Changes In anti-Mullerian Hormone Research Articles

Dose-Dense Chemotherapy Regimen for Breast Cancer Associated with Significant Decline in Ovarian Reserve.

Purpose: To determine the impact of dose-dense chemotherapy administration on ovarian reserve in women undergoing treatment for breast cancer. Patients and Methods: We conducted a retrospective cohort study of reproductive age women who underwent dose-dense chemotherapy regimens with doxorubicin hydrochloride and cyclophosphamide with or without paclitaxel for a new diagnosis of breast cancer. We compared pre- and post-treatment serum antimullerian hormone (AMH) levels and assessed changes in AMH over time. Results: Fifty-seven patients met inclusion criteria. Median pre-treatment AMH was 2.9 ng/mL, whereas post-treatment AMH was 0.1 ng/mL, demonstrating a dramatic reduction in AMH levels after treatment with a dose-dense regimen. This change was independent of age and was sustained over 12 months from treatment completion. Conclusions: Dose-dense chemotherapy regimens for breast cancer lead to marked and sustained decreases in AMH irrespective of patient age.

Reduction of ovarian reserves and activation of necroptosis to in vivo air pollution exposures

ABSTRACT We investigated the association between air pollution and changes in ovarian follicles, anti-mullerian hormone (AMH) levels, the occurrence of necroptosis cell death by activation of receptor-interacting protein kinase 3 (RIPK3) and, the activation of mixed lineage kinase domain-like (MLKL) proteins. Forty-two female Wistar rats were divided into three groups of 14 each, which were exposed to real-ambient air, filtered air and purified air (control) in two periods of 3 and 5 months. The results showed that the number of ovarian follicles decreased in the group exposed to real-ambient air versus the control group (P < 0.0001). The trend of age-related AMH changes with respect to exposure to air pollutants was affected and its levels decreased after 3 months of exposure. The MLKL increased in the group exposed to the real-ambient air compared to the control group (P = 0.033). Apparently long-term exposure to air pollution can reduce ovarian reserves.

Characteristics of patients with stage III and IV ovarian endometriomas and trends in postoperative anti-Mullerian hormone changes.

This study aimed to investigate the manifestations of postoperative Anti-Mullerian hormone (AMH) changes in patients with stage III and IV ovarian endometriomas. Trends in postoperative AMH were categorized and described, and the risk factors for postoperative AMH decline were screened using dichotomous logistic regression. The overall trend of postoperative AMH decreased, with a more significant decrease in stage IV than stage III cases. Elevated preoperative CA-125 levels, a history of caesarean section, and abortion were independent risk factors for postoperative AMH decline. There is a general trend toward decreasing AMH levels after surgery, but each case may also show a different elevation.

O-190 Comparison between effects of exposure to platinum-based chemotherapeutics (cisplatin and carboplatin) on Sertoli cell number and functions in immature human testicular tissues

Abstract Study question Does exposure to either cisplatin or carboplatin have a damaging effect on the Sertoli cell population in the immature human testicular tissues? Summary answer Exposure to cisplatin or carboplatin did not appear to have a major effect on Sertoli cell number or function in the immature human testicular tissues What is known already Long-term survival rates for children with cancer are more than 80%. However, childhood cancer treatment may result in subsequent infertility. Cisplatin is one of the most commonly used drugs for childhood cancers. Carboplatin, a second generation platinum drug, is administered at 10-times the dose of cisplatin and is believed to be less gonadotoxic. In our recent publication we have shown that exposure to both cisplatin and carboplatin acutely reduce the germ cell number in immature human testicular tissues. However, it is not known how cisplatin and carboplatin affect Sertoli cell number and function. Study design, size, duration In-vitro culture of human fetal and pre-pubertal testicular tissues was utilised. Tissue pieces were cultured for 1-3 days prior to exposure to clinically-relevant doses of chemotherapeutics or vehicle control for 24hrs in two sets of experiments: 1) 0.5 or 1 μg/ml cisplatin and culture ended at 24 and 96hrs post-exposure (fetal only); 2) 0.5 μg/ml cisplatin or 5 ­μg/ml carboplatin until 72 (both fetal and pre-pubertal) and 240hrs post-­exposure (fetal only). Participants/materials, setting, methods Testicular tissue fragments from second trimester human fetal (14-22 gestational weeks; n = 3-6) or pre-pubertal patients (1-8years old; n = 5) were cultured in a ‘hanging drop’ system.Quantification of Sertoli cell number (cells per cord/tubular area (mm2)) was performed on sections stained for expression of SOX9. Culture medium was collected to measure levels (ng/ml) of Anti-Mullerian hormone (AMH) and Inhibin B using ELISA. Statistical analysis was performed using two-way ANOVA to account for inter-individual variation between fetuses/patients. Main results and the role of chance Quantification of positively stained Sertoli cells showed that exposure to both doses of cisplatin had no effect on Sertoli cell number at 24 and 96hrs post-exposure. No changes in AMH and inhibin B levels were observed at these time-points. Comparison between cisplatin- or carboplatin-exposed human fetal testicular tissues showed no difference in Sertoli cell numbers at either 72hrs or 240hrs post-exposure. No difference in Sertoli cell number was observed in pre-pubertal testicular tissues exposed to either cisplatin or carboplatin at 72hrs post-exposure. Limitations, reasons for caution Human fetal and pre-pubertal testis tissue is of limited availability, thus, sample sizes used in this study were relatively low. ‘Hanging drop’ culture might not recapitulate all in-vivo aspects of immature testis microenvironment. Wider implications of the findings Exposure to cisplatin or carboplatin did not affect Sertoli cell number in the immature human testicular tissues. Taken together with our recent publication, this suggests that these two platinum-based chemotherapeutic agents cause direct damage to germ cells. Functionality of Sertoli cells in chemotherapy-exposed tissues need to be further investigated. Trial registration number not applicable

Comparison of Postoperative Ovarian Reserve Function Following Laparoscopic Hysterectomy and Laparoscopic Myomectomy: A Prospective Comparative Pilot Study.

This prospective study aimed to investigate the impact of laparoscopic hysterectomy (LH) and laparoscopic myomectomy (LM) on ovarian reserve by comparing serum anti-Mullerian hormone (AMH) changes following surgery. Serum AMH levels were measured preoperatively (AMH0), and 7 days (AMH1), 2 months (AMH2), and 6 months (AMH3) after LH and LM in 79 premenopausal women (LH = 59; LM = 20). AMH0, AMH1, AMH2, and AMH3 were significantly higher in the LM group than in the LH group (p = 0.012, 0.001, 0.001, and 0.015, respectively). Since there are differences in indications between myomectomy and hysterectomy, logically, women who underwent myomectomy were younger and had higher AMH baseline levels. In addition, AMH changes at 7 days postoperatively from the baseline level were significantly decreased in the LH group compared to those in the LM group (p = 0.042). However, AMH changes at 2 months and 6 months postoperatively, compared to the baseline level, were not different between the two groups (p = 0.053 and 0.752, respectively). Moreover, the significant decrease in AMH (more than 60% decrease from the baseline level) was not different at 7 days, 2 months, and 6 months postoperatively between the two groups (p = 0.415, 487, and 0.364, respectively). Our data suggest that serum AMH levels were significantly decreased directly after LH, which suggests that LH may have adverse effects on ovarian reserve. However, mid-term follow-up showed that the damaged ovarian reserve in women who underwent LH may be partially restored in 6 months.

Anti-Mullerian Hormone Changes Following Laparoscopic Ovarian Cystectomy: A Prospective Comparative Study.

PurposeTo investigate whether laparoscopic ovarian cystectomy (LOC) affects ovarian reserve.Patients and MethodsIn 46 premenopausal women, who underwent either LOC (study group, n=26) or laparoscopic myomectomy (LM) (control group, n=20), serum anti-Mullerian hormone (AMH) levels were measured pre-operatively (AMH0), and postoperatively at 7 days (AMH1), 2 months (AMH2), and 6 months (AMH3). Changes in AMH from baseline level (AMH0) in each group were compared.ResultsAMH0 did not differ between the two groups (3.5 ± 3.33 in LOC vs 2.4 ± 2.72 in LM, P=0.250). AMH1, AMH2, and AMH3 in each group were also similar. However, a significant decline of AMH (ie more than 50% decrease compared to AMH0) at postoperative 6 months occurred more frequently in the LOC group than in the LM group. In the sub-analysis of the LOC group, a significant decline of AMH at postoperative 2 months and 6 months was highly correlated with bilateral ovarian tumors (P=0.001).ConclusionCompared to LM, serum AMH level showed a minimal decrease after 1 week following LOC, which did not revert to normal over 6 months of follow-up. In addition, a significant decline of ovarian reserve at postoperative 6 months was significantly more frequent in the LOC group, suggesting that LOC may have more adverse effects on ovarian reserve compared to the LM (control) group. Thus, care is required during the LOC procedure, specifically in women with bilateral tumors.

Can Autologous Adipose-Derived Mesenchymal Stem Cell Transplantation Improve Sexual Function in People with Sexual Functional Deficiency?

Sexual functional deficiency occurs at some point in life and becomes a problematic issue in middle-aged adulthood. Regenerative medicine, especially mesenchymal stem cell (MSC) transplantation, has developed extensively, with preclinical and clinical trials emphasizing the benefits of stem cell therapy for restoration of sexual deficiency. This study was designed to develop a new therapeutic stem cell treatment for people with sexual functional deficiency. Thirty-one patients, including 15 males and 16 females with a medical history of reduced sexual activity, met the inclusion criteria and were enrolled in the study, phase I/IIa clinical trial with a 12-month follow-up. Adipose tissue-derived mesenchymal stem/stromal cells (ADSC) were isolated by type I collagenase digestion and cultured at the Stem Cell Core Facility under ISO 14644-1. Each participant received 1 million cells/kg of body weight via the intravenous route. Safety was evaluated by assessing the occurrence of adverse events or severe adverse events. Efficacy was assessed in males by monitoring testosterone levels and administering the International Index of Erectile Function (IIEF) questionnaire and in females by monitoring anti-Mullerian hormone (AMH), estradiol (E2), and follicle-stimulatinghormone (FSH) levels and administering the Female Sexual Functioning Index (FSFI) questionnaire at baseline and 3-, 6-, and 12-months post-transplantation. There was no occurrence of severe adverse events after ADSC administration in our study. Post-transplantation sexual satisfaction was observed in all patients enrolled in this study. Testosterone levels in males increased soon after transplantation and were maintained at high levels for up to 6 months before decreasing again at the 12-month follow-up. No significant changes in AMH,FSH or E2 levels were recorded in female patients. Autologous ADSC infusion is a potential therapeutic option for patients with reduced sexual activity, especially for male patients. ClinicalTrials.gov. NCT03346967, Registered November 20, 2017.

The impact of major uterine wall resection and reconstruction of the uterus (MURU) on uterine hemodynamics and ovarian function in patients with adenomyosis: a clinical study

Background: Previous studies had shown that major uterine wall resection and reconstruction of the uterus (MURU) was safe and effective in the treatment of adenomyosis. However, MURU results in loss of a significant amount of myometrial and some endometrial tissues, which may have an impact on uterine hemodynamics and ovarian function. Therefore, it is necessary to study the changes of uterine hemodynamics and ovarian function in patients after MURU, in order to provide an evidence-base for its clinical application. Objective: To explore the effects of major uterine wall resection and reconstruction of the uterus (MURU) on uterine hemodynamics and ovarian function in patients with adenomyosis. Study design: The maximum thickness of unilateral uterine muscle wall or the maximum diameters of adenomyosis focus were measured by ultrasonography. Patients with adenomyosis were divided into three groups: mild, moderate or severe. Fifty cases of adenomyosis without fertility requirement were treated with MURU (observation group), and levonorgestrel-releasing system (LNG-IUS) was placed in uterine cavity during the operation. Fifty patients with intramural myoma of the uterus were selected for hysteromyomectomy (control group). The changes of arterial pulsation index (PI) and resistance index (RI) of uterine artery, as well as antral follicle count (AFC) and serum antimullerian hormone (AMH) were observed before operation and 1 month, 3 months, 6 months, 12 months and 18 months post-operation. Results: No complications were observed in both groups, no significant difference in uterine hemodynamics and ovarian function were found between the two groups (P &gt; 0.05). During intragroup comparison, there were no significant changes in PI and RI before and after operation in the two groups, and no significant changes in AFC and AMH were detected in both groups before and after operation (P &gt; 0.05). Conclusions: MURU did not significantly affect the uterine hemodynamics and ovarian function in patients with adenomyosis, but the long-term effects need to be further investigated.

Comparisons and correlations of anti mullerian hormone and thyroid stimulating hormones in fertile and subfertile women

Introduction and Objectives: Thyroid dysfunction and autoimmunity are related to adverse impact on fertility in reproductive aged women. Anti-Mullerian hormone (AMH), biomarker of ‘ovarian age’ may be affected by impaired thyroid function, but the relationship between AMH and thyroid hormone is unclear. The aim of this study was to determine the impact of thyroid stimulating hormone (TSH) on AMH levels. Materials and Methods: In this case–control study, to identify the impact of thyroid hormone on ovarian reserve, we recruited 30 consecutive Indian infertile patients and 30 normal fertile women aged 19 –39 years without impact factors on thyroid and ovarian functions between April 2017 and September 2017. We assessed patient age, AMH, and TSH levels of all study participants as independent variables. We also evaluated the correlations between AMH and TSH in our study groups. In addition, independent variables were subjected to multiple regression analysis. Results: Our results showed significant changes in AMH and TSH between groups. The increased TSH status in the subfertile cases was inversely correlated with the TSH levels (r=-0.44, p Conclusion:AMH levels were inversely correlated with TSH levels in infertile women of reproductive age. Further studies with large sample size are warranted in future. Keywords Infertility, Hypothyroidism, Thyroid stimulating hormone, Anti-Mullerian hormone, Ovarian reserve.

Impact of Opportunistic Salpingectomy on Ovarian Reserve and Vascularity in Patients Undergoing Hysterectomy

To evaluate the effect of opportunistic salpingectomy on ovarian reserve and vascularity. In this observational study, 45 premenopausal women undergoing hysterectomy were divided into two groups: group 1 (22 patients) with salpingectomy and group 2 (23 patients) without salpingectomy. Serum anti-Mullerian hormone (AMH) estimation and transvaginal sonography were done to assess ovarian Doppler indices prior to and 3 months after surgery. Before surgery, median values of AMH (0.45 ng/ml vs 0.44 ng/ml) and ovarian Doppler indices (RI, PI and S/D ratio) were matched in both the groups. The serum AMH levels were decreased by 0.01 ng/ml in group 1 and increased by 0.08 ng/ml in group 2 at 3 months post-surgery (p value 0.19). Positive changes in AMH were seen in 45% versus 65% patients and negative changes in 55% versus 35% patients in both the groups (p value 0.34). Changes (Δ) in RI (− 0.08 vs − 0.15 p value 0.17), PI (− 0.15 vs − 0.17 p value 0.78) and S/D ratio (− 0.39 vs − 0.35 p value 0.84) from baseline to 3 months postoperatively showed a trend towards increased vascularity and were not found to be significantly different between the two groups. Opportunistic salpingectomy did not affect ovarian reserve and vascularity at post 3 months of surgery.

Evaluation of Anti-Mullerian Hormone Predictive Value and Antral Follicle Count in the Success Rate of Ovarian Drilling in Polycystic Ovary Syndrome

Background: Laparoscopic ovarian drilling (LOD) is recommended for the treatment of women with polycystic ovary syndrome (PCOS) resistant to clomiphene citrate. Objectives: This study aimed to evaluate the effect of ovarian drilling on the serum levels of anti-mullerian hormone (AMH), androgens, and the number of antral follicles. Methods: This was a pre- and post-clinical trial performed on 30 infertile women with PCOS resistant to clomiphene citrate. Patients underwent standard laparoscopic ovarian drilling. Serum levels of AMH and androgens and antral follicle count (AFC) were surveyed before LOD and three and six months after LOD. The ovarian ovulation rate in each month was also monitored for six months. Then, the association between changes in these parameters, especially the level of AMH, and postoperative ovulation was investigated. A P &lt; 0.05 was considered statistically significant. Results: The number of antral follicles three (3.00 ± 8.00) and six months (7.73 ± 4.14) after ovarian drilling showed a significant decrease compared to preoperative values (12.40 ± 4.02) (repeated-measures ANOVA, P &lt; 0.001). The mean AMH (6.78 ± 1.08 versus 12.25 ± 1.35; P = 0.005) and the antral follicle count (7.71 ± 0.54 versus 12.29 ± 0.67 and P &lt; 0.001) were lower in ovulation than in non-ovulation patients. The significantly more AMH reductions were seen in pregnant women (3.63 ± 5.61) than in non-pregnant women (3.63 ± 1.24) (P = 0.01). Conclusions: It may be possible to use the changes in AMH and AFC to predict the success rate of LOD.

Developmental Programming: Prenatal Testosterone Excess on Ovarian SF1/DAX1/FOXO3

Prenatal testosterone (T) excess, partly via androgenic programming, enhances follicular recruitment/persistence in sheep as in women with polycystic ovarian syndrome (PCOS). Decreased anti-Mullerian hormone (AMH) in early growing and increased AMH in antral follicles may underlie enhanced recruitment and persistence, respectively. Changes in AMH may be mediated by steroidogenic factor 1 (SF1), an enhancer of AMH, and dosage-sensitive sex reversal, adrenal hypoplasia critical region, on chromosome X, gene 1 (DAX1), that antagonizes SF1. Another mediator could be forkhead box 03 (FOXO3) which regulates follicular recruitment/atresia. To test if androgen-programmed changes in SF1, DAX1, and FOXO3 proteins contribute to follicular defects in prenatal T-treated sheep, ovaries from control, prenatal T-, and dihydrotestosterone (DHT)-treated (days 30-90 of gestation) animals at fetal day (FD) 90, FD140, and 1 and 2years-of-age were studied. Prenatal T increased DAX1 in granulosa cells of primordial through large preantral and theca cells of large preantral follicles at FD140 and increased SF1 in the granulosa cells of preantral and antral and theca cells of large preantral follicle at 2years-of-age. Prenatal T increased FOXO3 only in theca cells of preantral (FD140) and antral (2years-of-age) follicles. Prenatal DHT increased DAX1 in granulosa cells from small preantral follicles at FD140 while increasing SF1 in granulosa cells from antral follicles at 1year-of-age. These age-dependent changes in DAX1/SF1 partly via androgen-programming are consistent with changes in AMH and may contribute to the enhanced follicular recruitment/persistence, and multifollicular phenotype of prenatal T-treated females and may be of translational relevance to PCOS.

Ovarian reserve markers after discontinuing long-term use of combined oral contraceptives.

How early do the ovarian reserve markers anti-Müllerian hormone (AMH) and antral follicle count (AFC) normalize after discontinuation of the long-term use of combined oral contraceptives (COC). This was a prospective cohort study of 68 women with a history of long-term COC use. Serum AMH concentrations, ovarian volume and AFC were measured during COC use and serially in a 4-month period after discontinuing COC: 1 and 2 weeks after discontinuation, and on cycle day 2-5 during three consecutive menstrual cycles. Changes in AMH and AFC were investigated using linear mixed models of repeated measurements adjusted for relevant covariates. Mean age was 29.4 years and mean duration of COC use 8.0 years. Baseline median AMH concentrations during COC use of 13pmol/l (interquartile range [IQR] 8.4-22pmol/l) increased to a median of 22.5 pmol/l (IQR 11-37 mol/l) 3 months after discontinuation. The estimated average increase was 53% (95% confidence interval [CI] 1.40-1.68, P < 0.001). AFC increased from a median value of 17 (IQR 11-25) to 24 (IQR 17-34). The estimated average increase was 41% (95% CI 1.30-1.52, P < 0.001). Ovarian volume increased from 2.4 to 5.8 ml (P < 0.001). The ovarian reserve markers increased continuously from baseline measurements until 2 months after discontinuation. Thereafter a plateau was reached. After discontinuation of COC, AMH increased by 53% and AFC by 41%, with values returning to normal within 2 months. This study provides clinicians with the highly relevant knowledge that AMH and AFC can be measured 2 months after discontinuation of COC without having to account for their influence.

Anti-Mullerian Hormone (AMH) is a Marker for Ovarian Reserve. There Are Many Studies About AMH Changes in Ovarian Surgery, But Little is Known for Other Surgeries. We Seek to Investigate the Hormone Variations Before and After Uterine Artey Ligation for Postpartum Hemorrage (PPH)

Anti-Mullerian Hormone (AMH) is a Marker for Ovarian Reserve. There Are Many Studies About AMH Changes in Ovarian Surgery, But Little is Known for Other Surgeries. We Seek to Investigate the Hormone Variations Before and After Uterine Artey Ligation for Postpartum Hemorrage (PPH)

The Effect of Resistance Training in Water and Land with Vitamin D Supplementation on Anti-Mullerian Hormone in Women with Polycystic Ovary Syndrome

Objectives: This study aimed to investigate the effect of resistance training in water and land with vitamin D on anti-Mullerian hormone in women with polycystic ovary syndrome (PCOS). Methods: Sixty women with PCOS (20 - 35 years old) referred to the Hafez Hospital in Shiraz in 2018 were selected and randomly divided into six groups of (1) control, (2) water training, (3) land training, (4) vitamin D, (5) water training with vitamin D, and (6) land training with vitamin D. Groups 2, 3, 5, and 6 performed resistance training in water and land for eight weeks, three sessions per week, while groups 4, 5 and 6 consumed vitamin D for eight weeks. For statistical analysis of data independent samples t-test, one-way ANOVA and Tukey’s post hoc tests were used (P ≤ 0.05). Results: Training in water and land have no significant effect on anti-Mullerian hormone (P ≥ 0.05); vitamin D, training in water with vitamin D, and training in land with vitamin D have significant effect on reduction of anti-Mullerian hormone (P = 0.001); training in water with vitamin D and training in land with vitamin D have more effect on reduction of anti-Mullerian hormone rather than vitamin D (P ≤ 0.05) and after training in water with vitamin D (P = 0.01) and training in land with vitamin D (P = 0.001) there is a significant relationship between anti-Mullerian hormone changes and weight. Conclusions: It appears that resistance training in water and land combined with vitamin D consumption may decrease the anti-Mullerian hormone by reduction in weight and as a result improve ovarian and reproductive function in women with PCOS.

Differential Rates of Change in Measures of Ovarian Reserve in Young Cancer Survivors Across the Reproductive Lifespan.

Recent studies have examined level and rate of change of anti-Müllerian hormone (AMH) for predicting time to menopause. Limited prospective, longitudinal data exists evaluating measures of ovarian reserve (MOR) in cancer survivors. Determine the rate of change of MOR in survivors (15 to 39 years) compared with similar-aged controls and compared with late reproductive-aged controls (40 to 50 years). Prospective cohort. Quaternary university hospital. Survivors at least 1 year from therapy completion, similar-aged controls, and late reproductive-aged controls. Annual visits with early follicular-phase hormone analysis and ultrasound. Changes in AMH and antral follicle count (AFC) were modeled using random effects linear regression. Cancer survivors (170) and 135 similar-aged controls had annual visits for an average of 38 months; 71 late reproductive-aged controls were followed for an average of 24 months. In models adjusted for body mass index, time since cancer therapy (for survivors), and exogenous hormone use, the geometric mean AMH and AFC levels were lower in the survivors than similar-aged controls at all ages. After age 24.5 AMH and AFC declined in both groups at rates that were similar (P = 0.78 for AMH, P = 0.37 for AFC). Late reproductive-aged controls declined at a much more precipitous rate of 30% per year for AMH and 16% per year for AFC (P < 0.01 compared with survivors). Although survivors had lower levels of AMH and AFC at the time of enrollment, the rate of change of AMH and AFC is not significantly different than similar-aged controls.

Magnetic resonance imaging features influencing high-intensity focused ultrasound ablation of adenomyosis with a nonperfused volume ratio of ≥90% as a measure of clinical treatment success: retrospective multivariate analysis

Objective: This retrospective study aimed (1) to investigate the magnetic resonance imaging (MRI) features influencing a nonperfused volume ratio (NPVr) ≥ 90% after high-intensity focussed ultrasound (HIFU) ablation of adenomyosis, and (2) to assess the safety, which was defined in terms of adverse events (AEs) and changes in anti-Mullerian hormone (AMH) concentrations, and clinical efficacy, which was defined in terms of adenomyosis volume reduction and symptom improvement at 6 months’ follow-up.Methods: Sixty-six women who underwent HIFU treatment were divided into groups A (NPVr ≥90%; n = 26) and B (NPVr <90%, n = 40). Multivariate logistic regression analyses of MRI features were conducted to identify the potential predictors of an NPVr ≥90%.Results: Generalized estimating equation (GEE) analysis was used to model the prediction of an NPVr ≥90% with four significant predictors from multivariate analyses: the thickness of the subcutaneous fat layer, adenomyosis volume, T2 signal intensity (SI) ratio of adenomyosis to myometrium, and the Ktrans ratio of adenomyosis to myometrium. Clinical efficacy was significantly greater in group A than in group B. The findings showed no serious AEs and no significant differences between AMH concentrations before and 6 months after treatment.Conclusions: The present retrospective study demonstrated that achievement of NPVr ≥90% as a measure of clinical treatment success in MRI-guided HIFU treatment of adenomyosis using multivariate analyses and a prediction model is clinically possible without compromising the safety of patients.

One-year impact of bariatric surgery on serum anti-Mullerian-hormone levels in severely obese women.

Although bariatric surgery seems to increase spontaneous fertility by improving ovulatory function in young women, its impact on ovarian reserve remains largely unknown. To evaluate changes in serum anti-Mullerian hormone (AMH) levels in reproductive-age severely obese women after bariatric surgery (BS). AMH levels were measured retrospectively in 39 women (mean age 34.6 ± 1.1years, range 18-45) that underwent a sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) at baseline, and 6 and 12months after BS. Metabolic and micronutrient status, including fasting plasma insulin and glucose, HOMA-IR, leptin, adiponectin, calcium, albumin, transthyretin, ferritin, vitamins (B9, B12, B1, A, E, D), zinc, and selenium, were assessed in all patients before and 1year after BS. Of the patients, 79% had class-3 obesity. At 6 and 12months, mean total weight losses (TWL) were 26 and 30%; mean excess weight losses (EWL) were 61.7 and 70.2%. Compared to baseline, AMH levels significantly decreased by 18% at 6months, and 32% at 12months post-operatively (p = 0.010 and p = 0.001, respectively). There was no correlation between AMH variation and changes in metabolic parameters or micronutrient levels. Remarkably, changes in AMH levels did not differ between sleeve and RYGB patients and were not correlated with EWL. This pilot study shows a drastic reduction in AMH levels at 1year after BS in reproductive-age severely obese women, which was not related to weight loss: this suggests a negative impact of BS on ovarian reserve, at least in the short term.

Differential response of AMH to GnRH agonist among individuals: the effect on ovarian stimulation outcomes.

The purpose of this study is to investigate whether individual response of anti-Mullerian hormone (AMH) to gonadotropin-releasing hormone (GnRH) treatment is associated with difference in ovarian stimulation outcomes. The retrospective study included 1058 non-polycystic ovary syndrome (PCOS) women undergoing long agonist protocol in a single in vitro fertilization unit from January 1, 2016, through December 31, 2016. Patients were grouped according to AMH changes from day 3 to the day of stimulation (group 1, change < 1ng/ml, n = 714; group 2, decrease ≥ 1ng/ml, n = 143; group 3, increase ≥ 1ng/ml, n = 201). A generalized linear model including Poisson distribution and log link function was used to evaluate the association between AMH response and the number of oocytes retrieved. Group 2 was characterized by higher basal AMH level and increased AMH to AFC ratio in comparison with two other groups. However, the number of oocytes and ovarian sensitivity index in group 2 was significantly lower than group 3. Adjusted for age, BMI, ovarian reserve markers, and stimulation parameters, the population marginal means (95% confidence interval) of oocyte number in groups 1 through 3 were 9.51 (9.17, 9.86), 8.04 (7.54, 8.58), and 10.65 (10.15, 11.18), respectively. For patients from group 2 and group 3, basal AMH is no longer significantly associated with oocyte yield. AMH change in response to GnRH agonist varies among individuals; for those undergoing significant changes in AMH following GnRH agonist treatment, basal AMH may not be a reliable marker for ovarian response in long agonist protocol.

203P - Follow-up of chemotherapy induced changes in anti-Mullerian hormone, antral follicle number and ovary volume in premenopausal breast cancer patients

Ovarian functions in premenopausal breast cancer patients are frequently affected due to the applied chemotherapy regimen. In this study, we aimed to evaluate the ovarian functions after chemotherapy by assessing the AMH, the number of antral follicle and the volume of ovaries in the premenopausal patients with breast cancer. Fifty-one premenopausal operable breast cancer patients who were given adjuvant and neoadjuvant chemotherapy were included in our study. We planned to evaluate the change of serum AMH levels throughout the timeline of the study and ovarian volume-antral follicle numbers measured by transvaginal ultrasonography. First measurements were performed before chemotherapy and repeated in every following 3 months for one-year follow-up period. Interim third month and initial results of 31 patients were evaluated. Median age: 39 (range: 23-48). The results of 31 patients' 3rd AMH results and the measurements of ovarian volumes and antral follicle numbers of 28 patients were recorded prospectively from database. Initial AMH levels and 3rd follow-up AMH levels were compared revealing statistically significant decrease (p = 0.000). When pre- and post-chemotherapy measurements were compared right and left ovary volumes and antral follicle numbers demonstrated statistically significant decrease after chemotherapy (p = 0.000). Preliminary data of this study showed that 3rd month AMH levels, antral follicle numbers and ovarian volumes were significantly lower in contrast to pretreatment measurements. By the end of study period we aimed to evaluate the effects of different chemotherapy regimens on ovarian function and predictive strength of utilized markers for evaluation of ovarian function.