Abstract
Anti-Mullerian Hormone (AMH) is a dimeric glycoprotein with a molecular weight of 140 kD, encoded by a gene on the short arm of chromosome and a member of the transforming growth factor-beta (TGF-β) superfamily. The expression of AMH is markedly different in males and females, both in concentration and temporality. In males, Sertoli cells maintain a high concentration of AMH in utero which peaks shortly after birth and then drops precipitously at puberty. In females, granulosa cells produce very low levels of AMH in utero followed by a transient spike in the neonatal period. Concentrations of the hormone then rise steadily through adolescence to a peak in the mid-twenties and subsequently decline until becoming undetectable in menopause. The study aimed to understand how Clinicians and Clinical Embryologists used anti-mullerian hormone (AMH) test to assess ovarian reserve, direct patient selection and treatment regimens and guide in vitro fertilization (IVF) cycle management in all registered fertility hospitals in a West African country, Ghana. A web-based survey (questionnaire) using google forms was performed to solicit responses from all IVF hospitals that are registered with the Fertility Society of Ghana (FERSOG). This questionnaire consisted of fifteen (15) broader questions, ten (10) of which assessed the clinics’ use of AMH. Responses were screened for quality to verify that only one (1) survey was completed by each IVF centre. The study was conducted during May and June 2020 at the In Vitro Fertilization (IVF) Department of the Airport Women’s Hospital (AWH) in Accra, Ghana. Results are reported as the proportion of IVF cycles represented by a particular answer choice. Survey responses were completed from 15 IVF centres, representing 2504 IVF cycles performed annually. A good majority (73.3%) [1835 IVF cycles] of the respondent IVF hospitals reported to use AMH as a first line test and 93.3% reported it as the best test for evaluating ovarian reserve. Another 66.7% reported that AMH results were extremely relevant to clinical practice. However, in contrast, for predicting live birth rate, 60% reported age as the best predictor in their practice. Overall, our results indicate that AMH is considered a first line test for assessing ovarian reserve and is relevant to the clinical practice of majority of Assisted Reproductive Technologies (ART) providers in Ghana.
Highlights
Most women are postponing childbearing worldwide as a result of extensive use of contraception, desire for higher education, lack or disruption of employment, socioeconomic concerns and the growing popularity of assisted reproductive technology (ART) which has given them the impression that female fertility may be manipulated at any stage of life [1]
When asked which test is best for evaluating ovarian reserve, 88.9% (2226 cycles) of respondent-in vitro fertilization (IVF) centres represented by selecting a specific test to evaluate ovarian reserve responded yes (Figure 1)
When respondents were asked in their opinion, what is the best use of Anti-Mullerian Hormone (AMH), 94.4% (2364 cycles) of respondent, IVF cycles reported it to predict both low and high ovarian reserve and response to stimulation
Summary
Most women are postponing childbearing worldwide as a result of extensive use of contraception, desire for higher education, lack or disruption of employment, socioeconomic concerns and the growing popularity of assisted reproductive technology (ART) which has given them the impression that female fertility may be manipulated at any stage of life [1]. Many women currently seeking fertility treatments are in their advance reproductive age(s). A recent study conducted by Hiadzi et al, 2019 [2] showed that, many sub-fertile couples start seeking fertility treatment from herbal products and associated traditional services, through religious leaders and by the time they visit ART centres, the woman will eventually be advanced in age. Half of the age-related decline in fertility that occurs between 30 and 35 years and a third of that between 35 and 40 years can be overcome by IVF [3] with expected live birth rates of 25% - 30%, in women in their 20s and 30s [3]. Live birth rates are even lower (10%) in women more than 40 years [6] and treatments with oocyte donation are likely to be effective in such cases [5]
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