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Shaikh R, More A, Dutta S, Choudhary N, Shrivastava J, Ansari AH, Gajabe G. Optimizing In Vitro Fertilization (IVF) Success in Hypergonadotropic Hypogonadism: A Case Study on the Impact of the Shanghai Protocol. Cureus 2024; 16:e54529. [PMID: 38516424 PMCID: PMC10956477 DOI: 10.7759/cureus.54529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
This article evaluated the effect of the Shanghai protocol on a hypergonadotropic hypogonadism patient undergoing in vitro fertilization (IVF) treatment. Hypergonadotropic hypogonadism was characterized by low sex hormone levels and elevated gonadotropins, leading to infertility. Poor ovarian response and failed pregnancy outcomes were the results of previous IVF treatments using conventional stimulation methods. The 37-year-old female patient was advised to follow the Shanghai protocol, which involved gonadotropin stimulation following pituitary suppression with a long-acting gonadotropin-releasing hormone agonist (GnRH-a). The Shanghai protocol significantly improved the ovarian response. Two oocytes were retrieved, and one 4AA grade (number 4 represents an expanded blastocyst, the embryo is large, and the zona is thin; first A represents the inner cell mass of numerous and tightly packed cells; second A represents trophectoderm, with many cells organized in epithelium) embryo was formed. According to her previous result, the patient with hypergonadotropic hypogonadism who had one unsuccessful IVF cycle after visiting our infertility center was advised of the Shanghai protocol. Establishing these results and enhancing the Shanghai protocol's implementation to this specific patient treatment, clinical pregnancy was achieved.
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Affiliation(s)
- Rokaiya Shaikh
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akash More
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shilpa Dutta
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Namrata Choudhary
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jarul Shrivastava
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Al Hera Ansari
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gauri Gajabe
- Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Qin X, Du J, He R, Li Y, Zhu Q, Li Y, Li H, Liang X. Adverse effects of type 2 diabetes mellitus on ovarian reserve and pregnancy outcomes during the assisted reproductive technology process. Front Endocrinol (Lausanne) 2023; 14:1274327. [PMID: 38033999 PMCID: PMC10686411 DOI: 10.3389/fendo.2023.1274327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Objective To study the effect of type 2 diabetes mellitus(T2DM)on overall ovarian reserve and pregnancy outcomes during assisted reproductive technology (ART) among childbearing infertile women. Design Retrospective cohort study. Setting The Reproductive Medicine Special Hospital, The First Hospital of Lanzhou University, between January 2019 and December 2022. Patients A total of 265 infertile female patients aged 20-45 years who underwent in vitro fertilization-embryo transfer (IVF-ET), intracytoplasmic sperm injection-embryo transfer (ICSI-ET), or rescue intracytoplasmic sperm injection-embryo transfer (RICSI-ET) in the first fresh cycle. Interventions None. Main Outcome Measures Serum Anti-Müllerian Hormone (AMH) levels, clinical pregnancy rate (CPR), live birth rate (LBR), and abortion rate (AR) in the T2DM group and non-T2DM group. Results Patients with T2DM showed statistically decreased levels of AMH compared to the non-T2DM group. During ovarian stimulation, those with T2DM required significantly higher total and initial doses of gonadotropin (GN), although they had fewer retrieved oocytes and worse pregnancy outcomes than the non-T2DM group. Multivariate logistic regression analysis adjusting for confounding factors showed that T2DM alone was an independent risk factor for CPR and LBR (adjusted odds ratio [a OR], 0.458, adjusted 95% confidence interval [CI], 0.235-0.891, P = 0.022; a OR, 0.227, 95% CI, 0.101-0.513, P<0.001; respectively), and the abortion rate in the T2DM group was 3.316 times higher than the non-T2DM group(a OR, 3.316, 95%CI, 1.248-8.811, P = 0.016). Conclusion Infertile patients with T2DM have decreased ovarian reserve, and T2DM has a deleterious impact on clinical pregnancy outcomes during the ART process compared with non-T2DM infertile women. Capsule Infertile women with T2DM have decreased ovarian reserve and pregnancy outcomes during the assisted reproductive technology process compared with non-T2DM infertile women.
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Affiliation(s)
- Xue Qin
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Junhong Du
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Ruifen He
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Yi Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Qinying Zhu
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Yaxi Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Hongli Li
- Department of Obstetrics and Gynecology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xiaolei Liang
- Department of Obstetrics and Gynecology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
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Choi E, Kim HI, Seo SK, Cho SH, Choi YS, Lee BS, Yun BH. Postoperative outcomes of ovarian preserving surgery in premenopausal women with adnexal torsion. Obstet Gynecol Sci 2023; 66:562-571. [PMID: 37840253 PMCID: PMC10663403 DOI: 10.5468/ogs.23071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/27/2023] [Accepted: 08/21/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVE We aimed to determine whether ovarian-preserving surgery for adnexal torsion helps preserve ovarian function without increasing the risk of postoperative complications. METHODS We retrospectively evaluated 71 women who were surgically diagnosed with adnexal torsion between January 2015 and December 2019 at Severance Hospital, Yonsei University College of Medicine (ovarian preservation group, 56; oophorectomy, 15). Serum anti-Müllerian hormone (AMH) levels measured within 6 months before surgery were compared to levels measured 6-24 months after surgery. Surgical findings and postoperative complications were compared between the groups. RESULTS There was a borderline significant difference in the decrease in serum AMH levels between the oophorectomy group and ovarian preservation group before and after surgery. There were no significant differences between the groups in terms of fever, infection, or duration of admission. Discoloration of the twisted ovary was found in 27.3% and 33.3% of the patients in the ovarian preservation and oophorectomy groups, respectively. There was no difference in the decrease in serum AMH levels between patients with and those without discoloration. CONCLUSION Ovarian-preserving surgery may not increase postoperative complications in patients with adnexal torsion, even if a twisted mass is suspected to be necrotic. Moreover, the ovarian reserve may not be affected by torsion if the ovary is preserved. Conservative ovarian surgery can be safely performed to preserve the reproductive potential of women with adnexal torsion and cystic masses.
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Affiliation(s)
- Euna Choi
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
| | - Hye In Kim
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
- Department of Obstetrics and Gynecology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin,
Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
| | - Si Hyun Cho
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Young Sik Choi
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
| | - Byung Seok Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
| | - Bo Hyon Yun
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
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Ünal Ç, Ordu Ç, Özmen T, İlgun AS, Çelebi F, Baysal B, Özkurt E, Duymaz T, Erdoğan İyigün Z, Kurt S, Öztürk MA, Pilancı KN, Alço G, Yararbaş K, Kayan Tapan T, Güven DC, Soybir G, Özmen V. Evaluation of Anti-Mullerian Hormone Levels, Antral Follicle Counts, and Mean Ovarian Volumes in Chemotherapy-Induced Amenorrhea among Breast Cancer Patients: A Prospective Clinical Study. Curr Oncol 2023; 30:9217-9229. [PMID: 37887566 PMCID: PMC10605884 DOI: 10.3390/curroncol30100666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
Estradiol (E2), a follicle-stimulating hormone (FSH), AMH, and inhibin B levels, along with AFC and MOV, are used to determine ovarian reserve in pre-menopausal women. Studies have shown that AMH levels are more sensitive than those of E2, FSH, and inhibin B and that AFC and MOV can be used to evaluate ovarian reserve. AMH, AFC, and MOV measurements were performed before and after adjuvant SC in 3-month periods for one year. Patients were classified as experiencing chemotherapy-induced amenorrhea (CIA) if they did not have menstrual cycles for a period of six months or longer following the conclusion of their chemotherapy treatment. We aimed to evaluate the factors affecting chemotherapy-induced amenorrhea in breast cancer patients treated with adjuvant chemotherapy and the performance of baseline measurements of AMH, AFC, and MOV to predict chemotherapy-induced amenorrhea. The effects of different chemotherapy regimens on the AMH level, AFC, and MOV in CIA patients were investigated. Seventy-one patients were eligible for this study, and the median age was 38 years (range: 23-45). The median follow-up was 37 months (range: 20-51), and CIA developed in 62% of the patients. The AMH level and AFC were significantly decreased one year after SC (p < 0.0001), whereas MOV was not (p = 0.507). AMH levels before chemotherapy (median: 1.520 vs. 0.755, p = 0.001) and at the end of the first year (median: 0.073 vs. 0.010, p = 0.030) and pre-treatment AFC (median: 12 vs. 4.50, p = 0.026) were lower in patients with CIA compared to those without CIA. The AMH levels before SC were the most valuable and earliest factor for predicting CIA development. In addition, there was no difference between the chemotherapy regimens (including or not including taxane) in terms of CIA development.
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Affiliation(s)
- Çağlar Ünal
- Division of Medical Oncology, Department of Internal Medicine, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul 34865, Turkey
| | - Çetin Ordu
- Division of Medical Oncology, Department of Internal Medicine, Gayrettepe Florence Nightingale Hospital, Istanbul 34349, Turkey
| | - Tolga Özmen
- Division of Gastrointestinal and Oncologic Surgery, Harvard Medical School, Boston, MA 02115, USA
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Filiz Çelebi
- Department of Radiology, Yeditepe University Hospital, Istanbul 34755, Turkey
| | - Bülent Baysal
- Department of Obstetrics and Gynecology, İstanbul Florence Nightingale Hospital, Istanbul 34381, Turkey
| | - Enver Özkurt
- Department of General Surgery, İstanbul Florence Nightingale Hospital, Istanbul 34381, Turkey
| | - Tomris Duymaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul 34060, Turkey
| | - Zeynep Erdoğan İyigün
- Department of Physical Theraphy and Rehabilitation, Göztepe Medical Park Hospital, Istanbul 34732, Turkey
| | - Sevgi Kurt
- Department of Plastic Surgery, İstanbul Florence Nightingale Hospital, Istanbul 34381, Turkey
| | | | - Kezban Nur Pilancı
- Division of Medical Oncology, Department of Internal Medicine, Memorial Bahçelievler Hospital, Istanbul 34180, Turkey
| | - Gül Alço
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul 34349, Turkey
| | - Kanay Yararbaş
- Department of Medical Genetics, Demiroglu Bilim University, Istanbul 34394, Turkey
| | - Tuba Kayan Tapan
- Department of Nutrition and Dietetic, Faculty of Health Science, Demiroglu Bilim University, Istanbul 34394, Turkey
| | - Deniz Can Güven
- Division of Medical Oncology, Department of Internal Medicine, Elazıg Fethi Sekin City Hospital, Elazıg 23280, Turkey
| | - Gürsel Soybir
- Department of General Surgery, Memorial Şişli Hospital, Istanbul 34384, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul School of Medicine, İstanbul University, Istanbul 34093, Turkey
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Stalzer A, Seybold D, Gantt P, Broce M, Cronkright A. Anti-Müllerian Hormone: A Predictor of Successful Intrauterine Insemination. Cureus 2023; 15:e47200. [PMID: 38022255 PMCID: PMC10652159 DOI: 10.7759/cureus.47200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION The anti-Müllerian hormone (AMH) produced by the granulosa cells of ovarian follicles has been shown to correlate with ovarian reserve and is often measured for fertility therapies. In this study, we evaluated the relationship between serum AMH values and the clinical pregnancy (CP) rates of female partners with unexplained infertility undergoing intrauterine insemination utilizing varying ovarian simulation protocols. METHODS This is a retrospective cohort study conducted among couples who underwent intrauterine insemination therapy over a period of four years at Charleston Area Medical Center, a tertiary care medical center in West Virginia, USA. Logistic regression was used to determine the best predictor of CP. RESULTS A total of 509 intrauterine inseminations resulting in 81 (15.9%) Cps were analyzed. The cycles with a CP had higher mean AMH values (3.7+3.5 vs. 2.2+2.1; p<0.001). The majority of patients were nulliparous (77.0%) with a mean age of 33.6+5.0 years. After including only patients with unexplained infertility (the predominate infertility diagnosis; n=255 (50.1% of the cycles)) and stimulation cycles >10, the final sample size for the analysis was 245/509=48.1%. Following a receiver operating characteristic (ROC) curve analysis, the optimal AMH cut-off point was 2.1 ng/mL with an area under the curve (AUC) equal to 0.61 and 95% confidence intervals (CIs) of 0.55- 0.67 (p=0.002). The CP rate was significantly higher with the AMH >2.1 ng/mL (20.0%) compared to <2.1 ng/mL (10.0%; p=0.041). With Clomid/human gonadotropins/human chorionic gonadotropin (hCG) trigger treatment, the CP rate quadrupled (odds ratio (OR): 4.6; 95% CI: 2.1-9.7; p<0.001). CONCLUSION This study indicates that higher AMH levels and a more aggressive ovarian stimulation protocol for intrauterine insemination therapy (IUI) have a better probability of resulting in CP.
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Affiliation(s)
- Allison Stalzer
- Obstetrics and Gynecology, Charleston Area Medical Center/West Virginia University, Charleston, USA
| | - Dara Seybold
- Institute for Academic Medicine, Charleston Area Medical Center, Charleston, USA
| | - Pickens Gantt
- Obstetrics and Gynecology, Charleston Area Medical Center/West Virginia University, Charleston, USA
| | - Mike Broce
- Institute for Academic Medicine, Charleston Area Medical Center, Charleston, USA
| | - Ashley Cronkright
- Internal Medicine, Charleston Area Medical Center/West Virginia University, Charleston, USA
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Özcan A, Gülseren V, Özcan E, Toz E, Turan V. Assessment of the ovarian reserve in patients with beta-thalassemia major: a prospective longitudinal study. J Turk Ger Gynecol Assoc 2023; 24:159-164. [PMID: 37351586 PMCID: PMC10493813 DOI: 10.4274/jtgga.galenos.2023.2022-12-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/19/2023] [Indexed: 06/24/2023] Open
Abstract
Objective Repeated blood transfusions in women with beta-thalassemia major (BTM) may lead to iron overload and increase oxidative stress, consequently resulting in ovarian damage. The aim was to evaluate alterations in ovarian reserve in transfusion-dependent BTM patients over a time period of one year and to compare levels of anti-Mullerian hormone (AMH) in women with BTM and their healthy peers. Material and Methods This longitudinal prospective study was conducted in women with transfusion-dependent BTM at a tertiary level hospital. The hospital database was interogated for women diagnosed with BTM between 1996 and 2021. AMH levels were assessed at baseline and one year later. Results Forty-one women with BTM were identified, of whom 25 (60.9%) had amenorrhea and 16 (39.1%) had normal cycles. The mean AMH level of all women was 2.7±1.8 ng/mL at baseline, significantly lower than the age-matched nomogram value of 4.0±0.4 ng/mL for a healthy population (p=0.001). The baseline AMH level of patients with amenorrhea were significantly lower than patients with normal menstrual cycles (2.1±1.8 vs. 3.6±1.5 ng/mL, p=0.009). After one-year follow-up, there was a trend towards a decrease in the AMH levels of patients with normal menstrual cycles. Conclusion Serum AMH values are decreased in patients with transfusion-dependent BTM. BTM patients should be educated about the possible effects of repeated blood transfusions on fertility.
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Affiliation(s)
- Aykut Özcan
- Department of Obstetrics and Gynecology, İzmir Katip Çelebi University Faculty of Medicine, İzmir, Turkey
| | - Varol Gülseren
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Esin Özcan
- Clinic of Pediatric Hematology and Oncology, University of Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Emrah Toz
- Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Volkan Turan
- Department of Obstetrics and Gynecology, İstanbul Health and Technology University Faculty of Medicine, İstanbul, Turkey
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Oktay KH, Turan V, Bedoschi G, Abdo N, Bang H, Goldfarb S. A prospective longitudinal analysis of the predictors of amenorrhea after breast cancer chemotherapy: Impact of BRCA pathogenic variants. Cancer Med 2023; 12:19225-19233. [PMID: 37698031 PMCID: PMC10557848 DOI: 10.1002/cam4.6527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Better tools for post-chemotherapy amenorrhea risk assessment are needed for fertility preservation decision-making. Our aim was to determine the predictors of amenorrhea risk at 12 and 18 months post-chemotherapy in women with breast cancer. METHODS 142 women with breast cancer were longitudinally followed for their menstrual changes at 6, 12, and 18 months after the completion of adjuvant chemotherapy with an Anthracycline-Cyclophosphamide-based (AC-based) or Cyclophosphamide-Methotrexate +5-Fluorouracil regimen. Pre- and/or post-chemo AMH levels, age, BMI, tamoxifen use, regimen type, and germline BRCA pathogenic variant (gBRCApv) status were evaluated for the prediction of amenorrhea at 6-18 months. RESULTS In multivariable-adjusted logistic regression, age (p = 0.03) and AMH (p = 0.03) at 12 months, and gBRCApv status (p = 0.03) at 18 months were significant predictors of amenorrhea (areas under the ROC curve of 0.77 and 0.76, for 12 and 18 months, respectively) among 102 evaluable subjects. An undetectable AMH immediately post-chemotherapy was predictive of amenorrhea with <18 month follow-up. In longitudinal analysis estimating time trends, baseline AMH and gBRCApv status was associated with the risk of amenorrhea over 6-18 months; the AMH >2.0 ng/mL group showed attenuated time-trend risk of amenorrhea versus AMH ≤2.0 group (ratio of ORs = 0.91, 95% CI = 0.86-0.97, p = 0.002), while the gBRCApv + showed a steeper time trend, versus the controls (ratio of ORs = 1.12, 95% CI = 1.04-1.20, p = 0.003). CONCLUSIONS In addition to the pre- and post-treatment AMH levels, gBRCApv status is a novel potential predictor of amenorrhea at 12 and 18 months after chemotherapy. The higher likelihood of amenorrhea in women gBRCApv suggests that they are more prone to losing their fertility post-chemotherapy.
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Affiliation(s)
- Kutluk H. Oktay
- Department of Obstetrics and Gynecology and Reproductive SciencesYale University School of MedicineNew HavenConnecticutUSA
| | - Volkan Turan
- Department of Obstetrics and GynecologyIstanbul Health and Technology University School of MedicineIstanbulTurkey
| | - Giuliano Bedoschi
- Department of Obstetrics and Gynecology, Ribeirao Preto School of MedicineUniversity of Sao PauloRibeirao PretoBrazil
| | - Nadia Abdo
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health SciencesUniversity of CaliforniaDavisCaliforniaUSA
| | - Shari Goldfarb
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Weill Cornell Medical CenterNew YorkNew YorkUSA
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Mohammad H, S JC, Haripriya G, Maskeri D, K P, Priya P. Model of Anti-Mullerian Hormone Over Age to Predict Menopause in Polycystic Ovary Syndrome and Eumenorrheic Women: A Study on Southern Indian Population. Cureus 2023; 15:e43419. [PMID: 37706124 PMCID: PMC10496936 DOI: 10.7759/cureus.43419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/15/2023] Open
Abstract
Introduction Anti-mullerian hormone (AMH) is a member of the transforming growth factor β family and is a marker of ovarian reserve; it is produced by the granulosa cells of developing preantral and early antral ovarian follicles. AMH concentration decreases with increasing age. Its concentration is increased relatively in those with polycystic ovary syndrome (PCOS) than eumenorrheic women. Objectives In this research, using a model of AMH over age, the age of menopause is predicted in PCOS and eumenorrheic women. Study design The study subjects were classified into two groups. Group 1 included PCOS subjects. Group 2 included eumenorrheic women. General profiles such as age, BMI, and hormonal parameters such as AMH were measured. Based on the exponential functional dependence of AMH over age, a model was proposed, and the value of exponential constants such as log βo and β1 were calculated using least square approximation. An arbitrary value of 0.2 ng/mL for AMH was taken as a cut-off value to predict the age of menopause in both groups. Outcome measures We predicted the age of menopause using a model of AMH over age by the least square approximation technique. Results The age prediction for menopause using the least squares model of AMH over age showed that in group 1 patients with PCOS, menopause is projected to occur at around 54.7 years, while in group 2 with eumenorrheic women, it is expected to happen at approximately 45.2 years. Conclusion Data demonstrates that serum AMH concentration declines over time, and predicting the age of menopause reflects sustained reproductive life span in PCOS subjects.
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Affiliation(s)
| | - Janaki C S
- Anatomy, Bharath Medical College and Hospital, Chennai, IND
| | | | | | - Prabhu K
- Anatomy, Sree Balaji Medical College and Hospital, Chennai, IND
| | - Padma Priya
- Microbiology, Bharath Medical College, Chennai, IND
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Yang M, Zhang F, Wu K, Yu D, Zhang Y, Liao Y, Xu G, Wang Y. Müllerian Duct Anomalies and Anti-Müllerian Hormone Levels in Women With Polycystic Ovary Syndrome. Cureus 2023; 15:e43848. [PMID: 37614824 PMCID: PMC10443887 DOI: 10.7759/cureus.43848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Significant associations between the presence of polycystic ovary syndrome (PCOS) and uterine anomalies have been reported. It is unclear whether high anti-Müllerian hormone (AMH) levels coexist with the development of uterine malformations in women with PCOS. This study sought to investigate the association between Müllerian duct anomalies and anti-Müllerian hormone (AMH) levels in women with PCOS. METHODS In this retrospective cohort study, the records of 1,391 women with PCOS were analyzed. The cohort was divided into a low-AMH group (n = 700) and a high-AMH group (n = 691), based on an AMH cutoff value of 8.45 ng/ml. Müllerian duct anomalies were classified into four subtypes based on three-dimensional ultrasonography: septate uterus, bicornuate uterus, uterus didelphys, unicornuate uterus, and arcuate uterus. The primary outcome was the overall incidence of Müllerian duct anomalies. The secondary outcome was the prevalence of the abovementioned specific types of Müllerian duct anomalies. The prevalence of Müllerian duct anomalies was analyzed using the chi-squared test or Fisher's exact test. RESULTS Among the patients with PCOS, the prevalence of unicornuate uterus anomalies was higher in the high-AMH group than in the low-AMH group (1.0% vs. 0.1%, P = 0.04). No statistically significant difference in the overall incidence of uterine malformations was found between the two AMH groups (4.3% vs. 5.7%, P = 0.22). CONCLUSIONS Our study confirmed a higher prevalence of unicornuate uterus in PCOS women with high AMH levels. Clinicians might decide to investigate the possibility of a unicornuate uterus in PCOS women with high AMH levels.
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Affiliation(s)
- Min Yang
- Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, CHN
| | - Fang Zhang
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, CHN
| | - Kaiqi Wu
- Department of Clinical Laboratory, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, CHN
| | - Dong Yu
- Department of Sonography, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, CHN
| | - Yi Zhang
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, CHN
| | - Yun Liao
- Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, CHN
| | - Gufeng Xu
- Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, CHN
| | - Yue Wang
- Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, CHN
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10
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Abstract
To search whether or not the severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) messenger ribonucleic acid (mRNA) vaccine affects the fertility of women at the 6th months by using AMH, which is an ovarian reserve test. Our study, designed as a prospective case-control study, included 104 women who presented to the GOP EAH obstetrics and gynecology outpatient clinic in January and February 2022. The study group included 74 women who presented to the outpatient clinic and planned to be vaccinated and 30 women who refused to be vaccinated as the control group. Anti-COVID-19 antibody levels in all participants were checked before participation in the study, and participants who were positive were excluded from the study. Blood was taken from the participants in both control and study groups to evaluate their AMH levels before the 2 doses of vaccination. After 2 doses of the vaccine, they were called for follow-up, and serological tests were performed to check whether they were positive for anti-COVID-19 antibodies. Participants in both groups were referred for follow-up after 6 months, samples were taken again for AMH, and the data were recorded. The mean age of the study group was 27.6 ± 5.3 years, and the mean age of the control group was 28.65 ± 5.25 years (P = .298). There was no statistically significant difference between the vaccinated and nonvaccinated groups in terms of AMH levels measured at the 6th month (P = .970). When the vaccinated group was compared in terms of AMH values at the first visit before vaccination and at the 6th month after vaccination, no statistically significant difference was found between them (p:0.127) mRNA vaccination to protect against SARS-CoV-2 does not adversely affect ovarian reserve, which is an indirect indicator of fertility. mRNA vaccines continue to be the most important method of protection against epidemics. Carefully and accurately informing women who are hesitant to get vaccinated is of great importance for the success of the fight against the epidemic.
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Affiliation(s)
- Elif Yildiz
- Department of Obstetrics and Gynecology, University of Health Sciences, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Burcu Timur
- Department of Obstetrics and Gynecology, University of Health Sciences, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Gurhan Guney
- Department of Obstetrics and Gynecology, Ordu University Training and Research Hospital, Ordu, Turkey
| | - Hakan Timur
- Department of Reproductive Endocrinology and Infertility, Balikesir University Medical Faculty, Balikesir, Turkey
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11
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Sivanandy MS, Ha SK. The Role of Serum Anti-Mullerian Hormone Measurement in the Diagnosis of Polycystic Ovary Syndrome. Diagnostics (Basel) 2023; 13. [PMID: 36900051 DOI: 10.3390/diagnostics13050907] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrinological disorder in women with significant reproductive, metabolic, and psychological health implications. The lack of a specific diagnostic test poses challenges in making the diagnosis of PCOS, resulting in underdiagnosis and undertreatment. Anti-Mullerian hormone (AMH) synthesized by the pre-antral and small antral ovarian follicles appears to play an important role in the pathophysiology of PCOS, and serum AMH levels are often elevated in women with PCOS. The aim of this review is to inform the possibility of utilizing anti-Mullerian hormone either as a diagnostic test for PCOS or as an alternative diagnostic criterion in place of polycystic ovarian morphology, hyperandrogenism, and oligo-anovulation. Increased levels of serum AMH correlate highly with PCOS, polycystic ovarian morphology, hyperandrogenism, and oligo/amenorrhea. Additionally, serum AMH has high diagnostic accuracy as an isolated marker for PCOS or as a replacement for polycystic ovarian morphology.
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12
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Ovayolu A, Bostancieri N. A prospective and comparative investigation of blood sFlt-1, P1GF, and niacin concentrations in women with premature ovarian insufficiency. J Obstet Gynaecol Res 2023; 49:1198-1205. [PMID: 36682889 DOI: 10.1111/jog.15554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Endothelial dysfunction is an important component of preeclampsia like premature ovarian insufficiency (POI), and it is reported that placental growth factor (P1GF) and soluble fms-like tyrosine kinase receptor-1 (sFlt-1) levels are important in preeclampsia. Extra-placental sources for P1GF and sFlt-1 have also been identified, including various cell types. In animal models of POI, niacin treatment inhibited follicular apoptosis under hazardous conditions while significantly reducing cumulus cell apoptosis. The number of developing follicles also increased after niacin was given. This study was designed to determine blood sFlt-1, P1GF, and niacin concentrations in women with idiopathic POI (iPOI) compared with those of healthy women. METHODS The study comprised 45 women with iPOI and 45 healthy women. Blood was obtained and analyzed at the early follicular phase of the menstrual cycle and sFlt-1, P1GF, and niacin levels were measured using a commercially available enzyme-linked immunosorbent assay kit. RESULTS No significant differences were observed in the two groups according to the gravidity numbers, parity, abortion, live births, and menarche ages (p ≥ 0.05). In the iPOI group, the mean anti-mullerian hormone value was 0.03 ± 0.04 (min-max, 0.00-0.21) ng/ml. sFlt-1, P1GF, niacin levels, and also the sFlt-1/P1GF ratio were lower in the iPOI group (p < 0.01). A significant discriminative role of sFlt-1, P1GF, niacin levels, and the sFlt-1/P1GF ratio for the presence of iPOI, with cut-off values of 5.13, 10.28, 37.17, and 0.61 ng/ml, respectively, were reported in the receiver operating characteristics curve analysis. CONCLUSIONS Lower levels of P1GF, sFlt-1, niacin, and sFlt-1/P1GF ratios may be associated with the development of POI/iPOI. Further studies are required to better understand the etiopathogenesis of POI/iPOI. CLINICAL TRIAL NUMBER NCT04641624 (clinicaltrials.gov).
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Affiliation(s)
- Ali Ovayolu
- Department of Obstetrics and Gynecology, Medical School of Istinye University, Istanbul, Turkey.,Department of Obstetrics and Gynecology, Liv Hospital, Gaziantep, Turkey.,Formerly, Department of Obstetrics and Gynecology, Cengiz Gokcek Women's and Children's Hospital, Gaziantep, Turkey
| | - Nuray Bostancieri
- Department of Histology and Embryology, Gaziantep University School of Medicine, Gaziantep, Turkey
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13
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Abdelghaffar S, AbdelMoneam EN, Hassanein SA, Radwan NA, Mira MF. Categorization of differences of sex development among Egyptian children and the role of antimullerian hormone and inhibin B. Front Endocrinol (Lausanne) 2023; 13:1072399. [PMID: 36686446 PMCID: PMC9858568 DOI: 10.3389/fendo.2022.1072399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
Background Differences of sex development (DSD) are congenital conditions linked to atypical development of chromosomal, gonadal, or anatomical sex. Objective The aim of this study was to demonstrate our experiences at the Diabetes Endocrine and Metabolism Pediatric Unit (DEMPU), Faculty of Medicine, Cairo University in the field of DSD by focusing on the clinical presentation, laboratory profile, classification, and etiological diagnosis of these conditions. In addition, the present study intended to delineate the importance of serum anti-Müllerian hormone (AMH) and inhibin B in detecting the presence of functioning testicular tissue. Methods This cohort study included 451 infants and children with various clinical presentations of DSD. The study performed a retrospective analysis on medical records of established DSD cases to evaluate the clinical importance of AMH and inhibin B. In addition, newly diagnosed patients were prospectively analyzed. Results Three hundred thirty-six (74.5%) patients were 46,XY DSD, 98 (21.7%) were 46,XX DSD, 14 patients had other karyotypes and 3 had missing karyotypes. Among the 46XY DSD patients, the most common cause was partial androgen insensitivity. In contrast, congenital adrenal hyperplasia constituted the most common diagnosis in 46,XX DSD cases. The cut off value of serum AMH was 14.5 ng/ml with 100% sensitivity and 55.1% specificity. Conclusion Partial androgen insensitivity was the most important cause of 46,XY DSD in Egyptian children, and congenital adrenal hyperplasia was the most common cause of 46,XX DSD. AMH was valuable in detecting functioning testicular tissue.
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Affiliation(s)
- Shereen Abdelghaffar
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department (DEMPU), Cairo University, Cairo, Egypt
| | - Engy Nasr AbdelMoneam
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department (DEMPU), Cairo University, Cairo, Egypt
| | - Samah A. Hassanein
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department (DEMPU), Cairo University, Cairo, Egypt
| | | | - Marwa Farouk Mira
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department (DEMPU), Cairo University, Cairo, Egypt
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14
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Kulahci Aslan E, Aslan K, Gurluler J, Uyaniklar O, Kilik T, Turk P, Ozden O, Kasapoglu I, Uncu G. EROSS study: effect of ovarian reserve on sexual satisfaction. J OBSTET GYNAECOL 2022; 42:3055-3060. [PMID: 35666951 DOI: 10.1080/01443615.2022.2081798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
TRIAL REGISTRATION NUMBER NCT04776902 Clinical Trials.
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Affiliation(s)
- Elif Kulahci Aslan
- Department of Obstetrics and Gynecology, Bursa Ceylan International Hospital, Bursa, Turkey
| | - Kiper Aslan
- Department of Obstetrics and Gynecology, ART Center, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Jale Gurluler
- Bursa Umi Plaza, Obstetrics and Gynecology Private Center, Bursa, Turkey
| | - Ozlem Uyaniklar
- Department of Obstetrics and Gynecology, Bursa City Hospital, Bursa, Turkey
| | - Tugba Kilik
- Department of Obstetrics and Gynecology, Medipol University Hospital, Istanbul, Turkey
| | - Pınar Turk
- Department of Obstetrics and Gynecology, Medicana Hospital, Bursa, Turkey
| | - Okan Ozden
- Department of Obstetrics and Gynecology, Medicana Hospital, Bursa, Turkey
| | - Isil Kasapoglu
- Department of Obstetrics and Gynecology, ART Center, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Gurkan Uncu
- Department of Obstetrics and Gynecology, ART Center, Bursa Uludag University School of Medicine, Bursa, Turkey
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15
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Farhat SA, Jabbari F, Jabbari P, Rezaei N. Targeting signaling pathways involved in primordial follicle growth or dormancy: potential application in prevention of follicular loss and infertility. Expert Opin Biol Ther 2022; 22:871-881. [PMID: 35658707 DOI: 10.1080/14712598.2022.2086042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Premature ovarian failure (POF) is one of the important causes of infertility in females. To date, no efficient preventive pharmacological treatment has been offered to prevent POF. Therefore, it is necessary to focus on strategies that provide a normal reproductive lifespan to females at risk of developing POF. AREAS COVERED Recently, attention has been drawn to discovering pathways involved in primordial follicle activation, as the inhibition of this process might maintain the stock of primordial follicles and therefore, prevent POF. In vitro and animal studies have resulted in the discovery of several of these pathways that can be used to develop new treatments for POF. These studies show crosstalk of these pathways at different levels. One of the important crossing points of many of these pathways involves anti-Mullerian hormone (AMH). Herein, we discuss different aspects of this topic by reviewing related published articles indexed in PubMed and Web of Science as of December 2021. EXPERT OPINION Although the findings seem promising, most of the studies were conducted on animals, and the interaction between these factors and the possible outcomes of their administration in the long term are still unknown. Therefore, further investigation is necessary to assess these aspects.
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Affiliation(s)
- Sara Ali Farhat
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Forouq Jabbari
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Jabbari
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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16
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Yu J, Qi YL, Lu DW, Fang QJ, Li L, Sang L. Multiple Protocols Combined with Hyperbaric Oxygen Therapy on the Maintenance of Ovarian Function in Patients After Ovarian Cystectomy. Front Surg 2022; 9:877114. [PMID: 35669250 PMCID: PMC9163415 DOI: 10.3389/fsurg.2022.877114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to explore the effect of adjuvant hyperbaric oxygen therapy on ovarian function after laparoscopic ovarian cystectomy. Methods A total of 60 patients with ovarian cysts treated at our hospital from January 2018 to August 2020 were enrolled. According to the different treatment modalities, the patients were divided into the control and observation groups. Patients in both groups underwent laparoscopic ovarian cystectomy with oral administration of Chinese patent medicine Kuntai capsules after surgery. Hyperbaric oxygen therapy was added to patients in the observation group in addition to the treatment in the control group. The anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and antral follicle count (AFC) serum levels were detected in both groups before the operation and at the first and third menstrual cycles postoperatively to evaluate ovarian function. Results At the first and third menstrual cycles after surgery, the AMH, E2, and AFC serum levels in the two groups were significantly lower than before surgery, and the FSH and LH serum levels were higher than before surgery. The differences were statistically significant (P < 0.05). After the operation, AMH, E2, and AFC serum levels in the observation group were significantly higher than in the control group. FSH and LH serum levels were significantly lower than in the control group, and the differences were statistically significant (P < 0.05). Conclusion For patients undergoing laparoscopic ovarian cystectomy, the adjuvant hyperbaric oxygen therapy could significantly improve the postoperative ovarian reserve function with remarkable effects.
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Affiliation(s)
- Jie Yu
- Department of Obsterics and Gynecology, The Second People's Hospital of Hefei (Hefei Hospital Affiliated to Anhui Medical University), An Hui, China
| | - Yin-Liang Qi
- Department of Hyperbaric Oxygen, Hefei Second People’s Hospital, An Hui, China
| | - Da-Wei Lu
- Department of Obsterics and Gynecology, The Second People's Hospital of Hefei (Hefei Hospital Affiliated to Anhui Medical University), An Hui, China
| | - Qian-Jin Fang
- Department of Obsterics and Gynecology, The Second People's Hospital of Hefei (Hefei Hospital Affiliated to Anhui Medical University), An Hui, China
| | - Lan Li
- Department of Obsterics and Gynecology, The Second People's Hospital of Hefei (Hefei Hospital Affiliated to Anhui Medical University), An Hui, China
| | - Lin Sang
- Department of Obsterics and Gynecology, The Second People's Hospital of Hefei (Hefei Hospital Affiliated to Anhui Medical University), An Hui, China
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17
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Bacanakgil BH, İlhan G, Ohanoğlu K. Effects of vitamin D supplementation on ovarian reserve markers in infertile women with diminished ovarian reserve. Medicine (Baltimore) 2022; 101:e28796. [PMID: 35147111 PMCID: PMC8830860 DOI: 10.1097/md.0000000000028796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/19/2022] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to evaluate the effects of vitamin D supplementation on ovarian reserve markers, including serum anti-Mullerian hormone (AMH) level, follicle-stimulating hormone (FSH) level, and antral follicle count (AFC), in infertile women with diminished ovarian reserve and vitamin D deficiency.A prospective, nonrandomized, cross-sectional study was conducted. Women aged 18 to 41 years who were unable to become pregnant after 12 months of sexual intercourse and had normal tubal patency, partners with normal semen analysis, diminished ovarian reserve, and 25-hydroxyvitamin D [25(OH)D] deficiency were included. Eligible patients' AFC and serum levels of AMH, FSH, 25(OH)D, 1,25-dihydroxyvitamin D [1,25(OH)D], calcium, phosphate, alkaline phosphatase, and parathormone were assessed before and after administration of 300,000 IU of vitamin D ampules. Changes in the parameter values after vitamin D supplementation were compared with the initial levels.The study was conducted in 62 of the 142 participants. The AFC and AMH, 25(OH)D, 1,25(OH)D, phosphate (P < .01), and calcium levels (P < .05) were statistically significantly increased after vitamin D supplementation. Statistically significant decreases in FSH (P < .01) and alkaline phosphatase levels (P < .05) were observed after vitamin D supplementation. No statistically significant correlations were found between 25(OH)D level and AFC, 1,25(OH)D level, AMH level, and FSH level before and after supplementation (P > .05).As improvements in the ovarian reserve markers were obtained with vitamin D supplementation, vitamin D might be considered as a fertility treatment for patients with diminished ovarian reserve and vitamin D deficiency.
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18
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Anh ND, Ha NTT, Tri NM, Huynh DK, Dat DT, Thuong PTH, Toan NK, Duc TA, Hinh ND, Tong HV. Long-Term Follow-Up Of Anti-Mullerian Hormone Levels After Laparoscopic Endometrioma Cystectomy. Int J Med Sci 2022; 19:651-658. [PMID: 35582413 PMCID: PMC9108410 DOI: 10.7150/ijms.69830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/27/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: The study aims to evaluate long-term ovarian reserve change by serum anti-Mullerian hormone (AMH) level and determine the factors that affect the changes after laparoscopic endometrioma cystectomy. Methods: In a prospective longitudinal study, 104 patients with unilateral (n=77) and bilateral (n=27) endometrioma underwent laparoscopic endometrioma cystectomy. AMH levels were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Multivariate linear regression analysis was performed to determine factors related to AMH level changes. Results: Median preoperative AMH levels significantly declined from 3.77 ng/mL to 1.60 ng/mL (P<0.001), 1.66 ng/mL (P<0.001), 1.67 ng/mL (P<0.001), and 1.72 ng/mL (P<0.001) at 1, 3, 6, and 12 months postoperatively, respectively. The rate of decrease in AMH was unchanged six months after surgery, 52.2%, 53.7%, 54.8% at 1, 3, 6 months, respectively, and declined to 43.2% at 12 months. Although most factors were associated with AMH level changes in monovariant linear regression, multivariant linear regression analysis showed only three factors that reached the statistical significance, including bilateral endometriomas, mean size of the endometrioma, and preoperative AMH levels. Conclusions: Serum AMH levels decline significantly after laparoscopic cystectomy of endometriomas but recovered at 12 months compared with the first 6 months with unilateral endometrioma. Bilateral endometriomas, size of the cyst, and preoperative AMH levels might independently affect AMH levels at 12 months after surgery.
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Affiliation(s)
- Nguyen Duy Anh
- Department of Gynecological of Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam.,Department of Obstetrics and Gynecological of Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Thi Thu Ha
- Department of assisted reproduction of Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - Nguyen Manh Tri
- Department of Gynecological of Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - Do Khac Huynh
- Department of Gynecological of Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - Do Tuan Dat
- Department of Obstetrics and Gynecological of Hanoi Medical University, Hanoi, Vietnam
| | - Phan Thi Huyen Thuong
- Department of Gynecological of Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - Nguyen Khac Toan
- Department of Gynecological of Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - Tran Anh Duc
- Department of Gynecological of Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - Nguyen Duc Hinh
- Department of Obstetrics and Gynecological of Hanoi Medical University, Hanoi, Vietnam
| | - Hoang Van Tong
- Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Hanoi, Vietnam
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19
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Rak AY, Protasov EA, Trofimov AV, Pigareva NV, Ischenko AM. A novel method for purification of biologically active C-terminal fragment of human recombinant anti-mullerian hormone. Biomed Chromatogr 2021; 36:e5259. [PMID: 34622972 DOI: 10.1002/bmc.5259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/19/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022]
Abstract
Anti-mullerian hormone (AMH) is one of the least studied members of transforming growth factor beta superfamily showing pro-apoptotic activity against cells positive for hormone type II receptor overexpressed by malignant cells in many cancer cases. Here, we propose an improved method for isolation of recombinant C-terminal AMH fragment (C-rAMH) to obtain homogeneous preparations of this protein with high biological activity. In contrast to our previously developed C-rAMH purification technology based on reversed-phase HPLC, the key stage of the new approach is hydrophobic interaction chromatography using Toyopearl Butyl-650S resin performed under more benign conditions. This modification of the previously developed method allowed highly purified C-rAMH to be obtained that is characterized by twice the specificity estimated as the ability to bind to the recombinant analog of AMH type II receptor and by significantly higher biological activity, that is, the ability to induce the death of target cells. Thus, we made the purification technology even more cost-effective and suitable for the production of drug forms based on C-rAMH.
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Affiliation(s)
- Alexandra Ya Rak
- State Research Institute of Highly Pure Biopreparations, St Petersburg, Russian Federation
| | - Evgeny A Protasov
- State Research Institute of Highly Pure Biopreparations, St Petersburg, Russian Federation
| | - Alexander V Trofimov
- State Research Institute of Highly Pure Biopreparations, St Petersburg, Russian Federation
| | - Natalia V Pigareva
- State Research Institute of Highly Pure Biopreparations, St Petersburg, Russian Federation
| | - Alexander M Ischenko
- State Research Institute of Highly Pure Biopreparations, St Petersburg, Russian Federation
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20
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Kalyanaraman R, Pal L. A Narrative Review of Current Understanding of the Pathophysiology of Polycystic Ovary Syndrome: Focus on Plausible Relevance of Vitamin D. Int J Mol Sci 2021; 22:ijms22094905. [PMID: 34063169 PMCID: PMC8124569 DOI: 10.3390/ijms22094905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 01/06/2023] Open
Abstract
Polycystic ovarian syndrome (PCOS) is the most prevalent endocrinopathy of reproductive years. Salient features in presentation of patients PCOS include menstrual dysfunction, hyperandrogenism and/or polycystic appearance of ovaries on ultrasound. While the diagnosis of PCOS depends on presence of specified criteria, misdiagnoses are common. Despite years of extensive research, the exact aetiology of PCOS remains largely unknown. In the past decade, apart from insulin resistance and hyperandrogenemia, anti-mullerian hormone (AMH), an important marker of ovarian reserve, and vascular endothelial growth factor (VEGF), a crucial factor in angiogenesis, have been examined as plausible players of causative relevance for PCOS. Vitamin D, a sex-steroid hormone that is universally known for its relevance for skeletal health, has received increasing attention due to growing evidence supporting its pivotal in reproductive physiology and in PCOS. In this review we summarize our current understanding of the mechanisms relevant to the pathophysiology of PCOS and examine the role of vitamin D signalling in this context.
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Affiliation(s)
- Rajeshwari Kalyanaraman
- Department of Obstetrics and Gynecology, St Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT 06105, USA
- Correspondence:
| | - Lubna Pal
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA;
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21
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Abstract
MATERIALS AND METHODS This was a prospective, cross-sectional, comparative study that included 70 women with PCOS and 58 non PCOS controls. PCOS patients were diagnosed according to the Rotterdam criteria. Age, body mass index (BMI), number of menstrual cycles per year, and the Ferriman-Gallwey Score were determined for each woman. Serum levels of kisspeptin, follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH), estradiol, total testosterone, dehydroepiandrosterone sulfate (DHEA-S), AMH, fasting glucose and insulin were determined. RESULTS Women with PCOS were younger (p < .001), with higher BMI (p = .027) and glucose values (p < .001); while displaying less number of menstrual cycles per year (p < .001). Although serum kisspeptin levels were similar in both groups, age was negatively (r= -0.33, p = .00018) and serum AMH levels were positively correlated (r = 0.25, p = .0039) with the serum kisspeptin levels in women with the PCOS. After adjusting for age, serum kisspeptin levels were comparable in both groups (p > .05). Serum LH, AMH, DHEA-S and total testosterone glucose, insulin levels and HOMA-IR values were significantly higher in women with PCOS as compared to controls (all p < .05). CONCLUSIONS Serum kisspeptin levels were similar in women with and without PCOS but positively correlated with AMH serum levels in PCOS women.
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Affiliation(s)
- Ayşegül Mut
- Department of Obstetrics and Gynecology, Istanbul University-Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Cemal Tamer Erel
- Department of Obstetrics and Gynecology, Istanbul University-Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Deniz İnan
- Department of Statistics, Marmara University, Istanbul, Turkey
| | - Yahya Özgün Öner
- Department of Obstetrics and Gynecology, Istanbul University-Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
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Kadirogullari P, Yalcin Bahat P, Topbas Selcuki F, Irak K, Seckin KD. Ovarian reserve assessment in crohn patients of reproductive age. Ginekol Pol 2021; 92:550-555. [PMID: 33844252 DOI: 10.5603/gp.a2020.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/23/2021] [Accepted: 10/05/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Crohn's disease (CD) is a repeating bowel disease characterized by remission and exacerbation periods. The disease mostly affects adults of reproductive age. Women with desires to conceive are concerned about the effects of CD on their fertility. To demonstrate the relationship between ovarian reserve and CD anti-Müllerian hormone (AMH) levels, antral follicle count (AFC) and ovarian volüme were evaluated. MATERIAL AND METHODS The prospective case-controlled study was conducted at a tertiary referral center in Istanbul between March-August 2019. Ovarian functions were evaluated in 50 patients with CD and in 95 healthy women. Serum gonadotropin and AMH levels were determined. AFCs and ovarian volumes were calculated for all subjects. RESULTS AMH levels were significantly lower in CD patients (2.1 ± 0.8) compared to the control group (3.3 ± 0.9) (P = 0.001). Serum AMH levels were significantly lower in patients with active CD (2.1 ± 0.6) than the CD patients in remission (2.6 ± 0.8) (p = 0.002). Ovarian volumes and AFC values were significantly lower in both ovaries in CD patients compared to the controls (p < 0.05). CONCLUSIONS AMH levels, ovarian volume and AFC counts, and thus ovarian reserve was shown to be decreased in CD patients of reproductive age compared to healthy control subjects. Because possible effects of inflammatory damage may be seen in newly diagnosed female CD patients who desire to have a child, we believe that CD patients should be comprehensively assessed for ovarian reserve.
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Affiliation(s)
- Pinar Kadirogullari
- Department of Obstetrics and Gynecology, Acıbadem University Atakent Hospital, Istanbul, Turkey.
| | - Pinar Yalcin Bahat
- Department of Obstetrics and Gynecology, Health Sciences University Kanuni Sultan Suleyman Suam, Istanbul, Turkey
| | - Fitnat Topbas Selcuki
- Department of Obstetrics and Gynecology, Health Sciences University Kanuni Sultan Suleyman Suam, Istanbul, Turkey
| | - Kader Irak
- Department of Gastroenterology, Istanbul Health Sciences University, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Kerem Doga Seckin
- Department of Obstetrics and Gynecology, Health Sciences University Kanuni Sultan Suleyman Suam, Istanbul, Turkey
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Elçi E, Güneş Elçi G, Çim N, Aras İ, Sayan S, Yıldızhan R. Energy drinks may affect the ovarian reserve and serum anti-mullerian hormone levels in a rat model. Turk J Obstet Gynecol 2021; 18:23-29. [PMID: 33715329 PMCID: PMC7962157 DOI: 10.4274/tjod.galenos.2020.07347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objective Energy drinks have an impact on concentration levels, physical performance, speed of reaction, and focus, but these drinks cause many adverse effects and intoxication symptoms. The main goal of this study was to determine the effect of energy drink consumption on ovarian reserve and serum anti-mullerian hormone (AMH) levels. Materials and Methods Female Wistar albino rats (n=16) were included and randomized into two groups (n=8). Serum AMH levels were checked before and after energy drinks were given. Eight weeks later, the ovaries and uteruses of the rats were analyzed histopathologically. The number of follicles in the ovaries was counted. Results The total number of the preantral plus small antral follicles, which show the ovarian reserve, was decreased at the end of eight weeks in both the control group and the energy drink group. There was a statistical difference between them (p=0.021). Also, there was a statistically significant difference in the initial/final AMH (ng/mL) reduction levels between the control group and the energy drink group (p=0.002). AMH levels were decreased more in the energy drink group. Conclusion The consumption of energy drinks can lead to a decrease in ovarian reserve and AMH values and may cause weight gain.
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Affiliation(s)
- Erkan Elçi
- University of Health Sciences Turkey, Ümraniye Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Gülhan Güneş Elçi
- University of Health Sciences Turkey, Sancaktepe Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Numan Çim
- İstanbul Bilim University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - İbrahim Aras
- Yüzüncü Yıl University Faculty of Medicine, Department of Pathology, Van, Turkey
| | - Sena Sayan
- Marmara University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Recep Yıldızhan
- İstanbul Bilim University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
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Rak AY, Trofimov AV, Ischenko AM, Sokolov AV. [The study of interaction of different forms of human recombinant anti-mullerian hormone with a chimeric analogue of the AMH type II]. Biomed Khim 2021; 67:66-73. [PMID: 33645523 DOI: 10.18097/pbmc20216701066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The homodimeric glycoprotein, anti-mullerian hormone (AMH), described over 70 years ago by A. Jost, is the least studied member of the transforming growth factor beta superfamily. Despite the antitumor activity of AMH discovered at the end of the last century, the creation of effective drugs based on AMH is hindered primarily by the lack of information on the mechanism of various AMH forms interaction with a specific type II receptor (MISRII). Previously, we have shown that not only the full-length activated hormone but also its C-terminal fragment (C-rAMH) could bind to MISRII. In this work, using the surface plasmon resonance technique, we compared the interaction of three forms of recombinant AMH (rAMH) with the MISRII analogue - the chimeric protein MISRII-Fc containing AMH type II receptor and a Fc-fragment of the human IgG1 heavy chain. Comparison of the binding of MISRII-Fc, immobilized on a chip with group specificity for human immunoglobulins, to C-rAMH, to intact rAMH (pro-rAMH), and to rAMH containing one uncleaved monomer (hc-rAMH), showed that the KD of the complexes increased: 1.7 nM, 88 nM and 110 nM, respectively. Thus, we have shown that C-terminal fragment of AMH has the maximum affinity for the recombinant MISRII analogue, which indicates the prospects for the development of drugs based on this hormone derivative.
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Affiliation(s)
- A Ya Rak
- State Research Institute for Highly Pure Biopreparations, Saint-Petersburg, Russia
| | - A V Trofimov
- State Research Institute for Highly Pure Biopreparations, Saint-Petersburg, Russia
| | - A M Ischenko
- State Research Institute for Highly Pure Biopreparations, Saint-Petersburg, Russia
| | - A V Sokolov
- Institute of Experimental Medicine, St. Petersburg, Russia
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Biyik I, Ozatik FY, Albayrak M, Ozatik O, Teksen Y, Ari NS, Soysal C. The effects of recombinant klotho in cisplatin-induced ovarian failure in mice. J Obstet Gynaecol Res 2021; 47:1817-1824. [PMID: 33611838 DOI: 10.1111/jog.14700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/20/2020] [Accepted: 01/28/2021] [Indexed: 01/16/2023]
Abstract
AIM To investigate whether recombinant klotho given concomitantly with cisplatin is effective in preventing cisplatin-induced ovarian damage. METHODS Thirty-two adult female mice were divided into four groups. Saline was given to the first group, cisplatin to the second group, recombinant mouse klotho to the third group, and recombinant mouse klotho + cisplatin to the fourth group. The removed ovarian tissues were examined and groups were compared histologically and immunohistochemical examination for antimullerian hormone (AMH), superoxide dismutase (SOD) and catalase expression were done. Glutathione peroxidase (GPx) and glutathione reductase (GR) activities were measured by ELISA. RESULTS Ovarian tissue weight, primary and secondary follicle counts were higher in cisplatin + recombinant klotho group compared to cisplatin group in our study (respectively p < 0.0001, p < 0.0001, and p = 0.010). Injury scores (stromal congestion, edema and infiltration, follicular degeneration scores and edema in corpus luteum scores) were similar between cisplatin and cisplatin + recombinant klotho groups (all p > 0.05). AMH staining intensities were similar between cisplatin and cisplatin + recombinant klotho groups (p = 0.925). There was no difference between the groups in terms of SOD, GPx, and GR (p > 0.05). CONCLUSIONS The recombinant klotho administered before cisplatin could partially protect the ovarian tissue from cisplatin-induced ovarian damage considering that there was no difference in histologic injury score parameters, AMH staining intensity and oxidative stress markers between cisplatin and cisplatin plus klotho groups except that klotho preserved follicules to some extent. The antioxidant mechanism of action of klotho may not be the primary protection mechanism in cisplatin induced ovarian injury.
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Affiliation(s)
- Ismail Biyik
- School of Medicine, Department of Obstetrics and Gynecology, Kutahya Health Sciences University, Kutahya, Turkey
| | - Fikriye Yasemin Ozatik
- School of Medicine, Department of Medical Pharmacology, Kutahya Health Sciences University, Kutahya, Turkey
| | - Mustafa Albayrak
- Department of Obstetrics and Gynecology, Florence Nightingale Hospital, Istanbul, Turkey
| | - Orhan Ozatik
- School of Medicine Department of Histology and Embryology, Kutahya Health Sciences University, Kutahya, Turkey
| | - Yasemin Teksen
- School of Medicine, Department of Medical Pharmacology, Kutahya Health Sciences University, Kutahya, Turkey
| | - Neziha Senem Ari
- Department of Histology and Embryology, Kutahya Evliya Celebi Education and Research Hospital, Kutahya, Turkey
| | - Cenk Soysal
- School of Medicine, Department of Obstetrics and Gynecology, Kutahya Health Sciences University, Kutahya, Turkey
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Parmova O, Vlckova E, Hulova M, Mensova L, Crha I, Stradalova P, Kralickova E, Jurikova L, Podborska M, Mazanec R, Dusek L, Jarkovsky J, Bednarik J, Vohanka S, Srotova I. Anti-Müllerian hormone as an ovarian reserve marker in women with the most frequent muscular dystrophies. Medicine (Baltimore) 2020; 99:e20523. [PMID: 32502004 PMCID: PMC7306369 DOI: 10.1097/md.0000000000020523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Some muscular dystrophies may have a negative impact on fertility. A decreased ovarian reserve is 1 of the factors assumed to be involved in fertility impairment. AMH (anti-Müllerian hormone) is currently considered the best measure of ovarian reserve.A total of 21 females with myotonic dystrophy type 1 (MD1), 25 females with myotonic dystrophy type 2 (MD2), 12 females with facioscapulohumeral muscular dystrophy (FSHD), 12 female carriers of Duchenne muscular dystrophy mutations (cDMD) and 86 age-matched healthy controls of reproductive age (range 18 - 44 years) were included in this case control study. An enzymatically amplified 2-site immunoassay was used to measure serum AMH level.The MD1 group shows a significant decrease of AMH values (median 0.7 ng/mL; range 0 - 4.9 ng/mL) compared with age-matched healthy controls (P < .01). AMH levels were similar between patients and controls in terms of females with MD2 (P = .98), FSHD (P = .55) and cDMD (P = .60).This study suggests decreased ovarian reserve in women with MD1, but not in MD2, FSHD and cDMD.
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Affiliation(s)
- Olesja Parmova
- Department of Neurology, University Hospital Brno
- Faculty of Medicine, Masaryk University, Brno
- European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Czechia
| | - Eva Vlckova
- Department of Neurology, University Hospital Brno
- Faculty of Medicine, Masaryk University, Brno
- European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Czechia
- CEITEC – Central European Institute of Technology, Masaryk University, Brno
| | - Monika Hulova
- Department of Neurology, University Hospital Brno
- Faculty of Medicine, Masaryk University, Brno
| | - Livie Mensova
- European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Czechia
- Department of Neurology, Second Faculty of Medicine, Charles University, Prague and University Hospital Motol, Prague
| | - Igor Crha
- Faculty of Medicine, Masaryk University, Brno
- Department of Obstetrics and Gynaecology, University Hospital Brno
| | - Petra Stradalova
- Department of Neurology, University Hospital Brno
- Faculty of Medicine, Masaryk University, Brno
| | | | - Lenka Jurikova
- Faculty of Medicine, Masaryk University, Brno
- European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Czechia
- Department of Paediatric Neurology, Masaryk University and University Hospital Brno
| | | | - Radim Mazanec
- European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Czechia
- Department of Paediatric Neurology, Masaryk University and University Hospital Brno
| | - Ladislav Dusek
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Josef Bednarik
- Department of Neurology, University Hospital Brno
- Faculty of Medicine, Masaryk University, Brno
- European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Czechia
- CEITEC – Central European Institute of Technology, Masaryk University, Brno
| | - Stanislav Vohanka
- Department of Neurology, University Hospital Brno
- Faculty of Medicine, Masaryk University, Brno
- European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Czechia
- CEITEC – Central European Institute of Technology, Masaryk University, Brno
| | - Iva Srotova
- Department of Neurology, University Hospital Brno
- Faculty of Medicine, Masaryk University, Brno
- European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Czechia
- CEITEC – Central European Institute of Technology, Masaryk University, Brno
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Fatima S, Naqvi Q, Tauseef A, Qamar M, Khan QU, Akram T, Saeed M. Correlation of Serum Anti-Mullerian Hormone with Ovarian Follicle Output Rate in Infertile Females: A Clomiphene Citrate Challenge Test. Cureus 2020; 12:e8032. [PMID: 32528768 PMCID: PMC7282373 DOI: 10.7759/cureus.8032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- Syeda Fatima
- Physiology, Islam Medical and Dental College, Sialkot, PAK
| | - Qanbar Naqvi
- Anatomy, Islam Medical and Dental College, Sialkot, PAK
| | - Ambreen Tauseef
- Physiology, Combined Military Hospital Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Mehwish Qamar
- Physiology, Islam Medical and Dental College, Sialkot, PAK
| | - Qudsia U Khan
- Physiology, Combined Military Hospital Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Tanzeela Akram
- Physiology, Combined Military Hospital Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Muniza Saeed
- Physiology, Ameer Ud Din Medical College, Lahore, PAK
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Karadağ C, Demircan S, Turgut A, Çalışkan E. Effects of laparoscopic cystectomy on ovarian reserve in patients with endometrioma and dermoid cyst. Turk J Obstet Gynecol 2020; 17:15-20. [PMID: 32341825 PMCID: PMC7171546 DOI: 10.4274/tjod.galenos.2020.37605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/09/2020] [Indexed: 12/01/2022] Open
Abstract
Objective: To compare the effects of laparoscopic cystectomy on ovarian reserve between women with endometrioma and dermoid cyst. Materials and Methods: Thirty-six patients were diagnosed as having endometrioma (group A) and 32 patients with dermoid cyst (group B) using ultrasonography. Preoperative anti-mullerian hormone (AMH) levels were measured and unilateral antral follicle counts (AFC) were calculated for the ovary side containing the cyst. Laparoscopic cystectomy was performed using the stripping technique for all participants. After 3 months, all participants were re-evaluated between the third and sixth day of their menstrual cycle to determine AFC and AMH levels. Results: The mean serum preoperative AMH level and AFC level were significantly lower in group A than in group B (p=0.001, p=0.002), respectively. At 3 months after the surgery, serum AMH levels decreased significantly in group A from 2.04±0.68 to 1.47±0.55 (p=0.001), and from 2.60±0.57 to 2.17±0.56 in group B (p=0.001). In group A, unilateral (operated side) AFC levels decreased significantly from 4.05±1.24 to 2.16±0.94 (p=0.001), and in group B, it decreased significantly from 4.93±0.94 to 3.40±0.87 (p=0.001). The decrease in AMH levels was significantly higher in group A than in group B (p=0.033). The decrease in AFC levels was also significantly higher in group A than in group B (p=0.044). Conclusion: Laparoscopic stripping has destructive effects on serum AMH levels and the operated side AFC levels after surgery for patients with endometrioma and dermoid cysts, and laparoscopic excision of endometrioma has more destructive effects on ovarian reserve than dermoid cysts.
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Affiliation(s)
- Cihan Karadağ
- Okan University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Sinem Demircan
- İstanbul Medeniyet University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Abdulkadir Turgut
- İstanbul Medeniyet University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Eray Çalışkan
- Okan University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
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Irvin SR, Weiderpass E, Stanczyk FZ, Brinton LA, Trabert B, Langseth H, Wentzensen N. Association of Anti-Mullerian Hormone, Follicle-Stimulating Hormone, and Inhibin B with Risk of Ovarian Cancer in the Janus Serum Bank. Cancer Epidemiol Biomarkers Prev 2020; 29:636-642. [PMID: 31932414 PMCID: PMC7060092 DOI: 10.1158/1055-9965.epi-19-0675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/05/2019] [Accepted: 12/18/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Reproductive factors, including parity, breastfeeding, and contraceptive use, affect lifetime ovulatory cycles and cumulative exposure to gonadotropins and are associated with ovarian cancer. To understand the role of ovulation-regulating hormones in the etiology of ovarian cancer, we prospectively analyzed the association of anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), and inhibin B with ovarian cancer risk. METHODS Our study included 370 women from the Janus Serum Bank, including 54 type I and 82 type II invasive epithelial ovarian cancers, 49 borderline tumors, and 185 age-matched controls. We used conditional logistic regression to assess the relationship between hormones and risk of ovarian cancer overall and by subtype (types I and II). RESULTS Inhibin B was associated with increased risk of ovarian cancer overall [OR, 1.97; 95% confidence interval (CI), 1.14-3.39; P trend = 0.05] and with type I ovarian (OR, 3.10; 95% CI, 1.04-9.23; P trend = 0.06). FSH was not associated with ovarian cancer risk overall, but higher FSH was associated with type II ovarian cancers (OR, 2.78; 95% CI, 1.05-7.38). AMH was not associated with ovarian cancer risk. CONCLUSIONS FSH and inhibin B may be associated with increased risk in different ovarian cancer subtypes, suggesting that gonadotropin exposure may influence risk of ovarian cancer differently across subtypes. IMPACT Associations between prospectively collected AMH, FSH, and inhibin B levels with risk of ovarian cancer provide novel insight on the influence of premenopausal markers of ovarian reserve and gonadotropin signaling. Heterogeneity of inhibin B and FSH effects in different tumor types may be informative of tumor etiology.
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Affiliation(s)
- Sarah R Irvin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Frank Z Stanczyk
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Hilde Langseth
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Gupta M, Yadav R, Mahey R, Agrawal A, Upadhyay A, Malhotra N, Bhatla N. Correlation of body mass index (BMI), anti-mullerian hormone (AMH), and insulin resistance among different polycystic ovary syndrome (PCOS) phenotypes - a cross-sectional study. Gynecol Endocrinol 2019; 35:970-973. [PMID: 31081410 DOI: 10.1080/09513590.2019.1613640] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
One hundred and fifty infertile polycystic ovary syndrome (PCOS) women were classified into four phenotypes on the basis of Rotterdam criteria. Homeostatic model assessment of insulin resistance (HOMA-IR) with a cutoff ≥2.5 was considered as a measure of insulin resistance (IR). Maximum number of patients, 57 (38%) in our cohort belonged to phenotype A or the classical phenotype with all 3 features of Rotterdam criteria. Mean body mass index (BMI) in all phenotypes was more than 25 kg/m2 and the highest was seen in phenotype B. According to BMI categories in the four phenotypes, more number of women was in the obese category in phenotype A (24.5%) and B (56.5%) in comparison to phenotype C (18.2%) and D (10.8%) (p<.001). There was no difference in median HOMA-IR among different phenotype categories (p=.718). The median value of anti-mullerian hormone (AMH) was highest in phenotype A (11.68 ng/ml [7.94-16.46]) and significantly more in comparison to B phenotype (Kruskal-Wallis, p=.018). Thus there is heterogeneity in AMH levels and BMI in different PCOS phenotypes with higher levels in the most severe phenotypes. There is, however, no correlation of IR among the different phenotype groups and further investigation is needed to characterize its role in phenotypic classification.
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Affiliation(s)
- Monica Gupta
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences , New Delhi , India
| | - Ritu Yadav
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences , New Delhi , India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences , New Delhi , India
| | - Anisha Agrawal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences , New Delhi , India
| | - Ashish Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences , New Delhi , India
| | - Neena Malhotra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences , New Delhi , India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences , New Delhi , India
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Abstract
The aim of this study is to evaluate ovarian reserve in women with psoriasis. Thirty-six women with psoriasis and 36 healthy women were enrolled in this prospective study. On day 3 of the menstrual cycle, blood samples for AMH and other hormones were collected. On the same day, antral follicle count (AFC), and ovarian volumes were measured. A multiple regression analysis was carried out to examine the contribution of factors to the serum AMH levels in patients with psoriasis. The serum AMH levels and ovarian volumes were lower in the psoriasis group than in the control group (1.85 ± 1.13 ng/ml vs 2.46 ± 1.21 ng/ml, p = .029 and 10.43 ± 3.08 cm3 vs 11.93 ± 3.01 cm3, p = .038). However, the mean AFC between the two groups was not significantly different. The psoriasis area severity index (PASI) score did not correlate with AMH. On the other hand, the duration of the disease negatively correlated with AMH, total AFC and ovarian volume. In the multiple regression analysis, duration of disease and total AFC were the most significant contributors to the serum AMH levels in patients with psoriasis. Autoimmune diseases may affect ovarian reserve regardless of immunosuppresive treatment. Longitudinal follow-ups regarding reproductive function might be required in women with psoriasis.
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Affiliation(s)
- Begum Aydogan Mathyk
- a Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility , University of North Carolina , Chapel Hill , NC , USA
| | - Berna Aslan Cetin
- b Department of Obstetrics and Gynecology , Kanuni Sultan Suleyman Research and Training Hospital , Istanbul , Turkey
| | - Sule Bilici
- c Department of Dermatology , Kanuni Sultan Suleyman Research and Training Hospital , Istanbul , Turkey
| | - Julia Fasse
- d Department of Obstetrics and Gynecology, Tufts University , Medford , MA , USA
| | - Pinar Avci
- e Department of Dermatology, Dermatooncology and Venerology , Semmelweis University School of Medicine , Budapest , Hungary
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Rak AY, Trofimov AV, Petrov AV, Gorbunov NP, Ischenko AM. [The dynamics of human total and activated anti-mullerian hormone serum levels in different life periods.]. Klin Lab Diagn 2019; 64:342-347. [PMID: 31200405 DOI: 10.18821/0869-2084-2019-64-6-342-347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/26/2019] [Indexed: 11/17/2022]
Abstract
Here, changes in the serum level of total anti-mullerian hormone (AMH) and its activated form in children of both sexes and women with different reproductive status are investigated. This TGFβ superfamily cytokine is known to provide the formation of the male-type reproductive system in mammalian embryogenesis, and regulate folliculogenesis, spermatogenesis and the balance of sex hormones after birth. The biologically active form of the hormone (aAMH) is formed as a result of limited proteolysis of the AMH molecule; it is not reliably known in which tissues and under the action of which enzyme it occurs. The serum level of aAMH seems to be a more informative clinical indicator than the content of total AMH (tAMH), but there are no ELISA systems at the world market that provide direct quantitative detection of aAMH. In this work, quantitative detection of total hormone (tAMH) and its biologically active form (aAMH) in serum was performed using specially developed enzyme immunoassay systems. We showed that in girls, the total serum AMH level, as well as the concentration ratio aAMH / tAMH, practically does not change with age, whereas in boys, there is not only a significant decrease in the total serum AMH level previously described in the literature (Pearson correlation coefficient R = - 0.86, p <0.001), but also in the ratios of the aAMH / tAMH level (R = -0.531, p <0.001). It was also found that in pregnant women, the amount of total AMH and the proportion of aAMH in serum was significantly higher (p <0.01 and p <0.001, respectively) than in the control group women. The obtained results are in good agreement with the available data on the total and activated AMH content in the blood serum of people of different sex and age and indicate a change in the ratio of aAMH / tAMH serum levels in pregnancy. These data may be important both for deepening the understanding of AMH biology and for interpreting the results obtained using AMH detection based diagnostics.
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Affiliation(s)
- A Ya Rak
- State Research Institute for Highly Pure Biopreparations, 197110, St. Petersburg, Russia
| | - A V Trofimov
- State Research Institute for Highly Pure Biopreparations, 197110, St. Petersburg, Russia
| | - A V Petrov
- State Research Institute for Highly Pure Biopreparations, 197110, St. Petersburg, Russia
| | - N P Gorbunov
- State Research Institute for Highly Pure Biopreparations, 197110, St. Petersburg, Russia
| | - A M Ischenko
- State Research Institute for Highly Pure Biopreparations, 197110, St. Petersburg, Russia
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Abstract
OBJECTIVE Anti-Mullerian hormone (AMH) together with luteinizing hormone (LH) and follicle-stimulating hormone (FSH) plays crucial roles in gonadal functions. However, the possible effects of GnRH on AMH via the hypothalamic-pituitary-gonadal (HPG) axis remain unexplored. We aimed to explore the changes in AMH levels after bolus GnRH stimulation and understand the relationship of AMH with FSH and LH in healthy subjects. METHODS Thirty-one prepubertal children (15 males/16 females) and 78 adults (36 males/42 females) were included. We collected basal (0 minute) samples for determining levels of hormones. After GnRH treatment at a dose of 2.5 μg/kg body weight (maximum of 100 μg/kg body weight) intravenously, blood was collected at 30 minutes intervals for 120 minutes. Serum LH, FSH and AMH were measured by electrochemiluminometric assays. RESULTS After injection of GnRH, AMH levels were significantly decreased in 30 minutes (P < 0.001) in all groups with parallel increase of FSH and LH. In the second 30 minutes, all hormones levels reversed. There was also a moderate correlation between AMH and FSH (r = -0.430, P < 0.001). CONCLUSIONS GnRH lowers serum AMH levels, which have a negative correlation with the increase in gonadotrophins. These data pinpoint GnRH as an important factor of the AMH regulation, leading new opportunities for the understanding of AMH role in reproductive function and dysfunction.
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Affiliation(s)
- Josef van Helden
- Laboratory Diagnostic Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Osman Evliyaoglu
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry, Aachen, Germany
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry, Aachen, Germany
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Long H, Nie Y, Wang L, Lu Y, Wang Y, Cai Y, Liu Z, Jia M, Lyu Q, Kuang Y, Sun Q. Serum anti-Mullerian hormone predicts ovarian response in (Macaca fascicularis) monkeys. Endocr Connect 2018; 7:983-989. [PMID: 30300541 PMCID: PMC6176281 DOI: 10.1530/ec-18-0189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AMH as a promising predictor of ovarian response has been studied extensively in women undergoing assisted reproductive technology treatment, but little is known about its prediction value in monkeys undergoing ovarian stimulation. In the current study, a total of 380 cynomolgus monkeys ranging from 5 to 12 years received 699 ovarian stimulation cycles. Serum samples were collected for AMH measure with enzyme-linked immunosorbent assay. It was found that serum AMH levels were positive correlated with the number of retrieved oocytes (P < 0.01) in the first, second and third stimulation cycles. In the first cycles, area under the curve (ROCAUC) of AMH is 0.688 for low response and 0.612 for high response respectively, indicating the significant prediction values (P = 0.000 and P = 0.005). The optimal AMH cutoff value was 9.68 ng/mL for low ovarian response and 15.88 ng/mL for high ovarian response prediction. In the second stimulation cycles, the significance of ROCAUC of AMH for high response rather than the low response was observed (P = 0.001 and P = 0.468). The optimal AMH cutoff value for high ovarian response was 15.61 ng/mL. In the third stimulation cycles, AMH lost the prediction value with no significant ROCAUC. Our data demonstrated that AMH, not age, is a cycle-dependent predictor for ovarian response in form of oocyte yields, which would promote the application of AMH in assisted reproductive treatment (ART) of female cynomolgus monkeys. AMH evaluation would optimize candidate selection for ART and individualize the ovarian stimulation strategies, and consequentially improve the efficiency in monkeys.
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Affiliation(s)
- Hui Long
- Department of Assisted ReproductionShanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yanhong Nie
- Institute of NeuroscienceState Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Li Wang
- Department of Assisted ReproductionShanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yong Lu
- Institute of NeuroscienceState Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Yan Wang
- Institute of NeuroscienceState Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Yijun Cai
- Institute of NeuroscienceState Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Zhen Liu
- Institute of NeuroscienceState Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Miaomiao Jia
- Department of Assisted ReproductionShanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qifeng Lyu
- Department of Assisted ReproductionShanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Correspondence should be addressed to Q Sun or Y Kuang or Q Lyu: or or
| | - Yanping Kuang
- Department of Assisted ReproductionShanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Correspondence should be addressed to Q Sun or Y Kuang or Q Lyu: or or
| | - Qiang Sun
- Institute of NeuroscienceState Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
- Correspondence should be addressed to Q Sun or Y Kuang or Q Lyu: or or
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Abstract
INTRODUCTION Preimplantation genetic diagnosis/screening (PGD/PGS) can effectively detect chromosomal abnormalities in an embryo but only if an embryo is available. However, not all couples can obtain an embryo that is available for testing. The purpose of this study was to identify factors which might affect the formation of PGD/PGS embryos to predict the possibility of obtaining embryos that could be detected. MATERIAL AND METHODS In a retrospective study, we included all couples who underwent PGD/PGS at our center from January 2015 to December 2016. We compared these patients according to the non-blastocyst group and the blastocyst group. RESULTS There were 302 couples who had blastocysts in their first PGD/PGS cycle. Fifty-seven couples had no blastocysts in their PGD/PGS cycles: 43 couples had no blastocysts in one cycle; 10 in two cycles; 4 in three cycles. The non-blastocyst group was older than the blastocyst group (32.37 vs. 30.69, p = 0.048). Anti-mullerian hormone (AMH, ng/ml) in the non-blastocyst group was significantly lower than in the blastocyst group (4.80 ±3.67 vs. 3.07 ±2.30, p = 0.00). Women whose chromosome were aneuploid (47, XXX or 45, X) had a similar AMH level compared with others, but the number of retrieved oocytes was much lower; the normal karyotype was 14.25 and aneuploidy was 5.40 (p = 0.01) in women < 30 years old. There was the same condition in women aged 30-38 years (14.60 vs. 3.44, p < 0.001). Male's different chromosome karyotype had no influence on double pronuclear number or the rate of blastocyst formation. Presence of endometriosis, polycystic ovary syndrome and tubal factor showed no difference between the blastocyst and non-blastocyst group. Nor did oligospermia and asthenospermia. CONCLUSIONS Elderly women, those with lower AMH and women with 47, XXX or 45, X have fewer ova, leading to the possibility of no blastocyst. These couples should be fully informed and weigh the advantages and disadvantages before undergoing PGD/PGS.
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Affiliation(s)
- Zhong Zheng
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Xiaoming Zhao
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Bing Xu
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
| | - Ning Yao
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
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Indran IR, Huang Z, Khin LW, Chan JKY, Viardot-Foucault V, Yong EL. Simplified 4-item criteria for polycystic ovary syndrome: A bridge too far? Clin Endocrinol (Oxf) 2018; 89:202-211. [PMID: 29851127 DOI: 10.1111/cen.13755] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/25/2018] [Accepted: 05/28/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although the Rotterdam 2003 polycystic ovarian syndrome (PCOS) diagnostic criteria is widely used, the need to consider multiple variables makes it unwieldy in clinical practice. We propose a simplified PCOS criteria wherein diagnosis is made if two of the following three items were present: (i) oligomenorrhoea, (ii) anti-mullerian hormone (AMH) above threshold and/or (iii) hyperandrogenism defined as either testosterone above threshold and/or the presence of hirsutism. DESIGN SETTING AND PARTICIPANTS This prospective cross-sectional study consists of healthy women (n = 157) recruited at an annual hospital health screen for staff and volunteers from the university community, and a patient cohort (n = 174) comprising women referred for suspected PCOS. MAIN OUTCOME MEASURES We used the healthy cohort to establish threshold values for serum testosterone, antral follicle counts (AFC), ovarian volume (OV) and AMH. Women from the patient cohort, classified as PCOS by simplified PCOS criteria, AMH alone and Rotterdam 2003, were compared with respect to prevalence of oligomenorrhoea, hyperandrogenism and metabolic indices. RESULTS In healthy women, testosterone ≥1.89 nmol/L, AFC ≥22 follicles and OV ≥8.44 mL, best predicted oligomenorrhoea and were used as threshold values for PCOS criteria. An AMH level ≥37.0 pmol/L best predicted polycystic ovarian morphology. AMH alone as a single biomarker demonstrated poor specificity (58.9%) for PCOS compared to Rotterdam 2003. In contrast, there was a 94% overlap in women selected as PCOS by the simplified PCOS criteria and Rotterdam 2003. The population characteristics of these two groups of PCOS women showed no significant mean differences in androgenic, ovarian, AMH and metabolic (BMI, HOMA-IR) variables. CONCLUSIONS Our data recommend the simplified PCOS criteria with population-specific thresholds for diagnosis of PCOS. Its ability to replace ovarian ultrasound biometry with the highly correlated variable AMH, and use of testosterone as a single marker for hyperandrogenaemia alongside the key symptoms of oligomenorrhoea and hirsutism confers significant clinical potential for the diagnosis of PCOS.
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Affiliation(s)
- Inthrani R Indran
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore, Singapore
- Deparment of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Zhongwei Huang
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore, Singapore
| | - Lay Wai Khin
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore, Singapore
| | - Jerry K Y Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | - Eu Leong Yong
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore, Singapore
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Fortner RT, Schock H, Jung S, Allen NE, Arslan AA, Brinton LA, Egleston BL, Falk RT, Gunter MJ, Helzlsouer KJ, Idahl A, Johnson TS, Kaaks R, Krogh V, Lundin E, Merritt MA, Navarro C, Onland-Moret NC, Palli D, Shu XO, Sluss PM, Staats PN, Trichopoulou A, Weiderpass E, Zeleniuch-Jacquotte A, Zheng W, Dorgan JF. Anti-Mullerian hormone and endometrial cancer: a multi-cohort study. Br J Cancer 2017; 117:1412-1418. [PMID: 28873086 PMCID: PMC5672934 DOI: 10.1038/bjc.2017.299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/30/2017] [Accepted: 08/04/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The Mullerian ducts are the embryological precursors of the female reproductive tract, including the uterus; anti-Mullerian hormone (AMH) has a key role in the regulation of foetal sexual differentiation. Anti-Mullerian hormone inhibits endometrial tumour growth in experimental models by stimulating apoptosis and cell cycle arrest. To date, there are no prospective epidemiologic data on circulating AMH and endometrial cancer risk. METHODS We investigated this association among women premenopausal at blood collection in a multicohort study including participants from eight studies located in the United States, Europe, and China. We identified 329 endometrial cancer cases and 339 matched controls. Anti-Mullerian hormone concentrations in blood were quantified using an enzyme-linked immunosorbent assay. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) across tertiles and for a doubling of AMH concentrations (ORlog2). Subgroup analyses were performed by ages at blood donation and diagnosis, oral contraceptive use, and tumour characteristics. RESULTS Anti-Mullerian hormone was not associated with the risk of endometrial cancer overall (ORlog2: 1.07 (0.99-1.17)), or with any of the examined subgroups. CONCLUSIONS Although experimental models implicate AMH in endometrial cancer growth inhibition, our findings do not support a role for circulating AMH in the aetiology of endometrial cancer.
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Affiliation(s)
- Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Cancer, Heidelberg, Germany
| | - Helena Schock
- Division of Cancer Epidemiology, German Cancer Research Cancer, Heidelberg, Germany
| | - Seungyoun Jung
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Naomi E Allen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alan A Arslan
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York University Perlmutter Cancer Center, New York, NY, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Marc J Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Kathy J Helzlsouer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Theron S Johnson
- Division of Cancer Epidemiology, German Cancer Research Cancer, Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Cancer, Heidelberg, Germany
| | - Vittorio Krogh
- Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Eva Lundin
- Department of Medical Biosciences and Pathology, Umeå University, Umeå, Sweden
| | - Melissa A Merritt
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Carmen Navarro
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - N Charlotte Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Florence, Italy
| | - Xiao-Ou Shu
- Department of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Patrick M Sluss
- Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Paul N Staats
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabete Weiderpass
- Department of Research, Group of Etiological Cancer Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Anne Zeleniuch-Jacquotte
- Department of Population Health and Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
| | - Wei Zheng
- Department of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Joanne F Dorgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Robertson DM, Lee CH, Baerwald A. Interrelationships among reproductive hormones and antral follicle count in human menstrual cycles. Endocr Connect 2016; 5:98-107. [PMID: 27856496 PMCID: PMC5314818 DOI: 10.1530/ec-16-0077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 11/17/2016] [Indexed: 01/28/2023]
Abstract
It is recognised that ovarian factors, including steroid and protein hormones, are critical in the feedback regulation of pituitary gonadotropins; however, their individual contributions are less defined. The aim of this study was to explore the reciprocal relationships between ovarian and pituitary hormones across the normal ovulatory menstrual cycle as women age. FSH, LH, oestradiol, progesterone, inhibin A, inhibin B and anti-mullerian hormone (AMH) were measured in serum collected every 1-3 days across one interovulatory interval (IOI) from 26 healthy women aged 18-50 years. The antral follicle count (AFC) for follicles 2-5 mm, >6 mm and 2-10 mm were tabulated across the IOI. Independent associations between ovarian hormones/AFC vs pituitary follicle-stimulating hormone (FSH) and luteinising hormone (LH) were investigated using multivariate regression analysis. The data were sub-grouped based on the presence or absence luteal phase-dominant follicles (LPDF). Serum oestradiol and AMH were inversely correlated with FSH in both follicular and luteal phases. Inhibin B correlated inversely with FSH and LH in the late follicular phase and directly in the luteal phase. AFC, inhibin A and progesterone were not key predictors of either FSH or LH. The strong association between AMH and FSH with age implies that AMH, as well as oestradiol and inhibin B are important regulators of FSH. The change in feedback response of inhibin B with both FSH and LH across the cycle suggests two phases of the negative feedback.
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Affiliation(s)
- David Mark Robertson
- Department of Molecular and Translational SciencesHudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia
- School of Women's & Children's HealthDiscipline of Obstetrics and Gynaecology, University of New South Wales, Sydney, Australia
| | - Chel Hee Lee
- Clinical Research Support UnitCollege of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Angela Baerwald
- Department of ObstetricsGynecology & Reproductive Sciences, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Davis S, Lahlou N, Bardsley M, Temple MC, Kowal K, Pyle L, Zeitler P, Ross J. Gonadal function is associated with cardiometabolic health in pre-pubertal boys with Klinefelter syndrome. Andrology 2016; 4:1169-1177. [PMID: 27637014 DOI: 10.1111/andr.12275] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/21/2016] [Accepted: 07/24/2016] [Indexed: 01/19/2023]
Abstract
The most common sex chromosome aneuploidy, Klinefelter syndrome (KS), is associated with primary gonadal failure and increased morbidity and mortality from cardiometabolic disorders in adulthood. Children with KS also have a high prevalence of metabolic syndrome (MetS) features. To assess the relationship of gonadal and cardiometabolic function in children with KS, we evaluated serum hormones [gonadotropins, inhibin B (INHB), anti-mullerian hormone (AMH), total testosterone (TT)], and features of MetS (waist circumference, fasting lipid panel, fasting blood glucose (FBG), and blood pressure) in 93 pre-pubertal boys with KS age 4-12 years (mean 7.7 ± 2.5 years). The cohort was grouped by age and tanner stage, and biomarkers were compared to normal ranges. A total of 80% of this pre-pubertal cohort had ≥1 feature of metabolic syndrome (MetS) and 11% had ≥3 features of MetS. Risk of MetS was independent of age and body mass index. Sertoli cell dysfunction was common with 18% having an INHB below the normal range. A low INHB was associated with higher FBG, triglycerides, LDL, and lower HDL (p < 0.05). An INHB <50 ng/dL yielded a sensitivity of 83% and a specificity of 79% for having ≥3 features of MetS. INHB and AMH positively correlated with each other (p < 0.001), and high AMH was protective of MetS. TT was below the lower limit of normal in 49% of subjects, with mean values significantly lower than expected (3.3 ng/dL vs. 4.9 ng/dL, p < 0.0001), however, no convincing relationship between TT and MetS was seen. In conclusion, gonadal and cardiometabolic dysfunction are prevalent in pre-pubertal boys with KS. Although the relationship of testosterone deficiency and MetS is well-known, this study is the first to report an association between impaired Sertoli cell function and cardiometabolic risk.
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Affiliation(s)
- S Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.,Section of Pediatric Endocrinology, Children's Hospital Colorado, Aurora, CO, USA
| | - N Lahlou
- Hormone Biology and Metabolism, Hospital Cochin, Paris, France
| | - M Bardsley
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA.,A.I. DuPont Hospital for Children, Wilmington, DE, USA
| | - M-C Temple
- Hormone Biology and Metabolism, Hospital Cochin, Paris, France
| | - K Kowal
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA.,A.I. DuPont Hospital for Children, Wilmington, DE, USA
| | - L Pyle
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.,Section of Pediatric Endocrinology, Children's Hospital Colorado, Aurora, CO, USA
| | - P Zeitler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.,Section of Pediatric Endocrinology, Children's Hospital Colorado, Aurora, CO, USA
| | - J Ross
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA.,A.I. DuPont Hospital for Children, Wilmington, DE, USA
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40
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Hou J, Cook-Andersen H, Su HI, Shayya R, Maas KH, Burt-Solorzano CM, Kumar A, Chang RJ. 17-Hydroxyprogesterone responses to human chorionic gonadotropin are not associated with serum anti-Mullerian hormone levels among adolescent girls with polycystic ovary syndrome. J Pediatr Endocrinol Metab 2016; 29:835-40. [PMID: 27166718 PMCID: PMC5424394 DOI: 10.1515/jpem-2015-0461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/29/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND In adult women with polycystic ovary syndrome (PCOS) 17-OHP responses to human chorionic gonadotropin (hCG) stimulation are highly variable and inversely correlated with serum anti-Mullerian hormone (AMH) levels. The objective of this study was to determine whether adolescents with PCOS exhibit similar variable 17-OHP responsiveness to hCG and whether these responses are correlated to AMH levels. METHODS In a prospective study, adolescent PCOS (n=14) and normal controls (n=10) received 25 μg of hCG, intravenously. Blood samples were obtained before and 24 h afterwards for measurement of 17-OHP and basal AMH. RESULTS Variable 17-OHP responses to hCG were observed among PCOS girls similar to that observed in adults. There was no correlation between AMH and 17-OHP responses to hCG. CONCLUSIONS Among adult and adolescent individuals with PCOS variable 17-OHP production appears to be characteristic of the disorder. In adolescent PCOS, 17-OHP responsiveness to hCG is not correlated to AMH.
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Affiliation(s)
- Jingwen Hou
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Heidi Cook-Andersen
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - H. Irene Su
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Rana Shayya
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Kevin H. Maas
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Christine M. Burt-Solorzano
- Department of Pediatrics, Center for Research in Reproduction, University of Virginia Charlottesville, VA, USA
| | | | - R. Jeffrey Chang
- Corresponding author: R. Jeffrey Chang, MD, Phone: +(858) 534-8930, Fax: +(868) 534-8856,
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Nieweglowska D, Hajdyla-Banas I, Pitynski K, Banas T, Grabowska O, Juszczyk G, Ludwin A, Jach R. Age-related trends in anti-Mullerian hormone serum level in women with unilateral and bilateral ovarian endometriomas prior to surgery. Reprod Biol Endocrinol 2015; 13:128. [PMID: 26596960 PMCID: PMC4657379 DOI: 10.1186/s12958-015-0125-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/17/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Endometriosis is a well-known cause of infertility, and the anti-Mullerian hormone (AMH) is an accepted biomarker of ovarian reserve and response to artificial reproductive technology procedures. The present study was a prospective analysis of age-dependent AMH serum concentration in women with bilateral and unilateral ovarian endometriomas before therapy onset compared with healthy controls. METHODS This prospective cross-sectional study included 384 women aged 18-48 years. AMH serum concentration was assessed between days 3 and 6 of the menstrual cycle in 78 patients with bilateral and 157 patients with unilateral ovarian endometriomas and compared with 149 healthy controls. Ovarian endometriosis was confirmed histopathologically, and data were presented as medians with interquartile range (IQR). RESULTS Stage III endometriosis was diagnosed in 53.2 %, stage IV in 18.3 %, stage V in 23.4 % and stage VI in 5.4 % of the patients. Patients with bilateral ovarian endometriomas showed the lowest median AMH levels compared with patients suffering from unilateral ovarian endometriosis (0.55; IQR: 0.59 vs. 2.00; IQR: 2.80; p < 0.001) and the control group (0.55; IQR: 0.59 vs. 2.84; IQR: 3.2; p < 0.001). Median AMH concentration values were not significantly different between patients with unilateral ovarian endometriosis and the healthy controls (2.00; IQR: 2.80 vs. 2.84; IQR: 3.2; p = 0.182). A strongly negative correlation between AMH levels and age was confirmed in healthy individuals (R = -0.834; p < 0.001) and women with unilateral ovarian endometriomas (R = -0.774; p < 0.001). Patients with bilateral ovarian endometriosis showed a significantly negative but only moderate correlation between AMH levels and age (R = -0.633; p < 0.001), which was significantly lower than in the healthy controls (R = -0.633 vs. R = -0.834; p = 0.006) but not in the patients with unilateral ovarian endometriosis (R = -0.663 vs. R-0.774; p = 0.093). Based on a multivariate regression analysis, only bilateral localization of ovarian endometrial cysts (p = 0.003) and patient age (p < 0.001), but not left/right localization of unilateral cyst or cyst volume, were negatively associated with AMH serum concentration. CONCLUSION According to our data, unilateral ovarian endometriosis had a moderately negative and nonsignificant effect on AMH-based ovarian reserve evaluated prior to surgery, irrespective of age. In contrast, the ovarian reserve was significantly reduced in women with bilateral ovarian endometriomas.
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Affiliation(s)
- Dorota Nieweglowska
- Department of Gynecology and Oncology, Jagiellonian University, Chair of Gynecology and Obstetrics, Krakow, 21 Kopernika Str, 30-501, Krakow, Poland
| | - Iwona Hajdyla-Banas
- Center of Rheumatology, Immunology and Rehabilitation, Dietl Specialistic Hospital, Krakow, Poland
| | - Kazimierz Pitynski
- Department of Gynecology and Oncology, Jagiellonian University, Chair of Gynecology and Obstetrics, Krakow, 21 Kopernika Str, 30-501, Krakow, Poland.
| | - Tomasz Banas
- Department of Gynecology and Oncology, Jagiellonian University, Chair of Gynecology and Obstetrics, Krakow, 21 Kopernika Str, 30-501, Krakow, Poland
| | - Oliwia Grabowska
- Nuffield Division of Clinical Laboratory Science, University of Oxford, Level 4, John Radcliffe Hospital, Headington, OX3 9DU, Oxford, UK
| | - Grzegorz Juszczyk
- Department of Public Health, Medical University of Warsaw, Warsaw, Poland
| | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Chair of Gynecology and Obstetrics, Krakow, 21 Kopernika Str, 30-501, Krakow, Poland
| | - Robert Jach
- Department of Gynecological Endocrinology, Jagiellonian University Medical College, Krakow, Poland
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Magri F, Schena L, Capelli V, Gaiti M, Zerbini F, Brambilla E, Rotondi M, De Amici M, Spinillo A, Nappi RE, Chiovato L. Anti-Mullerian hormone as a predictor of ovarian reserve in ART protocols: the hidden role of thyroid autoimmunity. Reprod Biol Endocrinol 2015; 13:106. [PMID: 26391773 PMCID: PMC4578365 DOI: 10.1186/s12958-015-0103-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 09/09/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Protocols of controlled ovarian hyper-stimulation (COH) require, as a crucial step, the identification of reliable predictors of ovarian reserve. Anti-Mullerian hormone (AMH) is one of the most reliable predictors of ovarian reserve but other factors including autoimmune thyroid diseases (ATD) have been associated with reduced fertility and poor COH outcome. Aim of the present study was to evaluate the relationship between ATD and AMH, and their role on the outcome of COH. METHODS The study group included 288 sub-fertile euthyroid women aged less than 40 years attending a single center for Reproductive Medicine. Among them, 55 were ATD-positive and 233 ATD-negative. The serum levels of AMH, FSH, LH, estradiol (E2), and TSH were measured before COH. The ratio between serum E2 concentration on the day of oocytes pick-up and the total dose of administered recombinant FSH (r-FSH) (E2/r-FSH ratio) was calculated. RESULTS The serum levels of AMH were significantly related to E2/r-FSH ratio, total dose of r-FSH and number of M II oocytes, both in ATD-positive and ATD-negative women. Within the low stratum of AMH levels, the presence of ATD did not further affect the outcome of COH. When the serum levels of AMH were in the high stratum, the presence of ATD significantly affected the E2/rFSH ratio, the total dose of r-FSH and the number of M II oocytes. CONCLUSIONS The probability of a poor response to COH is high, and independent from ATD, in women with low AMH serum levels. In women with a good ovarian reserve, as assessed by high AMH serum levels, the presence of ATD impairs the outcome of COH.
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Affiliation(s)
- Flavia Magri
- Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia, via S.Maugeri 10, 27100, Pavia, Italy.
| | - Lucia Schena
- Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia, via S.Maugeri 10, 27100, Pavia, Italy.
| | - Valentina Capelli
- Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia, via S.Maugeri 10, 27100, Pavia, Italy.
| | - Margherita Gaiti
- Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia, via S.Maugeri 10, 27100, Pavia, Italy.
| | - Francesca Zerbini
- Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia, via S.Maugeri 10, 27100, Pavia, Italy.
| | - Emanuela Brambilla
- Research Center for Reproductive Medicine, Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, University of Pavia, Pavia, Italy.
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia, via S.Maugeri 10, 27100, Pavia, Italy.
| | - Mara De Amici
- Department of Pediatrics, University of Pavia, IRCCS Policlinico S. Matteo, Pavia, Italy.
| | - Arsenio Spinillo
- Research Center for Reproductive Medicine, Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, University of Pavia, Pavia, Italy.
| | - Rossella E Nappi
- Research Center for Reproductive Medicine, Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, University of Pavia, Pavia, Italy.
| | - Luca Chiovato
- Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia, via S.Maugeri 10, 27100, Pavia, Italy.
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HUANG JILIANG, WANG XIAOYAN, LI ZHILING, MA RUOWU, XIAO WANFEN. Effects of GnRH agonists on the expression of developmental follicular anti-mullerian hormone in varying follicular stages in cyclic mice in vivo. Mol Med Rep 2015; 12:4305-4313. [PMID: 26126720 PMCID: PMC4526049 DOI: 10.3892/mmr.2015.3993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 06/05/2015] [Indexed: 02/05/2023] Open
Abstract
Gonadotrophin‑releasing hormone (GnRH) agonists (GnRHa) have been widely used to induce a state of downregulation for in vitro fertilization, and its direct effects on the pituitary are well known. However, the effects of GnRHa on the expression of anti‑mullerian hormone (AMH) by follicles in varying stages in vivo remain to be fully elucidated. In the present study 84 cyclic mice were randomly divided equally into four GnRHa groups and three cyclic mice were used as a control group. The expression levels of AMH in follicles of varying stages between days 0 and 7 following GnRHa administration were quantified using immunohistochemistry. The expression of AMH in follicles at various stages revealed dynamic changes during the process of downregulation. AMH in primary follicles initially increased and then decreased gradually. In small and large preantral follicles and in granulosa cells (GCs) surrounding the oocyte of small antral follicles, the expression of AMH began to increase on day 1, was attenuated on day 2, and then increased to a peak. The expression levels of AMH in the GCs surrounding the basement membrane, in contrast to the GCs surrounding the oocyte, were significantly lower and did not increase on day 1. In all stages of follicles, the expression of AMH declined gradually between the peak level and last day of downregulation. On day 7, the varying follicular stages all expressed lower levels of AMH than on day 0. This decrease was more prominent in the higher dose groups, compared with the lower dose groups. In conclusion, GnRHa was observed to induce time‑dependent changes in the expression of AMH at varying follicular stages, which occurred in a dose‑dependent manner.
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Affiliation(s)
| | | | - ZHILING LI
- Correspondence to: Professor Zhiling Li, Reproductive Center, First Affiliated Hospital of Shantou University Medical College, Shantou University, 54 Changping Road, Jinping, Shantou, Guangdong 515041, P.R. China, E-mail:
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Sopher AB, Grigoriev G, Laura D, Cameo T, Lerner JP, Chang RJ, McMahon DJ, Oberfield SE. Anti-Mullerian hormone may be a useful adjunct in the diagnosis of polycystic ovary syndrome in nonobese adolescents. J Pediatr Endocrinol Metab 2014; 27:1175-9. [PMID: 25003376 PMCID: PMC4415850 DOI: 10.1515/jpem-2014-0128] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 06/12/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to [1] confirm that nonobese adolescents with polycystic ovary syndrome (PCOS) have higher anti-Mullerian hormone (AMH) than controls; [2] examine the relationship of AMH with PCOS features and hormonal profile; and [3] approximate an AMH value that discriminates between adolescents with PCOS and controls. DESIGN Case-control study. SETTING Subspecialty ambulatory clinic. PATIENTS Thirty-one nonobese adolescent girls (age 13-21 years), 15 with PCOS diagnosed using the National Institutes of Health (NIH) criteria and 16 healthy control subjects. Subjects and controls were comparable for body mass index z-score, age and ethnicity. MAIN OUTCOME MEASURE(S) AMH in PCOS subjects and control groups, correlation of AMH with hormonal parameters. RESULTS AMH was higher in PCOS subjects (4.4±3.4 ng/mL) than in controls (2.4±1.3 ng/mL), when adjusted for menstrual age. In the entire group (PCOS and controls), AMH correlated with androgens, ovarian size and the presence of polycystic ovary (PCO) appearance. There was no difference in average ovarian size between PCOS (7.1±2.6 cm³) and controls (6.7±1.8 cm³). PCOS subjects were 1.49 times more likely to have AMH >3.4 ng/mL (confidence interval 0.98-2.26 ng/mL). CONCLUSIONS Our data suggest that AMH may be a useful adjunct in the diagnosis of PCOS in adolescents.
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Affiliation(s)
- Aviva B. Sopher
- Corresponding author: Aviva B. Sopher, MD, MS, Phone: +1 212 30056559, Fax: +1 212 3054778,
| | - Galina Grigoriev
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Medical Center, New York, NY, USA
| | - Diana Laura
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Medical Center, New York, NY, USA
| | - Tamara Cameo
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Medical Center, New York, NY, USA
| | - Jodi P. Lerner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - R. Jeffrey Chang
- Department of Reproductive Medicine, University of California – San Diego, La Jolla, CA, USA
| | - Donald J. McMahon
- Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Sharon E. Oberfield
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Medical Center, New York, NY, USA
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Abstract
The strongest association between FMR1 and the ovary in humans is the increased risk of premature ovarian failure (POF) in women who carry the premutation level of CGG repeats (55–199 CGGs). Research on the FMR1 gene has extended to other endpoints of relevance in the OB/GYN setting for women, including infertility and ovarian hormones. After reviewing the nomenclature changes that have occurred in recent years, this article reviews the evidence linking the length of the FMR1 repeat length to fertility and ovarian hormones (follicle stimulating hormone and anti-mullerian hormone as the primary methods to assess ovarian reserve in clinical settings). The literature is inconsistent on the association between the FMR1 trinucleotide repeat length and infertility. Elevated levels of follicle stimulating hormone have been found in women who carry the premutation; however the literature on the relationship between anti-mullerian hormone and the CGG repeat length are too disparate in design to make a summary statement. This article considers the implications of two transgenic mouse models (FXPM 130R and YAC90R) for theories on pathogenesis related to ovarian endpoints. Given the current screening/testing recommendations for reproductive age females and the variability of screening protocols in clinics, future research is recommended on pretest and posttest genetic counseling needs. Future research is also needed on ovarian health measurements across a range of CGG repeat lengths in order to interpret FMR1 test results in reproductive age women; the inconsistencies in the literature make it quite challenging to advise women on their risks related to FMR1 repeat length.
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Affiliation(s)
- Lisa M Pastore
- Department of Obstetrics and Gynecology, School of Medicine, University of Virginia Charlottesville, VA, USA
| | - Joshua Johnson
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University New Haven, CT, USA
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Groh KJ, Schönenberger R, Eggen RIL, Segner H, Suter MJF. Analysis of protein expression in zebrafish during gonad differentiation by targeted proteomics. Gen Comp Endocrinol 2013; 193:210-20. [PMID: 23968773 DOI: 10.1016/j.ygcen.2013.07.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 06/07/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
Abstract
The molecular mechanisms governing sex determination and differentiation in the zebrafish (Danio rerio) are not fully understood. To gain more insights into the function of specific genes in these complex processes, the expression of multiple candidates needs to be assessed, preferably on the protein level. Here, we developed a targeted proteomics method based on selected reaction monitoring (SRM) to study the candidate sex-related proteins in zebrafish which were selected based on a global proteomics analysis of adult gonads and representational difference analysis of male and female DNA, as well as on published information on zebrafish and other vertebrates. We employed the developed SRM protocols to acquire time-resolved protein expression profiles during the gonad differentiation period in vas::EGFP transgenic zebrafish. Evidence on protein expression was obtained for the first time for several candidate genes previously studied only on the mRNA level or suggested by bioinformatic predictions. Tuba1b (tubulin alpha 1b), initially included in the study as one of the potential housekeeping proteins, was found to be preferentially expressed in the adult testis with nearly absent expression in the ovary. The revealed changes in protein expression patterns associated with gonad differentiation suggest that several of the examined proteins, especially Ilf2 and Ilf3 (interleukin enhancer-binding factors 2 and 3), Raldh3 (retinaldehyde dehydrogenase type 3), Zgc:195027 (low density lipoprotein-related receptor protein 3) and Sept5a (septin 5a), may play a specific role in the sexual differentiation in zebrafish.
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Affiliation(s)
- Ksenia J Groh
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600 Dübendorf, Switzerland.
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Souter I, Smith KW, Dimitriadis I, Ehrlich S, Williams PL, Calafat AM, Hauser R. The association of bisphenol-A urinary concentrations with antral follicle counts and other measures of ovarian reserve in women undergoing infertility treatments. Reprod Toxicol 2013; 42:224-31. [PMID: 24100206 DOI: 10.1016/j.reprotox.2013.09.008] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 09/18/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
In this prospective cohort of women undergoing infertility treatments, we measured specific-gravity adjusted urinary BPA (SG-BPA) concentrations and used regression models to evaluate the association of BPA with antral follicle count (AFC), day-3 serum follicle stimulating hormone levels (FSH), and ovarian volume (OV). BPA, detected in >80% of women, had a geometric mean (±GSD) of 1.6±2.0, 1.7±2.1, and 1.5±1.8μg/L for the women contributing to the AFC (n=154), day-3 FSH (n=120), and OV (n=114) analyses, respectively. There was an average decrease in AFC of 12% (95% CI: -23%, -0.6%), 22% (95% CI: -31%, -11%), and 17% (95% CI: -27%, -6%), in the 2nd, 3rd, and 4th SG-BPA quartile compared to the 1st quartile, respectively (p-trend: <0.001). No association of SG-BPA with FSH or OV was observed. Among women from an infertility clinic, higher urinary BPA concentrations were associated with lower AFC, raising concern for possible accelerated follicle loss and reproductive aging.
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Affiliation(s)
- Irene Souter
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Harvard Medical School/Massachusetts General Hospital Fertility Center, Yawkey 10-A, 55 Fruit Street, Boston, MA 02114, USA.
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Köninger A, Kauth A, Schmidt B, Schmidt M, Yerlikaya G, Kasimir-Bauer S, Kimmig R, Birdir C. Anti-Mullerian-hormone levels during pregnancy and postpartum. Reprod Biol Endocrinol 2013; 11:60. [PMID: 23844593 PMCID: PMC3724719 DOI: 10.1186/1477-7827-11-60] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of unintentionally childless couples is increasing as more couples seek to conceive for the first time in the third or fourth decade of the woman's life. Determination of ovarian reserve is an essential component of infertility assessment. The Anti-Müllerian-Hormone (AMH) seems to be the most reliable predictor of ovarian reserve. In this study we analyzed AMH in a cohort of pregnant women without fertility impairment to determine age-dependent decline and possible AMH fluctuations during pregnancy and postpartum. METHODS A total of 554 healthy women aged 16 to 47 years without history of infertility or previous surgery on the ovaries were enrolled in the study between 1995 and 2012. In 450 women, a single measurement of AMH was taken during pregnancy, allowing for cross sectional analysis of trimester- and age-related differences in AMH levels. For another 15 women longitudinal data on AMH levels for all trimesters was recorded. In addition, for 69 women AMH was measured at the time just before and after delivery, and for another 20 AMH was measured just before delivery and once on each of the first four days after delivery. We used AMH-Gen-II ELISA (Beckman Coulter, Immunotech, Webster, USA) for the assessment of AMH levels. Non-parametric statistical tests were used to compare AMH levels between age groups, trimesters and postpartum. RESULTS Comparison between the trimesters revealed a significant difference in AMH values at each trimester (first trimester: 1.69 ng/ml (IQR 0.71-3.10), second trimester: 0.8 ng/ml (IQR 0.48-1.41), third trimester: 0.5 ng/ml (IQR 0.18-1.00)). AMH significantly dropped during the course of pregnancy and immediately after delivery, whereas an increase was observed over the first four days postpartum. Women, greater than or equal to 35 years, showed significant lower AMH levels than those <35 years across all trimesters. CONCLUSIONS AMH levels decrease during pregnancy. The decline in AMH levels during pregnancy indicates ovarian suppression. AMH levels recover quickly after delivery. AMH levels assessed in pregnant women are not an accurate indicator of ovarian reserve, since AMH levels during pregnancy seem not to be independent of gestational age.
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Affiliation(s)
- Angela Köninger
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Alexis Kauth
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Boerge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Markus Schmidt
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
- Department of Gynecology and Obstetrics, Klinikum Duisburg GmbH, Zu den Rehwiesen 9-11, 47055 Duisburg, Germany
| | - Guelen Yerlikaya
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
- Department of Gynecology and Obstetrics, University of Vienna, Spitalgasse 23, 1090 Wien, Austria
| | - Sabine Kasimir-Bauer
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Rainer Kimmig
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Cahit Birdir
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
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Abstract
PURPOSE To investigate whether preoperative serum anti-mullerian hormone (AMH) levels are lower in women with ovarian endometrioma and in women with mature cystic teratoma of the ovaries. MATERIALS AND METHODS In a tertiary university hospital, a retrospective case-control study was performed. Serum AMH levels between an advanced (stage III and IV) endometrioma group (n=102) and an age- and body mass index (BMI)-matched control group were compared. Serum AMH levels between an ovarian mature cystic teratoma group (n=48) and age- and BMI-matched controls were also compared. RESULTS Absolute serum AMH and multiples of the median for AMH (AMH-MoM) relevant to Korean standards were lower in the endometrioma group than controls, but this was not statistically significant (mean±SEM, 2.9±0.3 ng/mL vs. 3.3±0.3 ng/mL, p=0.28 and 1.3±0.1 vs. 1.6±0.1, p=0.29, respectively). Specifically, the stage IV endometriosis group (n=51) exhibited significantly lower serum AMH and AMH-MoM (2.1±0.3 vs. 3.1±0.4 ng/mL, p=0.02 and 1.1±0.1 vs. 1.7±0.2, p=0.03, respectively). Serum AMH and AMH-MoM levels were similar between stage III endometriosis and controls (3.7±0.5 vs. 3.4±0.5 ng/mL and 1.6±0.2 vs. 1.5±0.2, respectively), as well as between the mature cystic teratoma group and controls (4.0±0.5 ng/mL vs. 4.0±0.5 ng/mL and 1.6±0.2 vs. 1.6±0.3, respectively). Interestingly, AMH-MoM level was negatively correlated with endometriosis score with statistical significance (r²=0.13, p<0.01). CONCLUSION In women with advanced ovarian endometrioma, preoperative serum AMH values tended to be lower than those for age and BMI-matched controls. Notably, stage IV endometrioma appeared to be closely associated with decreased ovarian reserve, even before operation. Clinicians should keep this information in mind before undertaking surgery of ovarian endometrioma.
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Affiliation(s)
- Ju Yeong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, 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
- Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, 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
- Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
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Abstract
BACKGROUND OF THE STUDY Mature and functional Sertoli cells are essential for the survival of germ cells in testes. In Sertoli cell only syndrome (SCOS), there is no germ cells. Then, question arises whether absence of germ cells in SCOS secondary to Sertoli cells immaturity or mal function. Sertoli cells maturational and functional status is unclear in SCOS. This study investigated status of maturation and function of Sertoli cells in patients with SCOS. MATERIALS AND METHODS The present study was comprised of 37 cases of SCOS and 50 normal control males. Detailed clinical examination and investigation were carried out as per pre-determined proforma. Semen analysis, hormonal analysis (FSH, LH, testosterone, etc.), and fine needle aspiration cytology (FNAC) of testes (bilateral) were performed. Fluorescence in situ hybridization (FISH) with XY probes was carried out in addition to conventional chromosome analysis to find out chromosomal abnormalities, in particular sex chromosome aneuploidy, including mosaicism. Yq microdeletion status was also investigated. The anti-mullerian hormone (AMH), inhibin B, and seminal lactate were estimated by ELISA methods. RESULTS The study did not find any case of high AMH. About 78% cases had low inhibin B, and 60% had low AMH. FSH was high in about 78% cases. Low level of lactate was found in 49% cases. There was one case of high level of inhibin B. There were 6 (16.2%) cases of chromosomal abnormality (2 mosaic Klinefelter and 4 Klinefelter syndrome) and 4 (10.8%) cases of Yq microdeletion. CONCLUSION We conclude that Sertoli cell immaturity does not play any role in SCOS (no case of high AMH). It seems, in majority cases, Sertoli cells are functionally- and/or numerically-deficient (low inhibin B, AMH and lactate). However, in about 22% cases, Sertoli cell function and/or number remains normal (normal inhibin B, AMH). Inhibin B and FSH seems best predictor/marker of Sertoli cell function.
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Affiliation(s)
- Manish Jain
- Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashutosh Halder
- Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India
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