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Erdogan-Yildirim Z, Carlson JC, Krishnan M, Zhang JZ, Lambert-Messerlian G, Naseri T, Viali S, Hawley NL, McGarvey ST, Weeks DE, Minster RL. A genome-wide association study of anti-Müllerian hormone (AMH) levels in Samoan women. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.12.05.24318457. [PMID: 39677481 PMCID: PMC11643216 DOI: 10.1101/2024.12.05.24318457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2024]
Abstract
Study question Can a genome-wide association study (GWAS) and transcriptome-wide association study (TWAS) help identify genetic variation or genes associated with circulating anti-Müllerian hormone (AMH) levels in Samoan women? Summary answer We identified eleven genome-wide suggestive loci (strongest association signal in ARID3A 19-946163-G-C [ p = 2.32 × 10⁻⁷]) and seven transcriptome-wide significant genes ( GINS2, SENP3, USP7, TUSC3, MAFA, METTL4, NDFIP1 [all with a p < 2.50 × 10⁻⁶]) associated with circulating AMH levels in Samoan women. What is known already Three prior GWASs of AMH levels identified eight loci in premenopausal women of European ancestry (AMH, MCM8, TEX41 , CHECK2, CDCA7 , EIF4EBP1, BMP4 and an uncharacterized non-coding RNA gene CTB-99A3.1 ), among which the MCM8 locus was shared among all three studies. Study design size duration We included a sample of 1,185 women from two independently recruited samples: a family study ( n = 212; [age: 18 to 40 years]) recruited in 2002-03 from Samoa and American Samoa; and the Soifua Manuia Study ( n = 973; age: 25 to 51 years), a crosssectional population-based study recruited in 2010 from Samoa. Participants/materials setting methods Serum AMH levels were measured using enzyme linked immunosorbent assays (ELISA). We performed GWASs in the two participant samples using a Cox mixed-effects model to account for AMH levels below detectable limits and adjusted for centered age, centered age², polity, and kinship via kinship matrix. The summary statistics were then meta-analyzed using a fixed-effect model. We annotated the variants with p < 1 × 10⁻⁵ and calculated posterior probability of causality for prioritization. We further annotated variants using FUMA and performed colocalization and transcriptome-wide association analysis. We also assessed whether any previously reported loci were replicated in our GWAS. Main results and the role of chance We identified eleven novel genome-wide suggestive loci ( p < 1 × 10⁻⁵) associated with AMH levels and replicated EIF4EBP1, a previously reported AMH locus, in the GWAS. The lead variant in ARID3A , 19-946163-G-C is in high linkage disequilibrium ( r ² = 0.79) with the known age-at-menopause variant 19-950694-G-A. Nearby KISS1R is a biologically plausibility causal gene in the region; kisspeptin regulates ovarian follicle development and has been linked to AMH levels. Further investigation of the ARID3A locus is warranted. Limitations reasons for caution The main limitations of our study are the small sample size for a GWAS and the use of the transcription model trained on mostly European samples from the Genotype Tissue Expression (GTEx) project, which may have led to reduced power to detect genotype-expression associations. Our findings need to be validated in larger Polynesian cohorts. Wider implications of the findings In addition to replicating one of the eight previously discovered AMH loci, we identified new suggestive associations. It is known that the inclusion of founder populations aids in the discovery of novel loci. These findings could enhance our understanding of AMH and AMH-related reproductive phenotypes (ovarian reserve, age at menopause, premature ovarian failure, and polycystic ovary syndrome) and help build a screening approach for women at risk for these phenotypes using genetically predicted AMH levels. Study funding/competing interests This work was funded by NIH grants R01-HL093093 (PI: S.T.M.), R01-HL133040 (PI: R.L.M.), and T90-DE030853 (PI: C.S. Sfeir). Molecular data for the Trans-Omics in Precision Medicine (TOPMed) Program was supported by the National Heart, Lung and Blood Institute (NHLBI). The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.
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Vural F, Vural B, Kardaş E, Ertürk Coşkun AD, Yildirim İ. The diagnostic performance of antimullerian hormone for polycystic ovarian syndrome and polycystic ovarian morphology. Arch Gynecol Obstet 2023; 307:1083-1090. [PMID: 36565362 DOI: 10.1007/s00404-022-06874-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/29/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE The diagnosis of polycystic ovary syndrome (PCOS) remains a challenge to clinicians due to heterogeneous clinical presentation and diagnostic criteria. This study investigated the utilization of Anti-Müllerian hormone (AMH) alone or replacing polycystic ovarian morphology (PCOM) in the PCOS diagnostic criteria. METHODS A total of 401 women were categorised as PCOS (n:154), nonPCOS with polycystic ovarian morphology (PCOM) (n:105), and nonPCOS with normal ovarian morphology (NOM) (n:142). First, the diagnostic performance of AMH for PCOS diagnosis in Rotterdam, Androgen Excess Society, and National Institutes of Health (NIH) criteria was analyzed. Second, AMH was used instead of PCOM in Rotterdam criteria and we searched diagnostic performance for PCOS phenotypes. RESULTS AMH levels were positively correlated with LH, testosterone, hirsutism score, menstrual cycle length, and antral follicle count (p < 0.05). AMH alone had specificity and sensitivity for PCOS diagnosis were 84.9% and 72.4% in Rotterdam (AUC: 0.866); 84.4% and 72% in Androgen Excess Society (AUC: 0.857); 83.3% and 66.4% in National Institute of Health criteria (AUC: 0.825). AMH alone had satisfactory diagnostic potential for phenotype A, but not other phenotypes. The replacement of PCOM with AMH in Rotterdam criteria had a high diagnostic potential for PCOS (AUC: 0.934, sensitivity:97.4%, specificity: 90.67%). Phenotype A and phenotype D were diagnosed with 100% sensitivity and 94.5% specificity. Phenotype C was recognised with 96.15% sensitivity and 94.5% specificity. CONCLUSION AMH may be used with high diagnostic accuracy instead of PCOM in the Rotterdam PCOS criteria.
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Affiliation(s)
- Fisun Vural
- Obstetrics and Gynecology Department, University of Health Sciences, Hamidiye Medical Faculty, Haydarpaşa Numune Training and Research Hospital, Tıbbiye Cad.No:40, 34668, Istanbul, Turkey.
| | - Birol Vural
- Obstetrics and Gynecology, IVF Center, BV Clinic, Istanbul, Turkey
| | - Eyupcan Kardaş
- Obstetric and Gynecology, Tuzla State Hospital, Istanbul, Turkey
| | - Ayşe Deniz Ertürk Coşkun
- Obstetric and Gynecology Department, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - İrem Yildirim
- Obstetric and Gynecology Department, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
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Oueslati I, Hammami MB, Boukriba S, Ben Hadj Hassen H, Yazidi M, Chaker F, Mizouni H, Feki M, Chihaoui M. Anti Mullerian hormone as a diagnostic tool for polycystic ovary syndrome in women of reproductive age with morbid obesity. Horm Mol Biol Clin Investig 2022; 43:381-387. [PMID: 35506902 DOI: 10.1515/hmbci-2021-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/25/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of the study was to analyze the performance of the anti-mullerian hormone (AMH) level for the diagnosis of polycystic ovary syndrome in women with morbid obesity. STUDY DESIGN A single-centre cross-sectional study was conducted in 50 women of reproductive age with a body mass index (BMI) ≥ 40 kg/m2. Each patient underwent a clinical examination, biological and hormonal assays, and an ovarian ultrasound between the third and the fifth day of the menstrual cycle. Polycystic ovary syndrome was diagnosed according to the Rotterdam's criteria. RESULTS The mean age of participants was 34.2 ± 7.5 years. Polycystic ovary syndrome was diagnosed in 20 women (40%). Age and anthropometric parameters did not differ between women with and without polycystic ovary syndrome. The mean AMH level was significantly higher in women with polycystic ovary syndrome (3.4 ± 3.6 vs 1.3 ± 1.2 ng/ml, p=0.010). It was positively correlated with the Ferriman and Gallwey score (r=0.496, p=0.016), total testosterone level (r=0.524, p < 10-3) and the LH/FSH ratio (r=0.290, p=0.046). In women aged between 35 and 45 years, the optimum cut-off level for the diagnosis of polycystic ovary syndrome was 0.81 ng/mL, providing a sensitivity and a specificity of 90 and 71%, respectively with an area under the ROC curve of 0.857. CONCLUSIONS AMH level was significantly higher in morbid obese women with polycystic ovary syndrome compared with those without polycystic ovary syndrome. Specific thresholds for this population must be assessed to improve the sensitivity and specificity of AMH for the diagnosis of polycystic ovary syndrome.
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Affiliation(s)
- Ibtissem Oueslati
- Department of endocrinology, Faculty of medicine, La Rabta university hospital, University of Tunis-El Manar, Tunis, Tunisia
| | - Mohamed Bassem Hammami
- Laboratory of biochemistry, Faculty of medicine, La Rabta university hospital, University of Tunis-El Manar, Tunis, Tunisia
| | - Seif Boukriba
- Department of radiology, Faculty of medicine, La Rabta university hospital, University of Tunis-El Manar, Tunis, Tunisia
| | - Hana Ben Hadj Hassen
- Department of endocrinology, Faculty of medicine, La Rabta university hospital, University of Tunis-El Manar, Tunis, Tunisia
| | - Meriem Yazidi
- Department of endocrinology, Faculty of medicine, La Rabta university hospital, University of Tunis-El Manar, Tunis, Tunisia
| | - Fatma Chaker
- Department of endocrinology, Faculty of medicine, La Rabta university hospital, University of Tunis-El Manar, Tunis, Tunisia
| | - Habiba Mizouni
- Department of radiology, Faculty of medicine, La Rabta university hospital, University of Tunis-El Manar, Tunis, Tunisia
| | - Moncef Feki
- Laboratory of biochemistry, Faculty of medicine, La Rabta university hospital, University of Tunis-El Manar, Tunis, Tunisia
| | - Melika Chihaoui
- Department of endocrinology, Faculty of medicine, La Rabta university hospital, University of Tunis-El Manar, Tunis, Tunisia
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Kazeminia M, Rajati F, Rajati M. The effect of exercise on anti-Mullerian hormone levels in patients with polycystic ovary syndrome: a systematic review and meta-analysis. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2022. [DOI: 10.1186/s43043-022-00121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Polycystic ovary syndrome (PCOS) is considered as the most common endocrinopathy among women of childbearing age and the most important cause of anovulatory infertility. The present study aimed to estimate the pooled effect of exercise on anti-Mullerian hormone (AMH) levels in PCOS women using systematic review and meta-analysis.
Main body
The present study was conducted according to the PRISMA guidelines from 2011 to October 2021. All published studies, which met the inclusion criteria, were searched in SID, MagIran, Embase, PubMed, Scopus, Web of Science (WoS) databases, and Google Scholar motor engine using related MeSH/Emtree terms, which were combined with free text word. Finally, 12 articles were included in the meta-analysis. As a result of the combination of the studies, after exercise, AMH level in the intervention group significantly decreased up to 0.517 ± 0.169 more than that in the control group (P ˂ 0.05). The results of subgroup analysis demonstrated that the effect of resistance training for 16 weeks was higher on women with body mass index (BMI) (≥ 25 kg/m2) and AMH (≥ 10 ng/mL) before the intervention. GRADEpro software was used to grade the level of evidence.
Conclusion
This systematic review and meta-analysis showed that either strength exercise or aerobic exercise decrease the AMH level in PCOS women. It seems more duration of the exercise has a more potential advantage to reduce the AMH levels in women with PCOS. Although the results graded by very low-quality evidence, it is recommended to include exercise in the treatment programs of PCOS patients.
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Le NSV, Le MT, Nguyen ND, Tran NQT, Nguyen QHV, Cao TN. A Cross-Sectional Study on Potential Ovarian Volume and Related Factors in Women with Polycystic Ovary Syndrome from Infertile Couples. Int J Womens Health 2021; 13:793-801. [PMID: 34512036 PMCID: PMC8412837 DOI: 10.2147/ijwh.s329082] [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: 07/12/2021] [Accepted: 08/15/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This study was designed to explore the value of ovarian volume (OV) measured by transvaginal ultrasound and its relationship with anthropometry and serum hormonal levels in a polycystic ovary syndrome (PCOS) population. Patients and Methods A total of 119 women with PCOS from infertile couples were recruited in this cross-sectional study. On days 2-4 of the menstrual cycle, transvaginal ultrasound examinations were performed, and hormonal profiles were measured. PCOS diagnosis was based on the Rotterdam 2003 criteria and classified into four phenotype groups. The PCOS group (study group) and the non-PCOS group (control group) were compared. Results The mean age of the participants was 32.66±4.10 years compared to 33.99±4.78 years in 273 cases (69.6%) without PCOS. The mean OV was statistically larger in the PCOS group than in the non-PCOS group (7.65±3.23 mL vs 6.08±3.67 mL, p < 0.001) and positively correlated with serum anti-Mullerian (AMH) and luteinizing hormone (LH) levels (r=0.30; p < 0.001 and r=0.23; p < 0.001, respectively), and weakly and inversely correlated with age (-0.182, p < 0.001). The area under the receiver operating characteristic (ROC) curve of OV in the diagnosis of PCOS was 0.613 (0.557-0.670, 95% CI). Conclusion The enlarged OV is remarkable in women with PCOS and is related to AMH and LH concentrations. Although the diagnostic potential of PCOS is substantially low, OV alone may contribute to predicting the severity of PCOS and better performance for the diagnosis of PCOS phenotypes.
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Affiliation(s)
- Nguyen Sa Viet Le
- Department of Assisted Reproduction, Hue Central Hospital, Hue, Vietnam.,Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Minh Tam Le
- Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.,Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Nguyen Dac Nguyen
- Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.,Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Nhu Quynh Thi Tran
- Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Quoc Huy Vu Nguyen
- Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thanh Ngoc Cao
- Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.,Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
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Vagios S, James KE, Sacha CR, Hsu JY, Dimitriadis I, Bormann CL, Souter I. A patient-specific model combining antimüllerian hormone and body mass index as a predictor of polycystic ovary syndrome and other oligo-anovulation disorders. Fertil Steril 2020; 115:229-237. [PMID: 33077236 DOI: 10.1016/j.fertnstert.2020.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/13/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine whether a patient-specific predictive model combining antimüllerian hormone (AMH) levels and body mass index (BMI) can aid in the diagnosis of polycystic ovary syndrome (PCOS) and other ovulatory dysfunction disorders (OVDYS) among infertile women. DESIGN Retrospective cohort study. SETTING Academic fertility center. PATIENT(S) One thousand and ten infertile women undergoing 3,160 intrauterine insemination (IUI) cycles, stratified by diagnosis in three groups: PCOS, OVDYS, and other etiologies. INTERVENTION(S) Ovulation induction followed by IUI or ultrasound-monitored natural cycles. MAIN OUTCOME MEASURE(S) The probability of either PCOS or OVDYS diagnosis based on AMH levels alone and a patient-specific predictive model that combines serum AMH and patient's BMI. RESULT(S) Median and interquartile range (IQR) for the serum AMH levels (ng/mL) were the highest in women with PCOS, and lowest in those with other infertility causes. Overall, for every 1 ng/mL increase in AMH, the odds of PCOS and OVDYS versus other causes increased by 55% and 24%, respectively. Postestimation from multivariate logistic regression models showed that PCOS diagnosis can be predicted with lower AMH values in women with a higher BMI compared with the AMH values predicting PCOS in normal-weight or underweight patients. The receiver operating characteristic curves reinforced these findings, and the best cutoffs for PCOS diagnosis were 7.5, 4.4, and 4.1 ng/mL for women belonging to the BMI groups 18.5-24.9, 25.0-29.9, and ≥30.0 kg/m2, respectively. CONCLUSION(S) Taking into account AMH and BMI, we developed a model that predicts the probability of an oligo-anovulation diagnosis, thus facilitating patient-specific counseling in the infertility setting.
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Affiliation(s)
- Stylianos Vagios
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Kaitlyn E James
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Caitlin R Sacha
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jennifer Y Hsu
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Irene Dimitriadis
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charles L Bormann
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Shi X, Peng D, Liu Y, Miao X, Ye H, Zhang J. Advantages of Serum Anti-Müllerian Hormone as a Marker for Polycystic Ovarian Syndrome. Lab Med 2019; 50:236-242. [PMID: 30535164 DOI: 10.1093/labmed/lmy068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To evaluate the advantages of using anti-Müllerian hormone (AMH) in the diagnosis of polycystic ovary syndrome (PCOS). METHODS We compared data from 56 Han Chinese patients with PCOS and 52 female control Han Chinese individuals in terms of biochemical markers and the antral follicle count (AFC). Then, the correlation between serum AMH levels and various endocrine and metabolic factors was analyzed. We generated receiver operating characteristic (ROC) curves to assess the usefulness of AMH, AFC, the luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio, and testosterone (T), to discriminate between the PCOS and control groups. RESULTS The LH/FSH ratio, homeostatis model assessment of insulin resistance (HOMA-IR), testosterone (T), blood glucose (Glu), triglyceride (TG), body mass index (BMI), AFC and, in particular, serum AMH level were significantly higher in the PCOS group than in the control group (P <.05; P <.001). The serum AMH level had a significant positive effect on the likelihood of AFC changes in patients with PCOS and control-group women. The areas under the ROC curve (AUC) of AMH, AFC, LH/FSH ratio, and T were 0.952, 0.778, 0.760, and 0.665, respectively. The best cutoff point for AMH was 6.09 ng per mL, with sensitivity of 88% and specificity of 88%.
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Affiliation(s)
- Xinyan Shi
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Clinical Laboratory, Hangzhou Women's Hospital, Hangzhou, Zhejiang, China
| | - Duo Peng
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Clinical Laboratory, Lishui People's Hospital, Lishui, Zhejiang, China
| | - Yanfei Liu
- Clinical Laboratory, Hangzhou Women's Hospital, Hangzhou, Zhejiang, China
| | - Xiaofen Miao
- Clinical Laboratory, Hangzhou Women's Hospital, Hangzhou, Zhejiang, China
| | - Hui Ye
- Clinical Laboratory, Hangzhou Women's Hospital, Hangzhou, Zhejiang, China
| | - Jun Zhang
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Casadei L, Fanisio F, Sorge RP, Collamarini M, Piccolo E, Piccione E. The diagnosis of PCOS in young infertile women according to different diagnostic criteria: the role of serum anti-Müllerian hormone. Arch Gynecol Obstet 2018; 298:207-215. [PMID: 29802450 DOI: 10.1007/s00404-018-4803-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/18/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE To diagnose polycystic ovary syndrome (PCOS) in young infertile women using different diagnostic criteria. To define serum anti-Müllerian hormone (AMH) cutoff values for PCOS definition. To investigate the correlation between AMH and body mass index (BMI). METHODS Retrospective case-control study. A total of 140 infertile women (age 21-35 years) were enrolled. PCOS was defined according to the National Institutes of Health (NIH) criteria, the Rotterdam consensus criteria and the Androgen Excess and PCOS Society (AE-PCOS) criteria. ROC curve analysis was performed to define AMH thresholds for PCOS definition according to the three different diagnostic criteria. Correlation between AMH and BMI was investigated. RESULTS The prevalence of PCOS under the NIH criteria, the Rotterdam criteria and the AE-PCOS criteria was 27.1, 40 and 29.3%, respectively. The optimal thresholds of AMH to distinguish NIH PCOS from infertile controls was 5.20 ng/ml (AUC = 0.86, sensitivity 79%, specificity 80%); the best cutoff to detect Rotterdam PCOS was 4.57 ng/ml (AUC = 0.85, sensitivity 78%, specificity 81%); a cutoff of 4.85 ng/ml (AUC = 0.85, sensitivity 80%, specificity 78%) defined PCOS women according to AE-PCOS criteria. The prevalence of the syndrome became 37.1, 44.3 and 39.2% according to the three criteria, respectively, using AMH threshold between 4.57 and 5.20 ng/ml as an alternative to antral follicle count and/or hyperandrogenism. CONCLUSION Anti-Müllerian hormone may reconcile the three diagnostic criteria and allow the PCOS diagnosis in women with mild symptoms. No significant correlation was found between AMH and BMI in PCOS women and controls.
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Affiliation(s)
- Luisa Casadei
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. .,Section of Gynecology and Obstetrics, Department of Surgery, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy.
| | - Francesca Fanisio
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Section of Gynecology and Obstetrics, Department of Surgery, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy
| | - Roberto Pietro Sorge
- Laboratory of Biometry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Matteo Collamarini
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Section of Gynecology and Obstetrics, Department of Surgery, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy
| | - Eleonora Piccolo
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Section of Gynecology and Obstetrics, Department of Surgery, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy
| | - Emilio Piccione
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Section of Gynecology and Obstetrics, Department of Surgery, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy
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Impact of cancer treatment on risk of infertility and diminished ovarian reserve in women with polycystic ovary syndrome. Fertil Steril 2018; 109:516-525.e1. [PMID: 29428311 DOI: 10.1016/j.fertnstert.2017.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/14/2017] [Accepted: 11/14/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare markers of fertility and ovarian reserve between cancer survivors and cancer-free women with and without polycystic ovary syndrome (PCOS). DESIGN Furthering Understanding of Cancer, Health, and Survivorship in Adult (FUCHSIA) Women's Study-a population-based cohort study. SETTING Not applicable. PATIENT(S) Female cancer survivors (n = 1,090) aged 22-45 years, diagnosed between ages 20 and 35 years, and at least 2 years after diagnosis; 369 participated in a clinic visit. Three hundred seventy-four reproductive-aged women without cancer also completed a clinic visit. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Infertility, time to first pregnancy after cancer diagnosis, and measures of ovarian reserve (antimüllerian hormone [AMH] and antral follicle count [AFC]). RESULTS Seventy-eight cancer survivors (7.2%) reported a PCOS diagnosis, with 41 receiving gonadotoxic treatment. Survivors with PCOS exposed to gonadotoxic treatment (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.2-4.5) and unexposed (OR 3.4, 95% CI 1.7-6.9) were more likely to report infertility than unexposed survivors without PCOS and were more likely to have fewer children than desired (exposed: OR 2.1, 95% CI 1.0-4.2; unexposed: OR 3.0, 95% CI 1.4-6.8). After adjusting for age, comparison women with PCOS had the highest markers of ovarian reserve (AMH: 2.43 ng/mL, 95% CI 1.22-4.82 ng/mL; AFC: 20.7, 95% CI 15.3-27.8), and cancer survivors without PCOS treated with gonadotoxic agents had the lowest levels (AMH: 0.19 ng/mL, 95% CI 0.14-0.26 ng/mL; AFC: 7.4, 95% CI 6.4-8.5). CONCLUSION(S) Despite having higher AMH and AFC on average after cancer treatment, cancer survivors with PCOS were less likely to meet their reproductive goals compared with survivors without PCOS.
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Brüggmann D, Berges L, Klingelhöfer D, Bauer J, Bendels M, Louwen F, Jaque J, Groneberg DA. Polycystic ovary syndrome: analysis of the global research architecture using density equalizing mapping. Reprod Biomed Online 2017; 34:627-638. [PMID: 28372893 DOI: 10.1016/j.rbmo.2017.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/23/2016] [Accepted: 03/09/2017] [Indexed: 11/29/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most common cause of female infertility worldwide. Although the related research output is constantly growing, no detailed global map of the scientific architecture has so far been created encompassing quantitative, qualitative, socioeconomic and gender aspects. We used the NewQIS platform to assess all PCOS-related publications indexed between 1900 and 2014 in the Web of Science, and applied density equalizing mapping projections, scientometric techniques and economic benchmarking procedures. A total of 6261 PCOS-specific publications and 703 international research collaborations were found. The USA was identified as the most active country in total and collaborative research activity. In the socioeconomic analysis, the USA was also ranked first (25.49 PCOS-related publications per gross domestic product [GDP]/capita), followed by the UK, Italy and Greece. When research activity was related to population size, Scandinavian countries and Greece were leading the field. For many highly productive countries, gender analysis revealed a high ratio of female scientists working on PCOS with the exception of Japan. In this study, we have created the first picture of global PCOS research, which largely differs from other gynaecologic conditions and indicates that most related research and collaborations originate from high-income countries.
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Affiliation(s)
- Dörthe Brüggmann
- Department of Gynecology and Obstetrics, Goethe-University, Theodor-Stern Kai 7, 60590 Frankfurt, Germany; Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Theodor-Stern Kai 7, 60590 Frankfurt, Germany; Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 2020 Zonal Ave, Los Angeles, California 90033, USA.
| | - Lea Berges
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Theodor-Stern Kai 7, 60590 Frankfurt, Germany
| | - Doris Klingelhöfer
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Theodor-Stern Kai 7, 60590 Frankfurt, Germany
| | - Jan Bauer
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Theodor-Stern Kai 7, 60590 Frankfurt, Germany
| | - Michael Bendels
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Theodor-Stern Kai 7, 60590 Frankfurt, Germany
| | - Frank Louwen
- Department of Gynecology and Obstetrics, Goethe-University, Theodor-Stern Kai 7, 60590 Frankfurt, Germany
| | - Jenny Jaque
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 2020 Zonal Ave, Los Angeles, California 90033, USA
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Theodor-Stern Kai 7, 60590 Frankfurt, Germany
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Verma AK, Rajbhar S, Mishra J, Gupta M, Sharma M, Deshmukh G, Ali W. Anti-Mullerian Hormone: A Marker of Ovarian Reserve and its Association with Polycystic Ovarian Syndrome. J Clin Diagn Res 2016; 10:QC10-QC12. [PMID: 28208941 DOI: 10.7860/jcdr/2016/20370.8988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/20/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Anti-Mullerian Hormone (AMH) is a useful endocrine marker for assessing the ovarian reserve. AMH serum level reflects the number of follicles that have made the transition from the primordial pool into the growing follicle pool, and it is not controlled by gonadotropins. AIM The present study was conducted to correlate serum AMH levels with Polycystic Ovarian Syndrome (PCOS) and type of treatment protocol. MATERIALS AND METHODS Serum AMH levels were performed in the early follicular phase (on 2nd day of menstrual cycle) both in infertile females including PCOS and control women. The results were analyzed in relation to age, Body Mass Index (BMI), ovarian volume, serum Follicle Stimulating Hormone (FSH) levels, Antral Follicle Count (AFC), type of treatment protocols and also in association with PCOS patients. The serum levels of AMH were measured in all the participants on 2nd day of menstrual cycle using ultra sensitive Enzyme Linked Immunosorbent Assay (ELISA). RESULTS The plasma AMH levels were significantly higher in women with polycystic ovarian syndrome. The significant association was seen between FSH and AFC with AMH. However, no significant association was observed between AMH levels with age, BMI, ovarian volume and type of treatment protocols. CONCLUSION The serum AMH measurement was significantly higher in PCOS patients. No association with type of treatment protocol was obtained.
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Affiliation(s)
- Anil Kumar Verma
- Assistant Professor, Department of Pathology, School of Medical Sciences and Research, Sharda Hospital , Greater Noida, Uttar Pradesh, India
| | - Sarita Rajbhar
- Senior Resident, Department of Obstetrics and Gynaecology, PGIMER and Dr Ram Manohar Lohia Hospital , New Delhi, India
| | - Jyoti Mishra
- Assistant Professor, Department of Pathology, School of Medical Sciences and Research, Sharda Hospital , Greater Noida, Uttar Pradesh, India
| | - Mayank Gupta
- Senior Resident, Department of Radiology, PGIMER and Dr Ram Manohar Lohia Hospital , New Delhi, India
| | - Mratunjai Sharma
- Assistant Professor, Department of Pathology, School of Medical Sciences and Research, Sharda Hospital , Greater Noida, Uttar Pradesh, India
| | - Geeta Deshmukh
- Professor, Department of Pathology, School of Medical Sciences and Research, Sharda Hospital , Greater Noida, Uttar Pradesh, India
| | - Wahid Ali
- Associate Professor, Department of Pathology, King George's Medical University , Lucknow, Uttar Pradesh, India
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