Anti-Mullerian Hormone: A Marker of Ovarian Reserve and its Association with Polycystic Ovarian Syndrome

Anti-Müllerian Hormone Levels among Female Firefighters

Female firefighters have occupational exposures which may negatively impact their reproductive health. Anti-müllerian hormone (AMH) is a clinical marker of ovarian reserve. We investigated whether AMH levels differed in female firefighters compared to non-firefighters and whether there was a dose-dependent relationship between years of firefighting and AMH levels. Female firefighters from a pre-existing cohort completed a cross-sectional survey regarding their occupational and health history and were asked to recruit a non-firefighter friend or relative. All participants provided a dried blood spot (DBS) for AMH analysis. Linear regression was used to assess the relationship between firefighting status and AMH levels. Among firefighters, the influence of firefighting-related exposures was evaluated. Firefighters (n = 106) and non-firefighters (n = 58) had similar age and BMI. Firefighters had a lower mean AMH compared to non-firefighters (2.93 ng/mL vs. 4.37 ng/mL). In multivariable adjusted models, firefighters had a 33% lower AMH value than non-firefighters (-33.38%∆ (95% CI: -54.97, -1.43)). Years of firefighting was not associated with a decrease in AMH. Firefighters in this study had lower AMH levels than non-firefighters. More research is needed to understand the mechanisms by which firefighting could reduce AMH and affect fertility.

After cyclophosphamide exposure, granulosa cells recover their anti-müllerian hormone-producing ability but not their numbers

Anti‐müllerian hormone (AMH) produced by granulosa cells (GCs), reserves the ovarian follicle pool for future recruitment and ovulation. However, women who have undergone cyclophosphamide (Cy) treatment have decreased AMH levels due to damaged GCs. This study establishes flow cytometry protocols for identification of GCs and investigates the cause of the Cy‐induced AMH decrease by analyzing the number of GCs and their AMH production at the single cell level. Over 2 weeks, C57BL/6 mice were intraperitoneally injected 6 times with 100 mg/kg Cy and sacrificed either immediately or 4 weeks after Cy treatment. Twenty‐four hours post‐Cy exposure, a decrease in serum AMH levels was seen due to a reduction in the number of follicle‐stimulating hormone receptor (FSHR)⁺AMH⁺ GCs and their ability to produce AMH. However, 4 weeks after Cy treatment, serum AMH levels were still decreased due to the decreased number of FSHR⁺AMH⁺ GCs, however, their AMH‐producing ability was unaltered. Consistently, in vitro, Cy‐induced low AMH production in FSHR⁺AMH⁺ hGL5 cells (immortalized human GCs) was restored 24 h after Cy treatment, although their numbers remained decreased. Thus, the surviving GCs after Cy exposure had intact AMH‐producing ability. In future, an effort to minimize GC death by Cy treatment is required, while maintaining its therapeutic effects.

Correlation of Serum Anti-Mullerian Hormone with Ovarian Follicle Output Rate in Infertile Females: A Clomiphene Citrate Challenge Test

Background

Failure to achieve a successful pregnancy after 12 months of unprotected intercourse is a pathology of the reproductive system known as infertility. Anti-Mullerian hormone (AMH) not only reflects the ovarian reserve but also is known to be a predictor of several assisted reproductive techniques, e.g., in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and clomiphene citrate challenge test. In this study, AMH levels are correlated with the follicular output rate after the clomiphene citrate challenge test.

Objective

The objective of this study is to correlate AMH with the follicular output rate (FORT) after the clomiphene citrate challenge test.

Materials and methods

This study included a total of 80 primary and secondary infertile females, divided into early (18-30) and late (31-45) reproductive age groups either currently under clomiphene citrate treatment or advised to start clomiphene treatment, culled from out-patient department and centers of assisted reproductive techniques. On the third day of the menstrual cycle, blood samples were taken to determine serum AMH levels by ELISA. Then on the fifth day of the menstrual cycle, antral follicular counts were calculated through transvaginal ultrasound and oral tablet clomiphene citrate was started, and on day 12 and then on day 5, transvaginal ultrasound was repeated to record the number and diameter of dominant follicles.

Results

The pre-ovulatory (mature) follicle count was divided by the antral follicle count ×100 for calculating the FORT, which showed a negative Spearman Rho correlation (p = 0.048) with AMH. P-value ≤ 0.05 was considered significant.

 

Conclusion

It is concluded that the most commonly administered drug, clomiphene citrate, may not be the treatment of choice for patients with high levels of AMH and may, in fact, interfere with the chances of achieving pregnancy. This study can provide guidelines to clinicians for patient counseling, given the results of the clomiphene citrate challenge test on the basis of AMH levels. 

Effect of Single-Dose Methotrexate Treatment on Ovarian Reserve in Women with Ectopic Pregnancy Undergoing Infertility Treatment: A Single-Center Experience

Background

The aim of this study was evaluation of the impact of single-dose methotrexate (MTX) treatment on ovarian reserve in women with ectopic pregnancy (EP) undergoing infertility treatment in Iranian population.

Materials and Methods

This prospective cohort study was done between March 2015 and March 2017 in Tehran General Women Hospital, Tehran, Iran. We enrolled 20 patients with EP who conceived during infertility treatment and received a single-dose MTX (50 mg/m²) intramuscularly. Serum anti-Mullerian hormone (AMH), 17 beta-estra diol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and antral follicle count (AFC) on transvaginal ultrasonography, were evaluated before and 8 weeks after administration of MTX.

Results

AMH did not significantly vary after the administration of MTX, compared to before treatment value (P=0.36). FSH, E2 and AFC changes were not statistically significant, while increment of LH was significant (P=0.02).

Conclusion

Results indicated that single-dose MTX treatment did not reduce ovarian reserve in women with EP. Further randomized controlled clinical trial studies with larger sample sizes, by using multiple dosages of MTX, and with long-term follow up are suggested to be done.