS patients undergoing their first IVF/ICSI cycle from 2019 to 2022. Univariate logistic regression analyses, least absolute shrinkage, selection operator regression analysis, and recursive feature elimination were employed to identify relevant characteristics and construct predictive models. Moreover, a nomogram was constructed based on the best model. Receiver operating characteristic curves, decision curve analysis (DCA), and calibration curves were used to evaluate the model. RESULTS The predictors included in the model were age, Anti-Mullerian hormone, antral follicle count, and basal follicle-stimulating hormone. The area under the receiver operating characteristic curve (AUC) was 0.7702 (95% confidence interval 0.7157-0.8191). The AUC, along with the DCA curve and calibration curve, demonstrated a satisfactory level of congruence and discrimination ability. CONCLUSION The nomogram effectively predicted the probability of suboptimal response in PCOS patients undergoing gonadotropin-releasing hormone antagonist protocol during IVF/ICSI treatment.
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Affiliation(s)
- Xiaohang Xu
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yilin Jiang
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jinlin Du
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou, China
| | - Haoyue Sun
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xue Wang
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou, China
| | - Cuilian Zhang
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Zhengzhou, China.
- Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou, China.
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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.
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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
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Huang H, Gao H, Shi Y, Deng B, He X, Lin J, Li P. Can AMH levels predict the need to step up FSH dose for controlled ovarian stimulation following a long GnRH agonist protocol in PCOS women? Reprod Biol Endocrinol 2023; 21:121. [PMID: 38110998 PMCID: PMC10726541 DOI: 10.1186/s12958-023-01173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/10/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND To explore the role of anti-Mullerian hormone (AMH) in predicting the need to step up recombinant FSH (rFSH) dose following long GnRH agonist protocol in IVF/ICSI cycles of polycystic ovarian syndrome (PCOS) women. METHODS This is a retrospective cohort study of 825 PCOS women undergoing long GnRH agonist protocol enrolled from Jan 2019 to Dec 2021. The daily rFSH dose at which the first response to rFSH were recorded. The dose at which the first response to rFSH was based on folliculometry during follow up in which two or more follicles reached ≥ 11 mm. A receiver operating characteristic (ROC) curve analysis was done to investigate the ability of AMH to predict the need to step up initial rFSH dose. RESULTS PCOS women who needed to step up initial rFSH dose had a significantly higher AMH compared with those didn't step up initial rFSH dose (11.37 ± 3.25ng/ml vs. 8.69 ± 3.16ng/ml, p < 0.001). In multivariate logistic regression analysis, increased AMH level was an independent factor for the need to step up initial rFSH dose in PCOS patients after adjusted for confounding factors. ROC curve analysis showed AMH could predict the need to step up initial rFSH dose (AUC = 0.738, 95%CI: 0.704-0.773), having 75.4% specificity and 63% sensitivity when the threshold AMH concentration was 9.30ng/ml. 58.8% PCOS women with AMH > 9.30 ng/ml required increased rFSH dose compared to 18.8% of women with AMH ≤ 9.30ng/ml (p < 0.001). Although the clinical pregnancy rate and live birth rate were not significantly different, there was a higher incidence of OHSS among women with AMH > 9.30 ng/ml vs. AMH ≤ 9.30ng/ml (20.8% vs. 15.3%, p = 0.043). CONCLUSION PCOS women with AMH > 9.30 ng/ml were resistant to rFSH stimulation and require increased dose for the cycle recruitment of ovarian follicles.
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Affiliation(s)
- Hui Huang
- Department of Reproductive medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Zhenhai Road 10, Xiamen, 361000, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Haijie Gao
- Department of Reproductive medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Zhenhai Road 10, Xiamen, 361000, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Yingying Shi
- Department of Reproductive medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Zhenhai Road 10, Xiamen, 361000, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Bingbing Deng
- Department of Reproductive medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Zhenhai Road 10, Xiamen, 361000, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Xuemei He
- Department of Reproductive medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Zhenhai Road 10, Xiamen, 361000, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Jin Lin
- Department of Reproductive medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Zhenhai Road 10, Xiamen, 361000, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Ping Li
- Department of Reproductive medicine, Women and Children's Hospital, School of Medicine, Xiamen University, Zhenhai Road 10, Xiamen, 361000, Fujian, China.
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China.
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Guo Z, Chen S, Chen Z, Hu P, Hao Y, Yu Q. Predictors of response to ovulation induction using letrozole in women with polycystic ovary syndrome. BMC Endocr Disord 2023; 23:90. [PMID: 37098539 PMCID: PMC10127327 DOI: 10.1186/s12902-023-01336-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/07/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the predictive value of the initial screening characteristics of women with anovulatory polycystic ovary syndrome (PCOS) who did or did not respond to 2.5 mg letrozole (LET). METHODS The clinical and laboratory characteristics of women with PCOS who underwent LET treatment were evaluated. Women with PCOS were stratified according to their responses to LET (2.5 mg). The potential predictors of their responses to LET were estimated using logistic regression analysis. RESULTS Our retrospective study included 214 eligible patients with a response to 2.5 mg LET (n = 131) or no response to 2.5 mg LET (n = 83). PCOS patients who responded to 2.5 mg LET showed better outcomes than those who did not (2.5 mg LET) for pregnancy rate, live birth rate, pregnancy rate per patient, and live birth rate per patient. Logistic regression analyses showed that late menarche (odds ratio [OR], 1.79 [95% confidence intervals (CI), 1.22-2.64], P = 0.003), and increased anti-müllerian hormone (AMH) (OR, 1.12 [95% CI, 1.02-1.23], P = 0.02), baseline luteinizing hormone (LH)/ follicle stimulating hormone (FSH) (OR, 3.73 [95% CI, 2.12-6.64], P < 0.001), and free androgen index (FAI) (OR, 1.37 [95% CI, 1.16-1.64], P < 0.001) were associated with a higher possibility of no response to 2.5 mg LET. CONCLUSIONS PCOS patients with an increased LH/FSH ratio, AMH, FAI, and late menarche may need an increased dosage of LET for a treatment response, which could be helpful in designing a personalized treatment strategy.
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Affiliation(s)
- Zaixin Guo
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Shuwen Chen
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiyan Chen
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Beijing, China
| | - Pan Hu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yanfang Hao
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Yu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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Sudhakaran G, Babu SR, Mahendra H, Arockiaraj J. Updated experimental cellular models to study polycystic ovarian syndrome. Life Sci 2023; 322:121672. [PMID: 37028548 DOI: 10.1016/j.lfs.2023.121672] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023]
Abstract
Polycystic ovarian syndrome (PCOS) develops due to hormonal imbalance and hyperandrogenism. Animal models are widely used to study PCOS because they mimic essential characteristics of human PCOS; however, the pathogenesis of PCOS remains unclear. Different sources of novel drugs are currently being screened as therapeutic strategies to alleviate PCOS and its symptoms. Simplified cell line in-vitro models could be preliminarily used to screen the bioactivity of various drugs. This review describes different cell line models focusing on the PCOS condition and its complications. Therefore, the bioactivity of the drugs could be preliminarily screened in a cell line model before moving to higher animal models.
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Affiliation(s)
- Gokul Sudhakaran
- Department of Biotechnology, College of Science and Humanities, SRM Institute of Science and Technology, Kattankulathur, 603 203 Chennai, Tamil Nadu, India
| | - Sarvesh Ramesh Babu
- Department of Biotechnology, College of Science and Humanities, SRM Institute of Science and Technology, Kattankulathur, 603 203 Chennai, Tamil Nadu, India
| | - Hridai Mahendra
- Department of Biotechnology, College of Science and Humanities, SRM Institute of Science and Technology, Kattankulathur, 603 203 Chennai, Tamil Nadu, India
| | - Jesu Arockiaraj
- Department of Biotechnology, College of Science and Humanities, SRM Institute of Science and Technology, Kattankulathur, 603 203 Chennai, Tamil Nadu, India.
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Nguyen MT, Krishnan S, Phatak SV, Karakas SE. Anti-Mullerian Hormone-Based Phenotyping Identifies Subgroups of Women with Polycystic Ovary Syndrome with Differing Clinical and Biochemical Characteristics. Diagnostics (Basel) 2023; 13:diagnostics13030500. [PMID: 36766605 PMCID: PMC9914382 DOI: 10.3390/diagnostics13030500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023] Open
Abstract
Even though polycystic ovary syndrome (PCOS) was originally defined as "amenorrhea associated with bilateral polycystic ovaries", women without PCO morphology can be included in this diagnosis. This may contribute to the clinical heterogeneity seen in PCOS. Serum anti-Mullerian hormone (AMH) correlates with the number of ovarian cysts. We investigated whether phenotyping based on serum AMH can distinguish subgroups of PCOS with different clinical and biochemical characteristics. The electronic medical records of 108 women with PCOS (Rotterdam criteria) were reviewed. The serum AMH value correlated inversely (0.03 < p < 0.0001) with age, weight, and BMI values and directly with serum total testosterone (T), free T, and bioavailable T values. When divided into quartiles based on serum AMH values, the women in the highest quartile (AMH: 18.5 ± 9.9 ng/mL; n = 27) had lower BMI (29.4 ± 6.9 vs. 34.0 ± 10.6-36.7 ± 7.2 kg/m2) but higher total T (51.3 ± 27.2 vs. 26.5 ± 10.4-35.1 ± 16.3 ng/dL), free T (7.7 ± 6.0 vs. 4.4 ± 2.3-5.7 ± 3.2 ng/dL), and bioavailable T (22.1 ± 17.0 vs. 12.2 ± 6.6-16.5 ± 8.7 ng/dL) values. The combination of high AMH and high testosterone values may point to the ovaries and reproductive etiology for PCOS in this subgroup. Thus, AMH-based phenotyping may provide a practical and cost-effective tool to explore the heterogeneity in PCOS.
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Affiliation(s)
- Minhthao Thi Nguyen
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of California Davis School of Medicine, Sacramento, CA 95817, USA
| | - Sridevi Krishnan
- Department of Pediatrics, Glycobiology Research and Training Center, University of California San Diego School of Medicine, La Jolla, CA 92037, USA
| | - Sonal V. Phatak
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of California Davis School of Medicine, Sacramento, CA 95817, USA
| | - Sidika E. Karakas
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of California Davis School of Medicine, Sacramento, CA 95817, USA
- Correspondence:
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Wang K, Guan Y, Zhang Y, Jia R, Wu S, Yao Z, Zhang M, Li Z. Analysis of cumulative outcomes and influencing factors of patients with discrepancies between age and AMH levels in the early follicular phase prolonged protocol. Front Endocrinol (Lausanne) 2023; 14:1098131. [PMID: 36967754 PMCID: PMC10031014 DOI: 10.3389/fendo.2023.1098131] [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: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To explore the cumulative outcomes and influencing factors of patients with discrepancies between age and Anti-Müllerian hormone (AMH) levels in the early follicular phase prolonged protocol. METHODS A total of 1282 cycles of in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) assisted pregnancy with the early follicular phase prolonged protocol in the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University from September 2015 to December 2020 were retrospectively analyzed. They were divided into the young low-AMH group (n=1076) and the older high-AMH group (n=206). The primary outcomes included cumulative clinical pregnancy rate (CCPR) and cumulative live birth rate (CLBR). Secondary outcomes included the number of oocytes retrieved, number of available embryos, clinical pregnancy rate (CPR), live birth rate (LBR), miscarriage rate (MR), pregnancy complications, and neonatal outcomes. RESULTS The CPR (68.7% vs. 59.4%) and the LBR (60.7% vs. 43.1%) in the young low-AMH group were higher than those in the older high-AMH group. In contrast, the number of oocytes retrieved (11 vs. 17), number of available embryos (5 vs. 8), and MR (10.6% vs. 18.3%) in the young low-AMH group were lower. There was no significant difference between the two groups in the CCPR, CLBR, pregnancy complications, and neonatal outcomes. Logistic regression analysis showed that infertility duration, basal follicle-stimulating hormone (FSH), and antral follicle count (AFC) correlated with CCPR, while maternal age, type of infertility, basal FSH, AFC, and infertility duration correlated with CLBR. The area under the receiver operating characteristic curves (ROC) curve for the combined model of infertility duration, AFC, and basal FSH to predict cumulative pregnancy was 0.629 (95%CI:0.592-0.666), while the combined model of maternal age, AFC, basal FSH, infertility duration, and type of infertility to predict cumulative live birth was 0.649 (95%CI:0.615-0.682). CONCLUSION Although AMH levels are low by contrast, young patients have a favorable outcome after IVF/ICSI. In patients with discrepancies between age and AMH levels in the early follicular phase prolonged protocol, maternal age correlates better with cumulative live birth. The model that combines maternal age and other factors can help predict cumulative live birth, but its value is limited.
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Prediction of Drug-Drug-Gene Interaction Scenarios of ( E)-Clomiphene and Its Metabolites Using Physiologically Based Pharmacokinetic Modeling. Pharmaceutics 2022; 14:pharmaceutics14122604. [PMID: 36559098 PMCID: PMC9781104 DOI: 10.3390/pharmaceutics14122604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Clomiphene, a selective estrogen receptor modulator (SERM), has been used for the treatment of anovulation for more than 50 years. However, since (E)-clomiphene ((E)-Clom) and its metabolites are eliminated primarily via Cytochrome P450 (CYP) 2D6 and CYP3A4, exposure can be affected by CYP2D6 polymorphisms and concomitant use with CYP inhibitors. Thus, clomiphene therapy may be susceptible to drug-gene interactions (DGIs), drug-drug interactions (DDIs) and drug-drug-gene interactions (DDGIs). Physiologically based pharmacokinetic (PBPK) modeling is a tool to quantify such DGI and DD(G)I scenarios. This study aimed to develop a whole-body PBPK model of (E)-Clom including three important metabolites to describe and predict DGI and DD(G)I effects. Model performance was evaluated both graphically and by calculating quantitative measures. Here, 90% of predicted Cmax and 80% of AUClast values were within two-fold of the corresponding observed value for DGIs and DD(G)Is with clarithromycin and paroxetine. The model also revealed quantitative contributions of different CYP enzymes to the involved metabolic pathways of (E)-Clom and its metabolites. The developed PBPK model can be employed to assess the exposure of (E)-Clom and its active metabolites in as-yet unexplored DD(G)I scenarios in future studies.
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Mohamed AA, Al-Hussaini TK, Hussein RS, Abdallah KS, Amer SA. The Impact of High Circulating Anti-Müllerian Hormone on Endometrial Thickness and Outcome of Assisted Reproductive Technology in Women with Polycystic Ovarian Syndrome: A Cohort Study. J Hum Reprod Sci 2022; 15:370-376. [PMID: 37033142 PMCID: PMC10077748 DOI: 10.4103/jhrs.jhrs_112_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/27/2022] [Accepted: 11/27/2022] [Indexed: 04/11/2023] Open
Abstract
Background Elevated circulating anti-Müllerian hormone (AMH) in women with the polycystic ovarian syndrome (PCOS) has been found to have a detrimental effect on endometrial function. This may adversely affect the outcome of in vitro fertilisation (IVF) in PCOS women. Aims To investigate the impact of high serum AMH concentrations on endometrial thickness (ET) and the outcome of IVF in women with PCOS. Settings and Design This retrospective cohort study included all PCOS women who underwent fresh IVF\intracytoplasmic sperm injection cycles between January 2016 and December 2021 in one major IVF centre. Materials and Methods PCOS diagnosis was based on Rotterdam criteria, and participants were identified from centre database. All women received antagonist protocol. Primary outcomes were trigger-day ET and live birth rate (LBR). Circulating AMH was correlated with ET and ovarian response. Statistical Analysis Used AMH levels were compared between women with and without live birth. ET and LBRs were compared between women with AMH <7.0 ng/ml versus those with AMH ≥7.0 ng/ml. Results The study included 102 PCOS women, of which six were excluded due to poor response (n = 4), hyperresponse (n = 1) or fertilisation failure (n = 1). Of the remaining 96 women, 42 (43.8%) achieved a live birth. There was no statistically significant (P > 0.05) correlation between AMH and ET. Mean ± standard deviation AMH concentration was not significantly (P > 0.05) different between women with live birth (6.5 ± 3.4 ng/ml) and those without (6.5 ± 2.4 ng/ml). High AMH positively correlated with the number of oocytes retrieved, metaphase II oocytes and embryos (P = 0.003, 0.006 and 0.006, respectively). There was no statistically significant (P > 0.05) difference in ET or LBR between women with AMH <7.0 ng/ml (n = 72; ET, 10.7 ± 1.8 mm; LBR, 45.8% [33/72] versus those with AMH ≥7.0 ng/ml (n = 24; ET, 10.8 ± 1.7 mm; LBR, 37.5% [9/24]). Conclusions High circulating AMH in PCOS women does not seem to negatively affect ET or LBRs during assisted reproductive technology.
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Affiliation(s)
| | | | - Reda S. Hussein
- Department of Obstetrics and Gynaecology, Assiut University, Assiut, Egypt
| | - Karim S. Abdallah
- Department of Obstetrics and Gynaecology, Assiut University, Assiut, Egypt
| | - Saad A. Amer
- Department of Obstetrics and Gynaecology, Academic Unit of Translational Medical Sciences, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
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Moradi A, Ghasemian F, Mashayekhi F. The reaggregation of normal granulosa-cumulus cells and mouse oocytes with polycystic ovarian syndrome in vitro: An experimental study. Int J Reprod Biomed 2022; 19:987-996. [PMID: 34977456 PMCID: PMC8717076 DOI: 10.18502/ijrm.v19i11.9914] [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: 07/13/2020] [Revised: 12/12/2020] [Accepted: 03/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background The dialogue between oocytes and their surrounding cells plays a major role in the progress of oocyte meiosis and their developmental potential. Objective This study aimed to evaluate the effect of co-culture of normal granulosa-cumulus cells (GCCs) with oocytes from polycystic ovarian syndrome (PCOS) mice. Materials and Methods Normal GCCs were collected from 10 virgin adult Naval Medical Research Institute female mice (30-35 gr, 7-8 wk old), and were cultured in an alpha-minimum essential medium supplemented with 5% fetal calf serum for 24-48 hr (1×106 cells/well). Then, germinal-vesicle oocytes from PCOS mice were cultured in the presence of cultured normal GCCs (experimental group) and without GCCs (control group). The maturation rate and quality of the PCOS oocytes were examined by evaluating TFAM and Cx43 gene expression (real-time PCR) and the connection among PCOS oocytes and normal GCCs after 24 hr of culture. Results The co-culture of normal GCCs and PCOS oocytes in the experimental group led to the formation of a complex called a PCOS oocyte-normal GCCs complex. The maturation rate of these complexes was significantly increased compared to that of the control group (p ≤ 0.001). A significant difference was also found in the expression of Cx43 (p ≤ 0.001) and TFAM (p < 0.05) genes in the experimental group compared with the control group. The connection between PCOS oocytes and normal GCCs was observed in the scanning electron microscope images. Conclusion Co-culture with normal GCCs improves the capacity of PCOS oocytes to enter meiosis, which may result in the promotion of assisted reproduction techniques.
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Affiliation(s)
- Amaneh Moradi
- Department of Biology, Faculty of Sciences, University of Guilan, Rasht, Iran
| | - Fatemeh Ghasemian
- Department of Biology, Faculty of Sciences, University of Guilan, Rasht, Iran
| | - Farhad Mashayekhi
- Department of Biology, Faculty of Sciences, University of Guilan, Rasht, Iran
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11
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Sun X, Xiong W, Liu L, Xiong J, Liao C, Lan Y, Li F, Tao S, Meng M, Sun C, Mao X. Comparison of the predictive capability of antral follicle count vs. the anti-Müllerian hormone for ovarian response in infertile women. Front Endocrinol (Lausanne) 2022; 13:862733. [PMID: 36387919 PMCID: PMC9659916 DOI: 10.3389/fendo.2022.862733] [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: 01/26/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare the predictive capability of antral follicle count (AFC) and the anti-Müllerian hormone (AMH) on ovarian response in infertile women and to identify potential factors influencing retrieved oocytes. METHODS A total of 2585 infertile women who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles had been enrolled in this study. Spearman correlation was used to investigate the correlation between retrieved oocytes and AFC. Multiple linear regression analysis was used to study the parameters affecting the number of retrieved oocytes. RESULTS Spearman correlation and multiple linear regression analysis revealed that the oocyte retrieval number was positively correlated with AFC (r = 0.651, p < 0.001) and AMH (r = 0.566, p < 0.001) and negatively correlated with age (r = -0.425, p < 0.001) and regimen selection (r = -0.233 p < 0.001). There was no significant correlation between retrieved oocytes and BMI (p = 0.913). ROC analysis revealed that AFC was a better predictor of adverse effects than AMH, BMI, and age (AUC: 0.916 VS 0.791, 0.575, 0.752). Meanwhile, AFC and AMH were comparable in predicting high response (AUC = 0.731 and AUC = 0.733, respectively). CONCLUSIONS This study showed that retrieved oocytes were positively correlated with serum AMH and AFC and negatively correlated with age and BMI. AFC had an ideal predictive performance in ovarian response prediction. The mechanism of the effect of AFC on ovarian response during controlled ovarian hyperstimulation (COH) needs to be further investigated.
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Affiliation(s)
- Xingyu Sun
- Department of Gynecology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Wang Xiong
- Department of Gynecology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Liting Liu
- Department of Gynecology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Junjun Xiong
- Department of Gynecology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Chenlu Liao
- Department of Ophthalmology, The First People’s Hospital of Neijiang, Neijiang, China
| | - Yunzhu Lan
- Department of Gynecology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Feifei Li
- Department of Gynecology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Shufei Tao
- Family Medicine, Carle Foundation Hospital, Urbana, IL, United States
| | - Muzi Meng
- American University of the Caribbean School of Medicine, Preston, United Kingdom
- Bronxcare Health System, The Bronx, NY, United States
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Xiguang Mao
- Department of Gynecology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- *Correspondence: Xiguang Mao,
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Anti-Müllerian Hormone in Pathogenesis, Diagnostic and Treatment of PCOS. Int J Mol Sci 2021; 22:ijms222212507. [PMID: 34830389 PMCID: PMC8619458 DOI: 10.3390/ijms222212507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 01/19/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive-aged women. It is characterized by chronic anovulation, hyperandrogenism, and the presence of polycystic ovary in ultrasound examination. PCOS is specified by an increased number of follicles at all growing stages, mainly seen in the preantral and small antral follicles and an increased serum level of Anti-Müllerian Hormone (AMH). Because of the strong correlation between circulating AMH levels and antral follicle count on ultrasound, Anti-Müllerian Hormone has been proposed as an alternative marker of ovulatory dysfunction in PCOS. However, the results from the current literature are not homogeneous, and the specific threshold of AMH in PCOS and PCOM is, therefore, very challenging. This review aims to update the current knowledge about AMH, the pathophysiology of AMH in the pathogenesis of PCOS, and the role of Anti-Müllerian Hormone in the treatment of this syndrome.
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Munira S, Banu J, Ishrat S, Shume MM, Uddin MJ, Sultana S. Anti-Mullerian Hormone (AMH) as a Predictor of Ovarian Response to Clomiphene Citrate in Polycystic Ovarian Syndrome. FERTILITY & REPRODUCTION 2021. [DOI: 10.1142/s2661318221500134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Serum Anti-Mullerian hormone (AMH) levels in women with polycystic ovary syndrome (PCOS) are two- to threefold higher than in ovulatory women with normal ovaries, corresponding to the two- to threefold increase in the number of small follicles in PCOS. The increased AMH has been hypothesized to reduce follicle sensitivity to follicle stimulating hormone (FSH) and estradiol production, thus preventing follicle selection, resulting in follicular arrest at the small antral phase with failure of dominance. Objective: The study was undertaken to test the hypothesis that high AMH level is associated with poor response to ovulation induction in PCOS women. Methods: This was a cross-sectional comparative study of 50 infertile women with PCOS, grouped into those with AMH level <8 ng/mL and those with AMH level [Formula: see text] 8 ng/mL. All participants received an initial dose of 100 mg/day of clomiphene citrate from 2nd to 6th day of menstrual cycle. Ovarian response (follicle size) was assessed by transvaginal monitoring on 12th day of cycle. Results: A total of 50 women were recruited, of which 4 dropped out. Women with AMH [Formula: see text] 8 ng/mL comprised only 23.91% of the PCOS women. AMH and day 12 follicle size had a statistically significant association. Adjusting for other confounding variables in linear, logarithmic, and logistic analysis, serum AMH had significant negative relationship with follicle size (r = 0.511, p < 0.001). AMH was also positively correlated with serum LH, testosterone and negatively correlated with serum follicle stimulating hormone (FSH), serum TSH and BMI. Conclusion: We observed that higher AMH level women had poor response to ovulation induction compared to women with low AMH level.
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Affiliation(s)
- Serajoom Munira
- Department of Reproductive Endocrinology & Infertility, Banagabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Jesmine Banu
- Department of Reproductive Endocrinology & Infertility, Banagabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shakeela Ishrat
- Department of Reproductive Endocrinology & Infertility, Banagabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Mehnaz Mustary Shume
- Department of Reproductive Endocrinology & Infertility, Banagabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Muhammad Jasim Uddin
- Department of Reproductive Endocrinology & Infertility, Banagabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sabiha Sultana
- Department of Reproductive Endocrinology & Infertility, Banagabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Salama S, Sharaf M, Salem SM, Rasheed MA, Salama E, Elnahas T, Lotfy R. FSH versus AMH: age-related relevance to ICSI results. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2021; 26:27. [PMID: 34421292 PMCID: PMC8369322 DOI: 10.1186/s43043-021-00071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/30/2021] [Indexed: 12/04/2022] Open
Abstract
Background Women’s fecundity is known to decrease with the increase in chronologic age. Several biomarkers of the ovarian reserve, including follicle stimulating hormone (FSH), anti Müllerian hormone (AMH), have been proposed as possible predictors for the response to controlled ovarian stimulation (COS). Although there are assumptions indicating that the relationship between age and ovarian reserve is highly variable and the potential different validity of ovarian reserve markers in women in different age groups remains to be demonstrated. The purpose of our study was evaluating FSH and AMH as potential predictors of response to controlled ovarian stimulation and prediction of intracytoplasmic sperm injection (ICSI) outcome according to age. This prospective study has been carried out on 218 women having ICSI cycles. Cases were divided into two groups, group 1 (n 148), their age < 35 years, and group 2 (n 70), their age ≥ 35 years. All women received antagonist protocol during their ICSI cycles. Basal FSH and AMH were measured and correlated to the number of follicles on the day of trigger, the number of oocytes retrieved, chemical, and clinical pregnancies. Results The fertilization rate in group 1 was 68.15%, while in group 2 was 77.82% (p = 0.003) while the implantation rate (number of gestational sacs observed at 6 weeks of pregnancy divided by the number of transferred embryos) was 18.95 and 11.98% in group 1 and group 2, respectively (p = 0.041). The clinical pregnancy rate among both groups was 38.51% in group 1, while 24.29% in group 2 (p = 0.038). Women who got pregnant among those aged < 35 years had significantly lower basal FSH (p < 0.001), while women who got pregnant among those aged ≥ 35 years had significantly higher AMH levels (p value < 0.001) and higher E2 levels on the day of trigger (p = 0.007). Conclusion We found that below the age of 35 years, the chances of pregnancy are more correlated to FSH levels, while above the age of 35 years, AMH was a more relevant test.
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Affiliation(s)
- Sameh Salama
- Reproductive Health and Family Planning Department, Medical Research Division, National Research Centre, 33 Al Bohouth Street, Dokki, Giza, Egypt
| | - Marwa Sharaf
- Obstetrics and Gynaecology Department, Kasr El Eini Teaching Hospital, Cairo University, Cairo, Egypt
| | - Sondos M Salem
- Reproductive Health and Family Planning Department, Medical Research Division, National Research Centre, 33 Al Bohouth Street, Dokki, Giza, Egypt
| | - Mazen Abdel Rasheed
- Reproductive Health and Family Planning Department, Medical Research Division, National Research Centre, 33 Al Bohouth Street, Dokki, Giza, Egypt
| | - Ehab Salama
- Reproductive Health and Family Planning Department, Medical Research Division, National Research Centre, 33 Al Bohouth Street, Dokki, Giza, Egypt
| | - Tamer Elnahas
- Reproductive Health and Family Planning Department, Medical Research Division, National Research Centre, 33 Al Bohouth Street, Dokki, Giza, Egypt
| | - Rehab Lotfy
- Obstetrics and Gynaecology Department, Kasr El Eini Teaching Hospital, Cairo University, Cairo, Egypt
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Wu Q, Li J, Ng EHY, Liu J, Mol BWJ, Wu X, Wang CC, Kuang H, Ma H, Gao J, Hou L, Hu Z, Shao X, Ge J, Zhang J, Xue H, Xu X, Liang R, Ma H, Yang H, Huang D, Sun Y, Hao C, Du S, Ding C, Gao Y, Wu T, Stener‐Victorin E, Zhang H, Legro RS. Do baseline AMH levels in women with polycystic ovary syndrome predict ovulation rate and time to ovulation: a secondary analysis of PCOSAct trial? BJOG 2021. [DOI: 10.1111/1471-0528.16742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Q Wu
- Department of Obstetrics and Gynaecology, Obstetrics and Gynecology Hospital Fudan University Shanghai China
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong City Hong Kong
| | - J Li
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong City Hong Kong
- Department of Obstetrics and Gynecology The Affiliated Hospital Gui Zhou Medical University Gui Zhou China
| | - EHY Ng
- Department of Obstetrics and Gynaecology The University of Hong Kong Hong Kong City Hong Kong
| | - J‐P Liu
- Centre for Evidence‐Based Chinese Medicine Beijing University of Chinese Medicine Beijing China
| | - BWJ Mol
- Department of Obstetrics and Gynaecology Monash Medical Centre Monash University 246 Clayton Road Clayton Vic. 3168 Australia
| | - X‐K Wu
- Department of Obstetrics and Gynaecology First Affiliated Hospital Heilongjiang University of Chinese Medicine Harbin China
- Heilongjiang Provincial Hospital Harbin Institute of Technology Harbin China
| | - CC Wang
- Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong City Hong Kong
- Reproduction and Development Laboratory Li Ka Shing Institute of Health Sciences The Chinese University of Hong Kong Hong Kong City Hong Kong
- School of Biomedical Sciences The Chinese University of Hong Kong Hong Kong City Hong Kong
- Chinese University of Hong Kong‐Sichuan University Joint Laboratory in Reproductive Medicine The Chinese University of Hong Kong Hong Kong City Hong Kong
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Huang L, Chang MY, Shiau CS, Hsieh TT. Changes in anti-müllerian hormone after ultrasound guided aspiration and ethanol sclerotic therapy of ovarian cyst. Taiwan J Obstet Gynecol 2021; 60:509-512. [PMID: 33966737 DOI: 10.1016/j.tjog.2021.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the effect of transvaginal ultrasound-guided aspiration and ethanol sclerotherapy on anti-müllerian hormone (AMH) in patients with ovarian endometriomas. SETTING Teaching hospital affiliated with Chang Gung University, Taipei. MATERIAL AND METHODS We retrospectively reviewed 124 patients, with ovarian endometriomas who underwent transvaginal aspiration and sclerotherapy of endometrioma(s) at a tertiary medical center, Chang Gung Memorial Hospital, Taipei, Taiwan. Preoperative evaluation included AMH, midcycle serum CA-125 level, and ultrasonography to exclude possibility of malignancies. Patients underwent ultrasonographic guided transvaginal aspiration and sclerotherapy with 95% ethanol irrigation of the cystic cavity. Patients were grouped into group 1, n = 44, retention of ethanol, and group 2, n = 80, no retention. Serum AMH level was checked at 6 months after aspiration. Those who were infertile prior to therapy were followed up for subsequent pregnancies (either by assisted reproductive technologies, or by natural conception). RESULTS The mean pre-operative AMH levels for the group without retention of ethanol and with ethanol retention were 3.80 and 3.06 respectively (p > 0.05). The change in AMH at 6-month follow up for retained group patients was significantly more than for non-retained group patients, with mean decrease of 0.72 (23.6%) and 0.10 (2.7%) respectively (p < 0.05). 54.5% (retained) and 47.2% (non-retained) of patients failed to achieve pregnancy during the observation period. CONCLUSIONS Transvaginal aspiration of endometriomas followed by sclerotherapy with ethanol can be effective in preserving ovarian reserve, provided that no ethanol is left in situ.
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Affiliation(s)
- Lulu Huang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, No 199 Dunhua N Rd, Songshan District, Taipei, 105, Taiwan.
| | - Ming-Yang Chang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, No 199 Dunhua N Rd, Songshan District, Taipei, 105, Taiwan.
| | - Chii-Shin Shiau
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, No 199 Dunhua N Rd, Songshan District, Taipei, 105, Taiwan.
| | - T'sang-T'ang Hsieh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, No 199 Dunhua N Rd, Songshan District, Taipei, 105, Taiwan.
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Vagios S, Sacha CR, Hammer KC, Dimitriadis I, James KE, Bormann CL, Souter I. Response to ovulation induction treatments in women with polycystic ovary syndrome as a function of serum anti-Müllerian hormone levels. J Assist Reprod Genet 2021; 38:1827-1833. [PMID: 33934267 DOI: 10.1007/s10815-021-02217-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/28/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To assess whether anti-Müllerian hormone (AMH) can predict response to ovulation induction (OI) with clomiphene citrate (CC), letrozole (LET), or follicle-stimulating hormone (FSH) in women with polycystic ovary syndrome (PCOS) undergoing OI/intrauterine inseminations (IUI). METHODS A total of 738 OI/IUI cycles from 242 patients at an academic center were stratified in three groups by medication: CC (n = 295), LET (n = 180), and FSH (n = 263), in a retrospective fashion. Ovarian response to treatment (RT, development of at least one dominant follicle) was assessed using mixed effects logistic regression models. RESULTS Overall, RT cycles had lower AMH levels compared to no-RT cycles (p < 0.001). This finding persisted when analysis was limited to oral agents but attenuated in FSH cycles. For CC and LET cycles, the predicted probability (PProb) for RT decreased as AMH levels increased (PProb (95%CI): 97% (93-100), 79% (70-88), and 75% (61-89); 85% (78-93), 75% (67-83), and 73% (63-86) for AMH pct.: ≤ 25th, ≥ 50th, and ≥ 75th, for CC and LET, respectively)). However, RT was noted in 98.5% of FSH/IUI cycles regardless of AMH. For CC cycles, those with AMH ≥ 75th pct. had lower odds for RT over cycles with AMH < 75th pct. (OR 0.2, 95%CI 0.04-0.8, p = 0.02). Similarly, lower odds for RT were observed in LET cycles with AMH ≥ 75th pct. (0.6, 0.3-1.4, p = 0.25). CONCLUSION In PCOS, increasing serum AMH levels are associated with lower probability of RT to oral agents. Our findings constitute a valuable tool for the clinician when counseling PCOS patients and designing a personalized ovulation induction treatment strategy.
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Affiliation(s)
- Stylianos Vagios
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Caitlin R Sacha
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA
| | - Karissa C Hammer
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA
| | - Irene Dimitriadis
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kaitlyn E James
- Deborah Kelly Center for Outcomes Research, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Charles L Bormann
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, Yawkey 10A, 55 Fruit Street, Boston, MA, 02114, USA
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Hashemian Z, Afsharian P, Farzaneh P, Eftekhari-Yazdi P, Vakhshiteh F, Daneshvar Amoli A, Nasimian A. Establishment and characterization of a PCOS and a normal human granulosa cell line. Cytotechnology 2020; 72:10.1007/s10616-020-00426-3. [PMID: 32989584 PMCID: PMC7695766 DOI: 10.1007/s10616-020-00426-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 11/29/2022] Open
Abstract
Oocyte maturation is an important phase in fertility and any disorder in this process could lead to infertility. The most common disorder during folliculogenesis is polycystic ovary syndrome (PCOS). Due to the secretive activity of granulosa cells (GCs), they play a vital role in folliculogenesis. Although scientists use various cellular and molecular methods to have a better understanding of the mechanism of these cells, some limitations still exist in GC culture such as low primary cell yield and proliferation capability. Therefore, immortalization of primary cells is an approach to overcome these limitations. In the current study, GCs were obtained from two females, one with PCOS and one with normal folliculogenesis. In the first stage, we established two human GC (hGC) lines by immortalizing them through retrovirus-mediated transfer of the human telomerase reverse transcriptase (hTERT) and c-Myc genes. Subsequently, the normal and PCOS cell lines were characterized and were investigated for their growth features. The cell lines were also examined in terms of immortal markers of hTERT, follicle stimulating hormone receptor (FSHR), aromatase, anti-Müllerian hormone (AMH), growth differentiation factor 9 (GDF9), bone morphogenetic protein 15 (BMP15), estrogen, and progesterone. Our results indicated that the normal and PCOS cell lines both showed similar characteristics to GCs during the follicular stage in normal and PCOS women. The normal and PCOS cell lines demonstrate molecular mechanisms similar to that of GCs such as folliculogenesis, oogenesis, and steroidogenesis, which enable researchers to perform further investigations in future.
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Affiliation(s)
- Zohreh Hashemian
- Human and Animal Cell Bank, Iranian Biological Resource Center (IBRC), ACECR, Tehran, Iran
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Parvaneh Afsharian
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Parvaneh Farzaneh
- Human and Animal Cell Bank, Iranian Biological Resource Center (IBRC), ACECR, Tehran, Iran
| | - Poopak Eftekhari-Yazdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Faezeh Vakhshiteh
- Human and Animal Cell Bank, Iranian Biological Resource Center (IBRC), ACECR, Tehran, Iran
| | | | - Ahmad Nasimian
- Human and Animal Cell Bank, Iranian Biological Resource Center (IBRC), ACECR, Tehran, Iran.
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High antimüllerian hormone levels are associated with preterm delivery in patients with polycystic ovary syndrome. Fertil Steril 2020; 113:444-452.e1. [DOI: 10.1016/j.fertnstert.2019.09.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 01/09/2023]
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Woodward A, Klonizakis M, Broom D. Exercise and Polycystic Ovary Syndrome. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1228:123-136. [PMID: 32342454 DOI: 10.1007/978-981-15-1792-1_8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a complex endocrinopathy affecting both the metabolism and reproductive system of women of reproductive age. Prevalence ranges from 6.1-19.9% depending on the criteria used to give a diagnosis. PCOS accounts for approximately 80% of women with anovulatory infer-tility, and causes disruption at various stages of the reproductive axis. Evidence suggests lifestyle modification should be the first line of therapy for women with PCOS. Several studies have examined the impact of exercise interventions on reproductive function, with results indicating improvements in menstrual and/or ovulation frequency following exercise. Enhanced insulin sensitivity underpins the mechanisms of how exercise restores reproductive function. Women with PCOS typically have a cluster of metabolic abnormalities that are risk factors for CVD. There is irrefutable evidence that exercise mitigates CVD risk factors in women with PCOS. The mechanism by which exercise improves many CVD risk factors is again associated with improved insulin sensitivity and decreased hyperinsulinemia. In addition to cardiometabolic and reproductive complications, PCOS has been associated with an increased prevalence of mental health disorders. Exercise improves psychological well-being in women with PCOS, dependent on certain physiological factors. An optimal dose-response relationship to exercise in PCOS may not be feasible because of the highly individualised characteristics of the disorder. Guidelines for PCOS suggest at least 150 min of physical activity per week. Evidence confirms that this should form the basis of any clinician or healthcare professional prescription.
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Affiliation(s)
- Amie Woodward
- Faculty of Health and Wellbeing, Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
| | - Markos Klonizakis
- Faculty of Health and Wellbeing, Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
| | - David Broom
- Faculty of Health and Wellbeing, Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK.
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Sakaguchi K, Yanagawa Y, Yoshioka K, Suda T, Katagiri S, Nagano M. Relationships between the antral follicle count, steroidogenesis, and secretion of follicle-stimulating hormone and anti-Müllerian hormone during follicular growth in cattle. Reprod Biol Endocrinol 2019; 17:88. [PMID: 31690325 PMCID: PMC6833202 DOI: 10.1186/s12958-019-0534-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/15/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The antral follicle count (AFC) in mammalian ovaries positively correlates with female fertility. To clarify the causes of differences in fertility between low and high AFC cows, we investigated follicular growth dynamics and hormone concentrations in plasma, follicular fluid, and in vitro growth (IVG) media at different stages of follicular growth. METHODS Seven cows were divided into high AFC (n = 4, > 30 follicles) and low AFC (n = 3, < 30 follicles) groups based on the peak AFC detected by ultrasonography. These cows were subjected to estrous synchronization, daily ovarian ultrasonography, and blood collection. Their follicular fluid was collected from dominant follicles at different stages (selection, luteal, and ovulatory phases). In another experiment, we cultured oocyte-cumulus-granulosa cell complexes collected from early antral follicles (< 1 mm) for 12 days. Estradiol-17β (E2), testosterone (T), progesterone (P4), and anti-Müllerian hormone (AMH) concentrations in follicular fluids and plasma were measured. Plasma follicle-stimulating hormone (FSH) concentrations were examined. E2, P4, and AMH concentrations were also measured in IVG media. RESULTS The numbers of small (< 4 mm) and intermediate (4-8 mm) follicles were larger in the high AFC group than in the low AFC group (P < 0.05). The number of intermediate follicles was stable in the low AFC group, indicating consistent development. However, the number of these follicles fluctuated in the high AFC group. Plasma FSH concentrations were higher, whereas E2 and T concentrations were lower in the low AFC group (P < 0.05). E2 concentrations and the E2/P4 ratio in ovulatory follicles and IVG media on day 8 were higher in the high AFC group (P < 0.05). AMH concentrations in plasma and IVG media (P < 0.01) were higher in the high AFC group. CONCLUSIONS The weaker response to FSH of granulosa cells caused low E2 production in the low AFC group, resulting in high FSH concentrations and the consistent development of intermediate follicles. Conversely, higher E2 concentrations suppressed FSH secretion in the high AFC group. Granulosa cells in the high AFC group had the ability to produce more AMH than those in the low AFC group throughout IVG culture.
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Affiliation(s)
- Kenichiro Sakaguchi
- 0000 0001 2173 7691grid.39158.36Laboratory of Theriogenology, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818 Japan
- 0000 0004 0614 710Xgrid.54432.34Research Fellow of the Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, 102-0083 Japan
| | - Yojiro Yanagawa
- 0000 0001 2173 7691grid.39158.36Laboratory of Theriogenology, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818 Japan
| | - Koji Yoshioka
- 0000 0004 0530 9488grid.416882.1National Institute of Animal Health, NARO, Tsukuba, Ibaraki 305-0856 Japan
| | - Tomoko Suda
- 0000 0004 0530 9488grid.416882.1National Institute of Animal Health, NARO, Tsukuba, Ibaraki 305-0856 Japan
| | - Seiji Katagiri
- 0000 0001 2173 7691grid.39158.36Laboratory of Theriogenology, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818 Japan
| | - Masashi Nagano
- 0000 0001 2173 7691grid.39158.36Laboratory of Theriogenology, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818 Japan
- 0000 0000 9206 2938grid.410786.cPresent address: Laboratory of Animal Reproduction Department of Animal Science, School of Veterinary Medicine, Kitasato University, Aomori, 034-8628 Japan
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Shi Y, Li L, Zhou J, Sun J, Chen L, Zhao J, Wu L, Cui Y, Wu L, Wu H. Efficacy of electroacupuncture in regulating the imbalance of AMH and FSH to improve follicle development and hyperandrogenism in PCOS rats. Biomed Pharmacother 2019; 113:108687. [PMID: 30851546 DOI: 10.1016/j.biopha.2019.108687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 01/24/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism and follicular arrest. These two characteristics may result from an imbalance between anti-Müllerian hormone and follicle stimulating hormone. Electroacupuncture is effective in improving hyperandrogenism and follicular arrest in PCOS; however, the mechanism is not sufficiently clear. This study aimed to elucidate whether electroacupuncture in PCOS is exerted by regulating an imbalance of anti-Müllerian hormone and follicle stimulating hormone. In this study, a rat model of polycystic ovary syndrome was treated with low-frequency electroacupuncture at acupoints (CV-3 and CV-4). To observe the mechanism of electroacupuncture in PCOS, we first observed the estrous cycle. We then observed ovarian morphology by hematoxylin-eosin staining and evaluated levels of testosterone, estradiol, P450arom, follicle stimulating hormone and its receptor, and anti-Müllerian hormone and its receptor by enzyme-linked immunosorbent assay, western blotting, double immunofluorescence assay and real-time PCR. Our results showed that in 80% of rats in the electroacupuncture acupoints group, their estrous cycle recovered, ovarian morphology significantly improved, testosterone level significantly decreased, and levels of estradiol and P450arom significantly increased in peripheral serum after 14 consecutive days of treatment (P < 0.01). The expression of anti-Müllerian hormone and anti-Müllerian hormone type II receptor decreased (P < 0.05), whereas the expression of follicle stimulating hormone receptor increased (P < 0.05). These results indicated that electroacupuncture improved hyperandrogenism and follicular arrest by decreasing the excessive expression of AMH to regulate FSH and AMH imbalance in granulosa cells in PCOS.
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Affiliation(s)
- Yin Shi
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Outpatient Department, Shanghai Institute of Acupuncture-Moxibustion and Meridian, Shanghai 200030, China
| | - Liang Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Jing Zhou
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Jie Sun
- Department of Acupuncture and Moxibustion, Shanghai Songjiang District Central Hospital, Shanghai 201600, China
| | - Liu Chen
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Jimeng Zhao
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Luyi Wu
- Qigong Institute, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China
| | - Yunhua Cui
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Lingxiang Wu
- Editorial Department, Shanghai Institute of Acupuncture-Moxibustion and Meridian, Shanghai 200030, China
| | - Huangan Wu
- Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
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23
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Gülşen MS, Ulu İ, Yıldırım Köpük Ş, Kıran G. The role of anti-Müllerian hormone in predicting clomiphene citrate resistance in women with polycystic ovarian syndrome. Gynecol Endocrinol 2019; 35:86-89. [PMID: 30044165 DOI: 10.1080/09513590.2018.1499085] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Clomiphene citrate (CC) is the agent of first choice in polycystic ovarian syndrome; however, anovulation problem does not resolve in a quarter of them. Thus, we investigated the value of anti-Müllerian hormone (AMH) in the prediction of ovarian response to CC in women with the polycystic ovarian syndrome (PCOS). This prospective cohort study included 90 anovulatory women with PCOS who were given 50 mg/d CC. The patients who ovulated occupied the group of responders and the patients who did not ovulate in three cycles included in the CC-resistant group. AMH levels of both groups were compared. p < .05 was considered statistically significant. Patients who ovulated had significantly lower serum AMH concentrations compared with the resistant group (p = .001). After analyzing the ROC curve, serum AMH concentration was found to be a useful predictor of CC resistance with the sensitivity of 66% and the specificity of 89%, when the threshold AMH concentration was >12.38 ng/ml in PCOS patients. In the present study, we revealed that the higher the AMH level the poorer the CC response would be in PCOS patients, therefore we recommend measuring the AMH levels of all PCOS patients before planning any ovulation induction treatment to achieve the desired success.
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Affiliation(s)
- Mehmet Serdar Gülşen
- a Department of Obstetrics and Gynecology , Health Sciences University Ümraniye Medical and Research Hospital , İstanbul , Turkey
| | - İpek Ulu
- a Department of Obstetrics and Gynecology , Health Sciences University Ümraniye Medical and Research Hospital , İstanbul , Turkey
| | - Şule Yıldırım Köpük
- a Department of Obstetrics and Gynecology , Health Sciences University Ümraniye Medical and Research Hospital , İstanbul , Turkey
| | - Gürkan Kıran
- a Department of Obstetrics and Gynecology , Health Sciences University Ümraniye Medical and Research Hospital , İstanbul , Turkey
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24
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Di Paola R, Garzon S, Giuliani S, Laganà AS, Noventa M, Parissone F, Zorzi C, Raffaelli R, Ghezzi F, Franchi M, Zaffagnini S. Are we choosing the correct FSH starting dose during controlled ovarian stimulation for intrauterine insemination cycles? Potential application of a nomogram based on woman's age and markers of ovarian reserve. Arch Gynecol Obstet 2018; 298:1029-1035. [PMID: 30242498 DOI: 10.1007/s00404-018-4906-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/12/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the potential application of a nomogram based on woman's age and ovarian reserve markers as a tool to optimize the follicle-stimulating hormone (FSH) starting dose in intrauterine insemination (IUI) cycles. METHODS We conducted a retrospective analysis enrolling 179 infertile women undergoing controlled ovarian stimulation (COS), followed by IUI. Each woman received an FSH starting dose according to clinical decision. After collecting data about COS and IUI procedures, we calculated the FSH starting dose according to the nomogram. The main outcomes measured were women's baseline characteristics, COS, and clinical outcomes. RESULTS The FSH starting dose calculated by the nomogram was significantly lower than the one actually prescribed (p < 0.001), in only 14.8% of the cycles nomogram calculated a higher starting dose. When gonadotropin dose was decreased during COS, and similarly in case of hyper-response (more than two follicles ≥ 16 mm retrieved), the FSH starting dose calculated by the nomogram would have been lower in most of the cases (81.8% and 48.8%, respectively). Conversely, when gonadotropin dose was increased during COS and in case of low ovarian response (no follicle ≥ 16 mm retrieved), the FSH starting dose calculated by the nomogram would have been lower in most of the cases (64.7% and 100%, respectively); in these groups median anti-Müllerian hormone (AMH) level was 5.62 ng/mL. CONCLUSIONS The application of this nomogram in IUI cycles would lead to a more tailored FSH starting dose and improved cost-effectiveness, although in PCOS women, particularly the ones with high AMH, it does not seem adequate.
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Affiliation(s)
- Rossana Di Paola
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy.
| | - Sara Giuliani
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, VA, Italy
| | - Marco Noventa
- Department of Woman and Child Health, University of Padua, Via Nicolò Giustiniani, 3, 35128, Padua, PD, Italy
| | - Francesca Parissone
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Carlotta Zorzi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, VA, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
| | - Stefano Zaffagnini
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, VR, Italy
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25
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Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting young women. Even though the definition of PCOS has changed over the years, all diagnostic criteria include two or more of the following: oligomenorrhea/oligoovulation/anovulation, androgen excess and polycystic ovaries (PCO). Traditional method of assessing the ovarian morphology has been transvaginal pelvic ultrasound. Recent studies support that serum anti-Mullerian hormone (AMH) levels correlate with the number of ovarian follicles and cysts. Hence, measurement of AMH is adequate to make the diagnosis. Traditionally, hyperandrogenemia has been assessed by measuring total-testosterone. The literature stresses the importance of sex hormone binding globulin (SHBG) measurements and bioavailable-testosterone and free-testosterone calculations, because insulin resistance decreases SHBG, lowers total-testosterone, and leads to under-estimation of bioavailable- and free-testosterone. Since 50-60% of PCOS patients have metabolic syndrome, assessment of metabolic risk is also necessary. It is important to diagnose insulin resistance before development of glucose intolerance and diabetes. This requires measurements of not only plasma glucose but also insulin concentrations. Determination of HgBA1 can be informative as well. This review aims to present an accurate and cost-effective approach to diagnosis and management of PCOS.
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Affiliation(s)
- Sidika E Karakas
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, The University of California at Davis, Davis, CA, United States; Department of Veterans Affairs Northern California Health Care System, Mather, CA, United States.
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Matsuzaki T, Munkhzaya M, Iwasa T, Tungalagsuvd A, Yano K, Mayila Y, Yanagihara R, Tokui T, Kato T, Kuwahara A, Matsui S, Irahara M. Relationship between serum anti-Mullerian hormone and clinical parameters in polycystic ovary syndrome. Endocr J 2017; 64:531-541. [PMID: 28381699 DOI: 10.1507/endocrj.ej16-0501] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is an ovulatory disorder that affects 6-10% of women of reproductive age. Serum AMH level may be an additional factor, or surrogate of PCOM, in the diagnostic criteria of PCOS. We evaluated the correlations between the serum AMH level and various endocrine and metabolic features in PCOS using the latest fully automated assay. Serum AMH level was compared between 114 PCOS patient (PCOS group) and 95 normal menstrual cycle women (Control group). Correlations between serum AMH level and various endocrine and metabolic factors were analysed in PCOS group. The serum AMH level was significantly higher in the PCOS group (8.35±8.19 ng/mL) than in the Control group (4.99±3.23 ng/mL). The serum AMH level was independently affected by age and the presence of PCOS on multiple regression analysis. Ovarian volume per ovary (OPVO) showed the strongest positive correlation (r=0.62) with the serum AMH level among related factors. On receiver operating characteristic (ROC) curve analysis, the cut-off value of AMH for the diagnosis of PCOS was 7.33 ng/mL, but this value did not have high efficacy (sensitivity 44.7%, specificity 76.8%). A cut-off value of 10 ng/mL had a high specificity of 92.6%, although the sensitivity was low (24.6%). The serum AMH level was elevated and reflected ovarian size in PCOS patients. The serum AMH level could be a surrogate for ultrasound findings of the ovaries in PCOS and might be useful for estimating ovarian findings without transvaginal ultrasound in the diagnosis of PCOS.
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Affiliation(s)
- Toshiya Matsuzaki
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Munkhsaikhan Munkhzaya
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Takeshi Iwasa
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Altankhuu Tungalagsuvd
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Kiyohito Yano
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Yiliyasi Mayila
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Rie Yanagihara
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Takako Tokui
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Takeshi Kato
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Akira Kuwahara
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Sumika Matsui
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Minoru Irahara
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
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27
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Kamel A, Ramadan W, Hussein AM, Dahab S, Elsherbini MM, Lasheen YS, Abu-Hamila F. Can AMH levels predict the need for increased medication during IVF/ICSI in PCOS women? J Matern Fetal Neonatal Med 2016; 31:32-38. [PMID: 27978775 DOI: 10.1080/14767058.2016.1272567] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the ability of anti-Mullerian hormone (AMH) to predict the step up of human menopausal gonadotropins (HMG) dose in women with polycystic ovarian syndrome (PCOS) undergoing IVF/ICSI cycles. METHODS AMH was drawn before ovulation induction in 976 PCOS women scheduled for IVF/ICSI. After all cycles ended, a receiver operating characteristic (ROC) curve analysis was done to investigate the ability of AMH to predict step up of the HMG. RESULTS The area under the curve (AUC) was 0.820 95%CI (0.792-0.848), and a cutoff value of 4.6 ng/ml (sensitivity 74%, specificity 82%) for AMH was taken (p < 0.01). Cases were divided into two groups retrospectively; group (A) (AMH ≤4.6 ng/ml), and group (B) (AMH >4.6 ng/ml). No difference in the mean age (p = 0.147); BMI (p = 0.411), basal FSH (p = 0.221), and starting dose (p = 0.195); however, the dose at which the first response occurred was higher in group (B) (p < 0.01). The total dose and number of days were higher in group (B) (both p < 0.01) irrespective of the PCOS subtype or androgen levels. Severe OHSS was also higher in group (B) (p = 0.026). CONCLUSIONS PCOS with AMH >4.6 ng/ml are resistant to HMG stimulation, require dose step up during ART cycles, and are at higher risk for severe OHSS.
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Affiliation(s)
- Ahmed Kamel
- a Obstetrics and Gynecology department , Cairo University , Cairo , Egypt
| | - Wafaa Ramadan
- a Obstetrics and Gynecology department , Cairo University , Cairo , Egypt
| | - Ahmed M Hussein
- a Obstetrics and Gynecology department , Cairo University , Cairo , Egypt
| | - Sherif Dahab
- a Obstetrics and Gynecology department , Cairo University , Cairo , Egypt
| | | | - Yossra S Lasheen
- a Obstetrics and Gynecology department , Cairo University , Cairo , Egypt
| | - Fouad Abu-Hamila
- a Obstetrics and Gynecology department , Cairo University , Cairo , Egypt
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28
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Lauritsen MP, Loft A, Pinborg A, la Cour Freiesleben N, Cohen A, Petersen JH, Mikkelsen AL, Bjerge MR, Nyboe Andersen A. Individualised gonadotrophin ovulation induction in women with normogonadotrophic anovulatory infertility: A prospective, observational study. Eur J Obstet Gynecol Reprod Biol 2016; 210:76-82. [PMID: 27960134 DOI: 10.1016/j.ejogrb.2016.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/30/2016] [Accepted: 12/08/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate an individualised gonadotrophin starting dose regimen for women with anovulatory infertility. STUDY DESIGN We included 71 normogonadotrophic anovulatory infertile women in a prospective, observational study. All underwent one ovulation induction cycle in a flexible, low-dose step-up protocol. The gonadotrophin starting dose (75-150IU/day) was individualised according to a nomogram incorporating menstrual cycle pattern (oligo- or amenorrhoea), BMI, and mean ovarian volume. The number of women who fulfilled the criteria for human chorionic gonadotrophin (hCG) administration (one follicle ≥17mm or 2-3 follicles ≥15mm) was assessed. RESULTS Of the 50 women (70.4%) who fulfilled the hCG criteria and underwent intrauterine insemination, 34 (47.9%) achieved monofollicular growth and 16 (22.5%) developed 2-3 mature follicles. Seventeen (23.9%) cycles were converted to in vitro fertilisation (IVF) due to the development of >3 mature follicles, and one (1.4%) cycle was cancelled due to risk of ovarian hyperstimulation syndrome. Baseline total antral follicle count was found to be significantly associated with fulfillment of the hCG criteria (OR 0.96, 95% CI: 0.92-0.99, P=0.01). CONCLUSIONS The nomogram-based dose regimen was not considered suitable for ovulation induction due to a tendency to overestimate the gonadotrophin starting dose. However, the model may serve as a mild IVF regimen, especially in women prone to excessive follicle growth.
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Affiliation(s)
- Mette Petri Lauritsen
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
| | - Anne Loft
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Anja Pinborg
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; The Fertility Clinic, Department of Obstetrics and Gynaecology, Hvidovre Hospital, 2650 Hvidovre, Denmark
| | - Nina la Cour Freiesleben
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Arieh Cohen
- Department of Clinical Biochemistry and Immunology, Statens Serum Institute, 2300 Copenhagen, Denmark
| | | | - Anne Lis Mikkelsen
- The Fertility Clinic, Department of Gynaecology and Obstetrics, Holbæk Hospital, 4300 Holbæk, Denmark
| | - Marianne Rich Bjerge
- The Fertility Clinic, Department of Gynaecology and Obstetrics, Holbæk Hospital, 4300 Holbæk, Denmark
| | - Anders Nyboe Andersen
- The Fertility Clinic, Section 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
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29
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Mumford SL, Legro RS, Diamond MP, Coutifaris C, Steiner AZ, Schlaff WD, Alvero R, Christman GM, Casson PR, Huang H, Santoro N, Eisenberg E, Zhang H, Cedars MI. Baseline AMH Level Associated With Ovulation Following Ovulation Induction in Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2016; 101:3288-96. [PMID: 27228369 PMCID: PMC5010565 DOI: 10.1210/jc.2016-1340] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Anti-Müllerian hormone (AMH) reduces aromatase activity and sensitivity of follicles to FSH stimulation. Therefore, elevated serum AMH may indicate a higher threshold for response to ovulation induction in women with polycystic ovary syndrome (PCOS). OBJECTIVE This study sought to determine the association between AMH levels and ovulatory response to treatment among the women enrolled into the Pregnancy in PCOS II (PPCOS II) trial. DESIGN AND SETTING This was a secondary analysis of data from a randomized clinical trial in academic health centers throughout the United States Participants: A total of 748 women age 18-40 years, with PCOS and measured AMH levels at baseline, were included in this study. MAIN OUTCOME MEASURES Couples were followed for up to five treatment cycles to determine ovulation (midluteal serum progesterone > 5 ng/mL) and the dose required to achieve ovulation. RESULTS A lower mean AMH and AMH per follicle was observed among women who ovulated compared with women who never achieved ovulation during the study (geometric mean AMH, 5.54 vs 7.35 ng/mL; P = .0001; geometric mean AMH per follicle, 0.14 vs 0.18; P = .01) after adjustment for age, body mass index, T, and insulin level. As AMH levels increased, the dose of ovulation induction medication needed to achieve ovulation also increased. No associations were observed between antral follicle count and ovulation. CONCLUSIONS These results suggest that high serum AMH is associated with a reduced response to ovulation induction among women with PCOS. Women with higher AMH levels may require higher doses of medication to achieve ovulation.
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Affiliation(s)
- Sunni L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Richard S Legro
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Michael P Diamond
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Christos Coutifaris
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Anne Z Steiner
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - William D Schlaff
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Ruben Alvero
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Gregory M Christman
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Peter R Casson
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Hao Huang
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Nanette Santoro
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Esther Eisenberg
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Heping Zhang
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
| | - Marcelle I Cedars
- Epidemiology Branch, Division of Intramural Population Health Research (S.L.M.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Department of Obstetrics and Gynecology (R.S.L.), Pennsylvania State University, Hershey, Pennsylvania; Department of Obstetrics and Gynecology (M.P.D.), Augusta University, Augusta, Georgia; Department of Obstetrics and Gynecology (C.C.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology (A.Z.S.), University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology (R.A., N.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology (G.M.C.), University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology (P.R.C.), University of Vermont, Burlington, Vermont; Department of Biostatistics (H.H., H.Z.), Yale University School of Public Health, New Haven, Connecticut; Fertility and Infertility Branch (E.E.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; and Department of Obstetrics, Gynecology and Reproductive Sciences (M.I.C.), University of California-San Francisco, San Francisco, California
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Mahran A. The relationship between Anti-müllerian hormone and the clinical, biochemical and sonographic parameters in women with polycystic ovarian syndrome. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2015.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Xi W, Yang Y, Mao H, Zhao X, Liu M, Fu S. Circulating anti-mullerian hormone as predictor of ovarian response to clomiphene citrate in women with polycystic ovary syndrome. J Ovarian Res 2016; 9:3. [PMID: 26864649 PMCID: PMC4750253 DOI: 10.1186/s13048-016-0214-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the impact of high circulating AMH on the outcome of CC ovulation induction in women with PCOS. METHODS This prospective cohort observational study included 81 anovulatory women with PCOS who underwent 213 cycles of CC ovarian stimulation. Serum AMH concentrations were measured on cycle day 3 before the commencement of CC in the first cycle, which were compared between responders and CC-resistant anovulation (CRA). Logistic regression analysis was applied to study the value of serum AMH for the prediction of ovarian responsiveness to CC stimulation. The receiver-operating characteristic (ROC) curve was used to evaluate the prognostic value of circulating AMH. MAIN OUTCOME MEASURES Serum AMH levels. RESULTS Women who ovulated after CC therapy had a significantly lower AMH compared with the CRA (5.34 ± 1.97 vs.7.81 ± 3.49, P < 0.001). There was a significant gradient increase of serum AMH levels with the increasing dose of CC required to achieve ovulation (P < 0.05). In multivariate logistic regression analysis, AMH was an independent predictor of ovulation induction by CC in PCOS patients. ROC curve analysis showed AMH to be a useful predictor of ovulation induction by CC in PCOS patients, having 92 % specificity and 65 % sensitivity when the threshold AMH concentration was 7.77 ng/ml. CONCLUSION Serum AMH may be clinically useful to predict which PCOS women are more likely to respond to CC treatment and thus to direct the selection of protocols of ovulation induction.
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Affiliation(s)
- Wenyan Xi
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an City, 710004, Shaanxi Prov., China.
| | - Yongkang Yang
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang City, 712000, Shaanxi Prov., China.
| | - Hui Mao
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an City, 710004, Shaanxi Prov., China.
| | - Xiuhua Zhao
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an City, 710004, Shaanxi Prov., China.
| | - Ming Liu
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an City, 710004, Shaanxi Prov., China.
| | - Shengyu Fu
- Department of Obstetrics and Gynaecology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an City, 710004, Shaanxi Prov., China
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Vaiarelli A, Drakopoulos P, Blockeel C, De Vos M, van de Vijver A, Camus M, Cosyns S, Tournaye H, Polyzos NP. Limited ability of circulating anti-Müllerian hormone to predict dominant follicular recruitment in PCOS women treated with clomiphene citrate: a comparison of two different assays. Gynecol Endocrinol 2016; 32:227-30. [PMID: 26559558 DOI: 10.3109/09513590.2015.1110138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The present retrospective cohort study was conducted to investigate whether serum anti-Müllerian hormone (AMH) levels, determined by either the Immunotech (IOT) or the second generation (Gen II) assay, can predict follicular recruitment in women with polycystic ovary syndrome (PCOS) undergoing ovulation induction with clomiphene citrate (CC). Patients received 50 mg CC daily for ovulation induction followed by natural intercourse or intrauterine insemination. Overall, 84 women had their serum AMH levels tested before treatment [42 patients with Immunotech (IOT), and 42 patients with the Gen II assay]. The primary outcome was to determine dominant follicle (>10 mm) recruitment in relation to AMH levels. Thirty-three (79%) patients in the IOT and 34 (81%) patients in the Gen II assay group developed a dominant follicle within 15 days after initiation of CC. Circulating AMH levels did not differ between women with or without dominant follicular recruitment in the both groups. By using either the AMH IOT or the Gen II assay, serum AMH levels were not predictive of the development of a dominant follicle. In conclusion, serum AMH levels measured by IOT or Gen II assay, has limited value to predict PCOS patients who will develop a dominant follicle following ovulation induction with CC.
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Affiliation(s)
- Alberto Vaiarelli
- a Centre for Reproductive Medicine , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium
| | - Panagiotis Drakopoulos
- a Centre for Reproductive Medicine , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium
| | - Christophe Blockeel
- a Centre for Reproductive Medicine , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium
| | - Michel De Vos
- a Centre for Reproductive Medicine , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium
| | - Arne van de Vijver
- a Centre for Reproductive Medicine , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium
| | - Michel Camus
- a Centre for Reproductive Medicine , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium
| | - Stefan Cosyns
- a Centre for Reproductive Medicine , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium
| | - Herman Tournaye
- a Centre for Reproductive Medicine , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium
| | - Nikolaos P Polyzos
- a Centre for Reproductive Medicine , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium
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Rocca ML, Venturella R, Mocciaro R, Zullo F, Morelli M. Will emerging pharmacotherapies improve the management of polycystic ovarian syndrome? Expert Opin Emerg Drugs 2015; 21:1-4. [PMID: 26667609 DOI: 10.1517/14728214.2016.1132701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Morena Luigia Rocca
- a Unit of Obstetrics and Gynaecology, Department of Experimental and Clinical Medicine , 'Magna Graecia' University , Catanzaro , Italy
| | - Roberta Venturella
- a Unit of Obstetrics and Gynaecology, Department of Experimental and Clinical Medicine , 'Magna Graecia' University , Catanzaro , Italy
| | - Rita Mocciaro
- a Unit of Obstetrics and Gynaecology, Department of Experimental and Clinical Medicine , 'Magna Graecia' University , Catanzaro , Italy
| | - Fulvio Zullo
- a Unit of Obstetrics and Gynaecology, Department of Experimental and Clinical Medicine , 'Magna Graecia' University , Catanzaro , Italy
| | - Michele Morelli
- a Unit of Obstetrics and Gynaecology, Department of Experimental and Clinical Medicine , 'Magna Graecia' University , Catanzaro , Italy
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[Does the serum AMH assay allow predicting reliably female fertility?]. ACTA ACUST UNITED AC 2015; 43:670-5. [PMID: 26388252 DOI: 10.1016/j.gyobfe.2015.08.004] [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: 07/22/2015] [Accepted: 08/19/2015] [Indexed: 11/22/2022]
Abstract
In women, the anti-Müllerian hormone (AMH) is secreted by the granulosa cells of growing follicles. Its measurement is strongly correlated with antral follicle count and represents a reliable marker of ovarian reserve. It also has the advantage of being highly reproducible since it has little variation within and between cycles. However, although it seems to be a good quantitative reflection of the ovarian reserve, it does not assess the oocyte quality. This drawback precludes any good prediction of female fertility in the general population. However, the AMH assay can become an indirect marker of female fertility in some situations at risk for premature ovarian failure or in the polycystic ovary syndrome. Its interest is no more to be proven in assisted reproductive technology where it is a valuable aid to the choice of the proposed techniques, ovarian stimulation protocols and gonadotropin doses. AMH is finally very informative in monitoring cancer patients having received ovariotoxic drugs or having undergone mutilating ovarian surgeries. In conclusion, although it cannot be considered itself as a reliable predictor of pregnancy in women, AMH is now a must in the management and treatment of female infertility.
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Kriseman M, Mills C, Kovanci E, Sangi-Haghpeykar H, Gibbons W. Antimullerian hormone levels are inversely associated with body mass index (BMI) in women with polycystic ovary syndrome. J Assist Reprod Genet 2015; 32:1313-6. [PMID: 26238387 DOI: 10.1007/s10815-015-0540-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/14/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE The purpose of this paper is to determine whether antimullerian hormone (AMH) levels were associated with BMI in patients with diagnosed infertility, and more specifically, in patients with polycystic ovarian syndrome (PCOS). METHODS A retrospective cohort study reviewed all females who presented to the clinical investigators' practice between November 2011 and March 2013. The following data was retrieved from the medical record: (1) AMH level, (2) age, (3) BMI, (4) ethnicity, and (5) if infertile, etiology of infertility. RESULTS AMH levels were available for 489 women. Of these, 104 were diagnosed with PCOS. Overall, there was no association between BMI and AMH (r -0.04, p > 0.05). On the other hand, in the women with PCOS, there was a significant association between BMI and AMH (r -0.31, p < 0.01). CONCLUSIONS BMI was not associated with AMH levels in the general population of infertile women or in patients without PCOS. However, BMI appeared to be significantly and inversely correlated with AMH in women with PCOS.
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Affiliation(s)
- Maya Kriseman
- Reproductive Endocrinology and Infertility, Baylor College of Medicine, 6651 Main St, Houston, TX, 77030, USA.
| | - Charity Mills
- Reproductive Endocrinology and Infertility, Baylor College of Medicine, 6651 Main St, Houston, TX, 77030, USA
| | - Ertug Kovanci
- Reproductive Endocrinology and Infertility, Baylor College of Medicine, 6651 Main St, Houston, TX, 77030, USA
| | - Haleh Sangi-Haghpeykar
- Reproductive Endocrinology and Infertility, Baylor College of Medicine, 6651 Main St, Houston, TX, 77030, USA
| | - William Gibbons
- Reproductive Endocrinology and Infertility, Baylor College of Medicine, 6651 Main St, Houston, TX, 77030, USA
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Fleming R, Seifer DB, Frattarelli JL, Ruman J. Assessing ovarian response: antral follicle count versus anti-Müllerian hormone. Reprod Biomed Online 2015; 31:486-96. [PMID: 26283017 DOI: 10.1016/j.rbmo.2015.06.015] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/27/2015] [Accepted: 06/23/2015] [Indexed: 11/29/2022]
Abstract
Oocyte number and quality decline with age; however, fertility varies significantly even among women of the same age. Various measures have been developed to predict response to ovarian stimulation and reproductive potential. Evaluation of ovarian reserve can identify patients who may experience poor response or hyper-response to exogenous gonadotrophins and can aid in the personalization of treatment to achieve good response and minimize risks. In recent years, two key methods, antral follicle count (AFC), an ultrasound biomarker of follicle number, and the concentration of serum anti-Müllerian hormone (AMH), a hormone biomarker of follicle number, have emerged as preferred methods for assessing ovarian reserve. In this review, a live debate held at the American Society for Reproductive Medicine 2013 Annual Meeting is expanded upon to compare the predictive values, merits, and disadvantages of AFC and AMH level. An ovarian reserve measure without limitations has not yet been discovered, although both AFC and AMH have good predictive value. Published evidence, however, as well as the objectivity and potential standardization of AMH level and the convenience of testing any time throughout the menstrual cycle, leans towards AMH level becoming the gold-standard biomarker to evaluate ovarian reserve and predict ovarian response to stimulation.
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Affiliation(s)
- Richard Fleming
- Glasgow Centre for Reproductive Medicine, 21 Fifty Pitches Way, Gardonald Business Park, Glasgow G51-4FD, UK.
| | - David B Seifer
- Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - John L Frattarelli
- Fertility Institute of Hawaii, 1401 South Beretania St, Suite 250, Honolulu, HI 96814, USA
| | - Jane Ruman
- Ferring Pharmaceuticals, Inc, 100 Interpace Pkwy, Parsippany, NJ 07054, USA
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Maas KH, Chuan SS, Cook-Andersen H, Su HI, Duleba A, Chang RJ. Relationship between 17-hydroxyprogesterone responses to human chorionic gonadotropin and markers of ovarian follicle morphology in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2015; 100:293-300. [PMID: 25313914 PMCID: PMC4283019 DOI: 10.1210/jc.2014-2956] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Women with polycystic ovary syndrome (PCOS) have increased 17-hydroxyprogesterone (17-OHP) responses to gonadotropin stimulation although individual variability is substantial, as reflected by exaggerated as well as normal responses. The relationship between 17-OHP responses to gonadotropin stimulation and markers of ovarian function has not been assessed. OBJECTIVE To determine whether 17-OHP responses are associated with antral follicle count (AFC), anti-Mullerian hormone (AMH), or inhibin B (Inh B) levels in PCOS and normal women. DESIGN Prospective study. SETTING Research center at an academic medical center. PARTICIPANTS Women with PCOS (n = 18) and normal controls (n = 18). INTERVENTIONS Blood samples were obtained before and 24 hours after administration of 25 μg recombinant-human chorionic gonadotropin. Ovarian imaging was conducted with three-dimensional pelvic ultrasound. MAIN OUTCOME MEASURES Basal and stimulated levels of 17-OHP, androgens, estrogen, AMH, Inh B, and AFC. RESULTS In women with PCOS, 17-OHP responses were heterogeneous and inversely correlated with AMH and Inh B levels, but not AFC. In a subgroup of PCOS women with exaggerated 17-OHP responses, AMH levels were equivalent to that of normal women. In PCOS women with normal 17-OHP responses, AMH levels were markedly elevated. CONCLUSION Based on heterogeneous 17-OHP responses to human chorionic gonadotropin in women with PCOS, AMH levels are inversely linked to ovarian androgen production while positively correlated with AFC. These findings suggest that in PCOS, AMH production may reflect redistribution of the follicle population or regulation by intraovarian mechanisms.
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Affiliation(s)
- Kevin H Maas
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, California 92093
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Kim JY, Yi G, Kim YR, Chung JY, Ahn JH, Uhm YK, Jee BC, Suh CS, Kim SH. Association between serum anti-Müllerian hormone level and ovarian response to mild stimulation in normoovulatory women and anovulatory women with polycystic ovary syndrome. Clin Exp Reprod Med 2013; 40:95-9. [PMID: 23875166 PMCID: PMC3714435 DOI: 10.5653/cerm.2013.40.2.95] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/30/2013] [Accepted: 06/03/2013] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To evaluate the correlation between serum levels of anti-Müllerian hormone (AMH) and ovarian response to mild stimulation in normoovulatory women and anovulatory women with polycystic ovary syndrome (PCOS). METHODS Seventy-four cycles of mild stimulation (clomiphene citrate+gonadotropin followed by timed intercourse or intrauterine insemination) performed in normoovulatory women (57 cycles) and anovulatory women with PCOS (17 cycles). Ovarian sensitivity was defined by the number of mature follicles (≥14 mm) on triggering day per 100 IU of gonadotropin. A correlation between ovarian sensitivity and the baseline serum AMH level (absolute or multiples of the median [MoM] value for each corresponding age) was calculated. Correlation between ovarian response and serum AMH level was evaluated. RESULTS Ovarian sensitivity to mild stimulation was positively correlated with absolute serum AMH (r=0.535, p<0.001) or AMH-MoM value (r=0.390, p=0.003) in normoovulatory women, but this correlation was not observed in anovulatory women with PCOS (r=0.105, p>0.05, r=-0.265, p>0.05, respectively). CONCLUSION Ovarian response to mild stimulation is possibly predicted by the serum AMH level in normoovulatory women, but not in anovulatory women with PCOS.
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Affiliation(s)
- Ju Yeong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gwang Yi
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeo Rang Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Jae Yeon Chung
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Ji Hyun Ahn
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - You Kyoung Uhm
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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