anti-Müllerian Hormone In Women Research Articles

Age-related change in AMH in women seeking fertility – a hospital-based study across India

Objective The emergence of Anti-Mullerian Hormone (AMH) as a reliable biomarker for evaluating ovarian reserve in females indirectly predicting fertility potentials. Related studies contribute to the importance of AMH level tests for ovarian reserve, but limited studies are there to contribute to the geographical distribution of AMH levels in PAN India. This study assessed the age-related change in AMH in the Indian scenario. Design and Setting This is a retrospective hospital-based study. Patient(s) The study included 1,71,595 Indian infertile females visiting different clinics of Indira IVF Hospital Private Limited during the year August 2015 –August 2022 in the age group of 21-50 years. Intervention(s) NA Result(s) The average AMH included in the study was 2.66±1.89 ng/mL. The maximum number of females younger than 30 years had AMH levels of 3.86 ±3.12 ng/mL, and those in older age (31-50 years) group had AMH levels of 2.86 ± 2.7ng/mL. The analysis revealed that AMH levels were negatively correlated with age in all four zones (South, West, East, and North). The correlation coefficients ranged from -0.394 to -0.423, indicating a moderate negative relationship between age and AMH levels. The median AMH levels in the different zones ranged from 1.76 to 2.24 ng/dl. In contrast, the mean AMH levels varied between 2.54±2.75 and 3.03±2.94 ng/dl, indicating some variability in the distribution of AMH levels across the regions. Conclusion(s) The result shows a moderate correlation between females and AMH where r = -0.418 across India. The AMH value shows a sharp fall around 27 years of age.

Neighborhood disadvantage is associated with decreased ovarian reserve in women with overweight and obesity

To evaluate the association between neighborhood disadvantage and ovarian reserve stratified by body mass index (BMI). Cross-sectional cohort study. Single academic medical center. A total of 193 healthy reproductive-age women with regular menstrual cycles in the St. Louis, Missouri metropolitan area. Residence in a disadvantaged neighborhood. Ovarian reserve as assessed by ovarian antral follicle count (AFC) and serum anti-Müllerian hormone (AMH) concentration. Women (n = 193) ranged from 20 to 44 years. The majority had overweight or obesity (59%, n = 117) with mean BMI of 28±7 kg/m2. Forty-eight women lived in the most disadvantaged neighborhood quartile, of which 75% had overweight or obesity, compared with 54% of the 145 women living in the 3 less disadvantaged neighborhood quartiles. When controlling for age, race, and smoking status, women with overweight or obesity living in the most disadvantaged neighborhoods had significantly lower AMH compared with those living in the less disadvantaged neighborhoods. Antral follicle count did not differ among women with overweight or obesity by neighborhood of residence. Neighborhood disadvantage was not associated with ovarian reserve by AFC or AMH in women with normal weight or underweight status. Living in a socioeconomically deprived area is associated with lower markers of ovarian reserve among women with an elevated BMI.

Effect of laparoscopic excision of the endometriotic cyst capsule on the ovarian reserve (a retrospective analysis)

Endometriotic cyst is one of manifestations of the endometriotic process and its incidence among all women with endometriosis varies from 17 to 44%. This chronic process in the ovary is accompanied by persistent inflammation, which leads to fibrosis of the ovarian cortex and loss of follicles. Laparoscopic excision of the endometriotic cyst capsule is by far the mainstay of treatment for cysts of 3 cm or more in diameter. This standard surgical procedure can reduce an ovarian reserve marker such as anti-Müllerian hormone (AMH), raising concerns about reduced fertility after surgery. The aim of the study was to analyze the effect of operative, in particular, laparoscopic cystectomy, on the ovarian reserve in women of fertile age with endometriotic cysts. A retrospective analysis of the data of 202 women with endometriotic cysts who underwent examination, surgery and outpatient observation from 2011 to 2020 was carried out. The analysis was carried out in comparison before and after surgical treatment of all cases. The state of the ovarian reserve was assessed by the level of serum AMH. At baseline, the mean AMH in women with bilateral cysts 1,78 (95% CI 1,62; 1,91) ng/ml was lower than in women with monolateral cysts 2,44 (95% CI 2,18; 2,54) ng/m (p<0.001). When comparing AMH values 6 months after surgery, it was found that in all women the median AMH level significantly decreased by an average of 0,34 (95% CI 0,2-0,48) ng/ml (p<0,001). Laparoscopic excision of the cyst capsule is the main method of treatment of endometriotic cysts, and its minimally invasiveness and acceptability of use in women of fertile age makes it the standard surgical approach. However, the analysis showed that, nevertheless, laparoscopic excision of the endometriotic cyst capsule does not guarantee the safety of the negative effect of this method on the ovarian reserve, both during and after its application, on the contrary, significantly reducing the AMH values in comparison with its levels before surgery.

AB1282 OVARIAN RESERVE IN BEHCET’S DISEASE

BackgroundBehcet’s disease (BD) is a multisystemic disease of unknown cause. Anti-Mullerian hormone (AMH) is one of the key parameters for assessing reproductive function and ovarian reserve. The levels of AMH correlates with the residual follicular pool in women of reproductive age.ObjectivesTo assess AMH levels in BD female patients of child-bearing potential, and analyze the relationship between AMH levels and disease severity, as well as relationship between serum AMH levels and different therapeutic regimens.MethodsThe study group included 45 women with BD (according to ISGBD 1990 and ICBD 2014) aged 20-40 years, and the control group icluded 15 age-matching healthy women. Pts’ mean age was 31,3 [27;35] yrs, disease duration 6 [3;8] yrs. 17,8% pts had severe BD according to Ch.Zouboulis classification (due to generalized uveitis, retinal vasculitis and parenchymatous CNS lesions), 37,8% pts had a moderate disease, 44,4% pts had a mild disease with mainly dermal-mucous manifestations. AMH levels was measured using ELISA. AMH reference values ranged within 1.0-10.6 ng / ml. Values <1.0 were interpreted as a decreased ovarian reserve.ResultsThe mean levels AMH was 2.5 ng/ml in BD pts, and 3.1 ng/ml in control group, showing no statistical difference. A decrease in ovarian reserve (AMH less than 1.0 ng/ml) was observed with the same frequency 18% in patient’s vs. in control group 13%.In the analysis of AMH, depending on the severity of BD, a decrease in ovarian reserve was more often observed in patients with moderate and severe forms of BD.Table 1.AMH and severe BDseveremild, n=20moderate disease, n=17severe, n= 8pАMH2,7 [1,6-3,5]2,5 [1,0-3,7]1,9 [0,8;6,7]nsАMH >1 ng/ml, %1023250,02There are no correlations of levels AMH with treatment of BD.A decrease in ovarian reserve was noted in two patients under 30 years old, one was 29 years old woman with “Neurobehcet” with two children, and the patient with BB+AS was not married, had no pregnancies, and received colchicine therapy for a long time. Two BD patients with low AMH had no pregnancies - unmarried, all other patients with reduced ovarian reserve had from 1 to 6 children.When analyzing the levels of AMH with the clinical picture and BD therapy, no correlations were found.ConclusionThe average levels of AMH in women with BD and in the control group did not differ. A decrease in ovarian reserve (AMH less than 1.0 ng/ml) occurred with the same frequency in patients with BD and controls. A decrease in ovarian reserve was more often observed in patients with moderate and severe BD.

Anti-Müllerian hormone as a marker of ovarian reserve and premature ovarian insufficiency in children and women with cancer: a systematic review.

BACKGROUNDFemale patients undergoing anticancer treatment are at elevated risk of adverse ovarian outcomes including infertility and premature ovarian insufficiency (POI), which is associated with short- and long-term health risks. Anti-Müllerian hormone (AMH) is a key biomarker of ovarian reserve, but its role prior to and after cancer treatment is less well understood.OBJECTIVE AND RATIONALETo conduct a systematic review evaluating AMH as a biomarker of ovarian reserve and POI before and after anticancer treatment, which has become a pressing clinical issue in reproductive medicine. There are a large number of observational studies, but differences in patient groups, cancer diagnoses and study design make this a confusing field that will benefit from a thorough and robust review.SEARCH METHODSA systematic literature search for AMH in women with cancer was conducted in PubMed, Embase and Cochrane Central Register of Controlled Trials up to 1 April 2021. Bias review was conducted using the Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) protocol along with qualitative assessment of quality. Exploratory subgroups were established based on age, cancer type and length of follow-up.OUTCOMESNinety-two publications (N = 9183 patients) were included in this analysis after quality and bias review. Reduced/undetectable AMH was consistently identified in 69/75 studies (92%) following chemotherapy or radiotherapy, with reductions ranging from 42% to concentrations below the limit of detection, and many reporting mean or median declines of ≥90%. Where longitudinal data were analysed (42 studies), a majority (33/42 (79%)) of studies reported at least partial recovery of AMH at follow-up, however, effect estimates were highly variable, reflecting that AMH levels were strongly impacted by anticancer treatment (i.e. the chemotherapy regimen used and the number of treatment cycles need), with recovery and its degree determined by treatment regimen, age and pre-treatment AMH level. In 16/31 (52%) publications, oligo/amenorrhoea was associated with lower post-treatment AMH consistent with impending POI, although menstruation and/or pregnancy were reported in patients with low or undetectable AMH. Long-term (>5 years) follow-up of paediatric patients following cancer treatment also found significantly lower AMH compared with control groups in 14/20 (70%) of studies, with very variable effect sizes from complete loss of AMH to full recovery depending on treatment exposure, as in adult patients.WIDER IMPLICATIONSAMH can be used to identify the damaging effect of cancer treatments on ovarian function. This can be applied to individual women, including pre-pubertal and adolescent girls, as well as comparing different treatment regimens, ages and pre-treatment AMH levels in populations of women. While there was evidence for its value in the diagnosis of POI after cancer treatment, further studies across a range of diagnoses/treatment regimens and patient ages are required to clarify this, and to quantify its predictive value. A major limitation for the use of AMH clinically is the very limited data relating post-treatment AMH levels to fertility, duration of reproductive lifespan or time to POI; analysis of these clinically relevant outcomes will be important in further research.

Reduced ovarian function in women with complex congenital heart disease

BackgroundThere is a high prevalence of menstrual disturbance in women with congenital heart disease (CHD). The purpose of this study was to evaluate ovarian function in women with CHD and factors associated with ovarian function. DesignSixty-one women with more than moderate complexity of CHD who visited our hospital from March to December in 2019 were prospectively enrolled. We investigated menstrual bleeding patterns with a questionnaire. Serum anti-Müllerian hormone (AMH) levels, which reflect ovarian reserve, were measured in 43 women (28.1±8.7 years old) with CHD and 43 age-matched healthy women controls. Ratios of AMH levels to the median of reference values (provided by Beckman Coulter, Inc.) at each age were expressed as percentages (%AMH). The %AMH were evaluated for each clinical characteristic (oxygen saturation, NYHA class, Fontan circulation, cardiac complexity, physiological stage). ResultsMenstrual cycle disorders were observed in 29 of 43 patients (68%) with CHD. The most frequent menstrual cycle disorder was frequent menstrual bleeding, observed in 14 patients (32%). Serum AMH levels were significantly lower in women with CHD than in controls (2.66±2.10 vs 4.55±4.02 ng/mL, P=0.008). The %AMH in women with Fontan circulation was significantly decreased, compared with those of controls [56.7 (1.1-152.4) % vs 94.6 (24.2-396.6) % P= 0.003]. The %AMH significantly reduced even in women with CHD whose oxygen saturation did not reduce (≧96%) [58.6 (4.9-313.9) % vs 94.6 (24.2-396.6) % P=0.033]. ConclusionMeasurements of AMH revealed reduced ovarian function that contributed to menstrual cycle disorders in patients with CHD

Assessment of different markers of ovarian reserve in women with papillary thyroid cancer treated with radioactive iodine.

Treatment with radioactive iodine (RAI) in women with differentiated thyroid cancer is associated with decreased serum concentrations of anti-Müllerian hormone (AMH); however, other markers have not been investigated. Therefore, this study aimed to evaluate the effect of RAI treatment on antral follicle count (AFC) and the serum concentration of inhibin B, follicle-stimulating hormone (FSH), and AMH in women with papillary thyroid cancer (PTC) treated with RAI. We examined 25 women at a median age of 33 years treated with a single dose of RAI. We divided the participants into women over (n = 11) and under 35 years of age (n = 14). Serum concentrations of inhibin B, FSH, AMH, and AFC were assessed at baseline and 1 year after RAI treatment. We found decreased AFC (P = 0.03), serum levels of AMH (P < 0.01), inhibin B (P = 0.03), but not FSH (P = 0.23), 1 year after RAI treatment in comparison to baseline in the whole group. When we compared serum levels of AMH in younger vs older women separately, we observed a significant reduction of this hormone’s serum level after RAI treatment in both groups (P < 0.01; P = 0.04, respectively). We concluded that RAI treatment significantly impacts the functional ovarian reserve in premenopausal women with PTC.

Body Composition and Serum Anti-Müllerian Hormone Levels in Euthyroid Caucasian Women With Hashimoto Thyroiditis.

ObjectiveWomen with Hashimoto thyroiditis (HT) are characterized by increased incidence of infertility and disturbances in body composition. Serum anti-Müllerian hormone (AMH), which reflects functional ovarian reserve, is decreased in women with HT and it be related to body mass. The aim of the present study was to investigate the relation between serum levels of AMH and body composition in HT compared to control group.Patients and MethodsWe examined 85 euthyroid women: 39 subjects with HT and 46 control women. Body composition was analysed by dual-energy X-ray absorptiometry and with bioimpedance method. Serum concentrations of AMH, leptin, TSH, thyroid hormones were assessed.ResultsWe observed lower serum concentration of AMH in women with HT in comparison to the control group (p=0.01), but without differences in serum concentration of leptin between studied groups (p=0.28). Women with HT were characterized by higher %body fat (p=0.01) estimated with bioimpedance method without differences in BMI, android and gynoid fat mass and visceral adipose tissue (VAT) mass estimated with DXA method when compared to the control group (all p>0.05). We found a negative relationship between serum concentration of AMH and %body fat (r=-0.38,p=0.03) in women with HT. Additionally, in HT group, the relationship between serum levels of AMH and leptin was not statistically significant (r=0.01,p=0.96). We observed a relationship between serum concentration of leptin and BMI, %body fat mass, android, gynoid and VAT mass in HT and in the control group (all p<0.01).ConclusionsWomen with HT are characterized by lower levels of AMH and it is associated with higher fat mass, independently of serum levels of leptin.

Anti-Müllerian hormone (AMH) as a marker of ovarian reserve and premature ovarian insufficiency (POI) in children and women with cancer: A systematic review.

e24057 Background: Female patients undergoing anticancer treatment are at elevated risk of ovarian damage including development of POI. AMH is a key serum biomarker of ovarian reserve. However, its role to identify risk of POI in cancer patients prior to and after treatment is less well understood. Methods: A systematic literature search for AMH in women with cancer was conducted up to 30 August 2020, with formal bias assessment. We aimed at evaluating AMH as a biomarker of ovarian reserve and POI before and after anticancer treatment. Exploratory subgroups were based on age, cancer type and length of follow-up. Results: : Eighty publications (including 7,708 patients) were included in this analysis. All papers reporting AMH before and after treatment reported a large reduction in AMH following treatment, in both adult and paediatric populations. Effect sizes varied depending on the treatment and diagnosis, but ranged from 42% to below the limit of detection, and many reported declines of ≥90%. A majority (25/34, 74%) of studies also reported at least partial recovery of AMH at follow-up. Pre-treatment AMH correlated with post-treatment levels in all studies and younger patient age with higher post-treatment AMH in 21/29 (72%) studies. In 18/32 (58%) publications, oligo/amenorrhea correlated with lower post-treatment AMH. No studies reported correlations between post-treatment AMH and pregnancy, although pregnancy was reported in some patients with low or undetectable AMH. 70% of publications found that within-study variations in treatment (estimated by chemotherapy or radiotherapy type, dosage, duration and/or number of cycles) correlated with AMH reductions and degree of recovery, indicating its potential value as a marker of gonadotoxicity. In women with breast cancer, recovery of AMH was reported in some patients in 10/18 publications; however, AMH levels showed no recovery in many patients receiving alkylating agents or cyclophosphamide-based chemotherapies. In lymphoma, patients receiving ABVD-based regimens had at least partial post-treatment recovery of AMH at follow-up compared with those receiving cyclophosphamide-containing regimens. 16/20 (80%) publications in pediatric cancer patients showed significant reductions in AMH compared with pre-treatment levels or controls. The diagnostic value of post-treatment AMH for POI was supported in 5/5 (100%) studies. AMH levels measured 1–2 years after treatment appeared to be equally reliable at indicating longer-term menstrual outcomes as studies with longer followup. Conclusions: AMH levels were strongly impacted by anticancer treatment, with recovery in some women determined by treatment regimen, age, and pretreatment AMH level. There was evidence for its role in diagnosis of POI, nut further studies are required to clarify its value to assist in patient management.

Association between arthritis treatments and ovarian reserve: a prospective study

Research questionHow do anti-Müllerian hormone (AMH) concentrations in women with and without arthritis compare? Is there an association between AMH and arthritis drug regimen? DesignIn this prospective cohort study, AMH was measured at two time points (T0 and T1) in 129 premenopausal women with arthritis. AMH at T0 was compared with that from a bank of serum samples from 198 premenopausal women without arthritis. Primary outcomes were: (i) diminished ovarian reserve (DOR) (AMH <1.1 ng/ml) and (ii) annual rate of AMH decrease. Univariate, multivariable and Firth logistic regression identified variables associated with annual AMH decrease in excess of the 75th percentile. ResultsMedian time between T0 and T1 was 1.72 years. At time T0, median age-adjusted AMH in women with arthritis was significantly lower than that of women without arthritis (median 2.21 ng/ml versus 2.78 ng/ml; P = 0.009). Women with arthritis at highest risk for DOR had a history of tubal sterilization or were over the age of 35. Those with highest odds of having an annual AMH decrease in excess of the 75th percentile (over 28% decrease per year) were those: over the age of 35 or who sought care for infertility. Women with arthritis taking methotrexate alone (OR 0.08, 95% CI 0.01–0.67) or methotrexate plus tumour necrosis factor-alpha antagonists (OR 0.13, 95% CI 0.02–0.89) were less likely to be in the highest quartile of annual AMH decrease than women with arthritis not taking medication. ConclusionsWomen with arthritis had lower AMH than healthy controls. Long-term methotrexate use was not associated with an annual AMH decrease.

The Relationship of Anti-Mullerian Hormone in Polycystic Ovary Syndrome Patients with Different Subgroups.

PurposeTo explore the value of anti-Mullerian hormone (AMH) in patients with polycystic ovary syndrome (PCOS) with different phenotypes and ages, and to identify the relationship between hyperandrogenism (HA) and polycystic ovary morphology (PCOM), in a Chinese cohort.MethodsA total of 2262 women (1631 with PCOS and 631 controls) were enrolled. The serum AMH and total testosterone (TT) were analyzed, the AMH levels of each subgroup were compared, and the value of each phenotype and age group of patients with PCOS was evaluated.ResultsThe level of AMH in women with PCOS (mean±SD, 8.63±4.73 ng/mL) was higher than that in controls (5.57±3.31 ng/mL) (P<0.01). The level of AMH in the PCOM subgroup (11.19±6.4 ng/mL) was significantly higher than that in the HA subgroup (8.58±4.74 ng/mL) (P<0.01), and both were higher than that in controls (P<0.01). AMH was higher in PCOS patients than in controls, but the same values were found in subgroups of PCOS patients under 30 years old.ConclusionAMH changed in different subgroups of PCOS, which was the possible reason why AMH was not a diagnostic indicator. However, AMH could help to differentiate between clinical subgroups, as it was strongly related with PCOM but not with HA. AMH changed substantially with age, but was stable in PCOS patients under 30 years old.

Anti-Müllerian hormone concentrations in women with chronic kidney disease

[This corrects the article DOI: 10.1093/ckj/sfz164.][This corrects the article DOI: 10.1093/ckj/sfz164.].

Improvement of anti-Müllerian hormone and oxidative stress through regular exercise in Chinese women with polycystic ovary syndrome.

Structured exercise is shown to be one of the most effective lifestyle interventions for women with polycystic ovary syndrome (PCOS). Anti-Müllerian hormone (AMH) has been proposed as a marker of ovarian dysfunction, and oxidative stress plays an important role in the development of PCOS. We sought to investigate whether there was any effect of aerobic exercise on AMH levels and oxidative stress in Chinese PCOS women. Thirty-eight PCOS women were enrolled and divided into two groups. The exercise group carried out a 12-week exercise program, while the control group maintained their normal lifestyle. All women underwent blood tests and cardiopulmonary exercise tests (CPETs) at enrollment and at 12-week follow-up. At baseline, there was no statistically significant difference between the two groups in clinical characteristics, AMH, oxidative biomarkers, and CPET parameters. After 12weeks, body mass index (BMI) and cardiovascular fitness indexes of the exercise group were improved. We also found a decrease in AMH (P= 0.021) and malondialdehyde (MDA) (P= 0.002) and an increase in superoxide dismutase (SOD) (P= 0.009) and total antioxidant capacity (TAC) (P= 0.012) in the exercise group, while there was no change in the control group. Moreover, the change of AMH was positively associated with the change of MDA (r = 0.23, P= 0.003) in the exercise group. Our findings demonstrated that 12weeks of aerobic exercise produced beneficial effects on BMI, cardiovascular fitness, AMH, and oxidative stress in PCOS women. Favorable modification of oxidative stress might thus be an effective method for improvement of AMH in these women, which deserves further exploration in the future.

Age-Related Value of Anti-Mullerian Hormone

Background: There is a correlation between anti-mullerian hormone (AMH) and the age when it becomes undetectable during menopause. The AMH immunoassay has been widely estimated in clinical practice to assist in reproduction and infertility treatment. Objective: To investigate the normal level of serum anti-mullerian hormone (AMH) in relation to women’s age in Basra. Patients and Methods: Cross-sectional study was carried out in Basra Maternity and Child Hospital from January 2018 to September 2019. Serum AMH levels were estimated for 975 women aged 15–50 years. They were classified into 7 age groups:15–20, 20–25, 25–30, 30–35, 35–40, 40–45 and 45–50 years. Serum AMH and FSH levels were determined by commercial enzyme-linked immunoassay. Results: Negative relationship was noticed between AMH concentration and age. The mean AMH levels for the age groups 1, 2, 3, 4, 5, 6 and 7 were 4.9 ng/ml, 4.25ng/ml, 3.27 ng/ml, 2.43ng/ml, 2.17ng/ml, 1.95ng/ml and 0.9ng/ml respectively. Conclusions: This study recorded normal levels of AMH in women in Basra. These levels can be considered for the medical treatment of infertile women. Keywords: age, anti-mullerian hormone, FSH.

Longitudinal Analysis of the Effect of Radioiodine Therapy on Ovarian Reserve in Females with Differentiated Thyroid Cancer.

Background: Although international guidelines have become more conservative on the use of radioactive iodine (RAI) therapy, it is still one of the cornerstones of the treatment of patients with advanced differentiated thyroid cancer (DTC). As a large proportion of females diagnosed with DTC is in their reproductive years, knowledge about the effect of RAI on their gonadal and reproductive function is important. Earlier studies evaluating Anti-Müllerian hormone (AMH) as a representative of ovarian reserve were either cross-sectional, had relatively low numbers, had no patients with multiple RAI therapies, or had a relatively short follow-up. The primary aim of our study was, therefore, to prospectively evaluate the effect of RAI on AMH in women undergoing treatment for DTC. Methods: We included females, aged 16 years until menopause, who were scheduled to undergo their first RAI treatment for DTC at our hospital. Serum AMH was measured before initial therapy and regularly thereafter. Repeated measurement analysis was used to assess the changes of AMH concentrations over time, and how this is influenced by age and cumulative RAI dose. Results: Longitudinal AMH assessments were available in 65 patients (mean age 32 years, median of five measurements during median follow-up of 34 months). AMH concentrations changed nonlinear over time, decreased until 12 months in the single RAI group (-55%), and stabilized thereafter. In the multiple RAI group, after stabilization, a further decrease occurred (-85% after 48 months). Age in both RAI groups significantly influenced AMH change over time, with younger patients (<35 years of age) showing a less steep decrease. Conclusions: In a population of female DTC patients treated with total thyroidectomy and a single RAI therapy, AMH concentrations significantly dropped during the first year after initial therapy, and thereafter they remained stable. In patients receiving multiple RAI therapies, a further decrease was seen. Age at baseline significantly influenced AMH change over time. These results support a less aggressive treatment with RAI in low-risk patients as is advocated in the current American Thyroid Association (ATA) guidelines, especially in females older than 35 years of age with the desire to have a child.

Can delivery mode influence future ovarian reserve? Anti-Mullerian hormone levels and antral follicle count following cesarean section: a prospective cohort study

BackgroundThe incidence of Cesarean has increased in recent years. The purpose of this study is to evaluate the effect of cesarean section on ovarian reserve.This is a prospective cohort study from January 2016 to November 2017. Inclusion criteria included singleton primigravid pregnant women whose gestational age was above 37 weeks. Exclusion criteria included history of infertility, pelvic surgery, underlying chronic diseases, any adverse pregnancy outcome and postpartum complication in current pregnancy and hormonal medication within six months of delivery. Anti-Mullerian hormone was measured at the admission time for delivery. The type of delivery was determined based on obstetrics indications. Six months after delivery, antral follicle count was performed and anti-Mullerian hormone was measured again.Result(s)First blood sample was taken from 730 women. After excluding 550 women, the second blood sample was taken from 180 participants. The mean of first anti-Mullerian hormone in women with cesarean and vaginal delivery were 1.01 ng/mL (95% CI 0.82 to 1.18) and 1.18 ng/mL (95% CI 0.96 to 1.40) respectively (P = 0.211). The mean of second anti-Mullerian hormone in women with cesarean and vaginal delivery were 4.77 ng/mL (95% CI:3.91 to 5.63) and 4.92 ng/mL (95% CI: 4.01 to 5.82) respectively (P = 0.818). No statistically significant difference existed in total AFC between cesarean and vaginal delivery groups (MD: 0.41, 95% CI: − 1.05 to 1.89, P = 0.576).ConclusionAntral follicle count and anti-Mullerian hormone, six month after delivery, are not affected by delivery mode even after adjusting for women’s age, baseline Anti-Mullerian hormone, body mass index, gestational age at delivery, breastfeeding, postpartum menstruation, neonatal sex and weight. Based on our best knowledge, this is the first report that investigates the effects of delivery mode on ovarian reserve. Decreased fertility following cesarean has been shown in some previous studies but most of them had assessed this association based on the incidence of subsequent pregnancy. Since subsequent pregnancy can be influenced by several confounding factors, we investigated the effect of cesarean on fertility using its impact on anti-Mullerian hormone levels and antral follicle count. We hope that this study will be a beginning of more detailed studies in this field. We believe that this link is yet to be studied.

Assessment of Circulating Anti-Müllerian Hormone in Women Using Hormonal Contraception: A Systematic Review.

Background: The status of ovarian reserve markers during hormonal contraception (HC) remains uncertain with conflicting literature data. The purpose of this study was to assess the impact of HC on circulating anti-Müllerian hormone (AMH) and other ovarian reserve markers. Materials and Methods: A systematic review was conducted, including all cohort, cross-sectional, and randomized controlled studies assessing serum anti Müllerian hormone concentration in women using HC. Data sources included MEDLINE, EMBASE, DynaMed Plus, ScienceDirect, TRIP database, ClinicalTrials.gov, and the Cochrane Library from January 2000 to October 2018. Results: A total of 366 studies were identified, of which 15 were eligible, including 3280 women, mostly using combined HC (CHC). Articles were divided according to duration of HC into short- (2-3 weeks), medium- (2-6 months), long- (>1 year), and varied-term studies. Two study designs were identified, including studies comparing AMH before and during/after CHC and studies comparing CHC users versus nonusers. Short- and medium-term studies (n = 284) reported no change in circulating AMH in women using cyclical CHC for one to six cycles. Apart from one study, all long- and varied-term studies (six studies, n = 1601) consistently showed a marked decline in AMH, antral follicle count, and ovarian volume. Three long-term studies (n = 1324) provided evidence of AMH recovery after discontinuation of HC. Conclusion: Circulating AMH seems to remain unchanged in women using cyclical CHC for up to 6 months, but appears to markedly decline in long-term users with recovery after discontinuation.

Indicators of an ovarian reserve in women of early reproductive age with PCOS depending on the phenotype.

Background The objective was to study ovarian reserve values in women of early reproductive age with polycystic ovary syndrome (PCOS) according to their phenotype. Materials and methods Two hundred women of early reproductive age with PCOS and without PCOS were studied by clinical, laboratory (hormonal), ultrasound and statistical methods. Results The anti-Müllerian hormone (AMH) index in women with PCOS with the main (A) and non-androgenic (D) phenotypes corresponded to a high level, with anovulatory (B), ovulatory (C) corresponding to a normal level. AMH in women with the main (A) phenotype differed and was higher compared with women with anovulatory (B) and ovulatory (C) phenotypes and had no differences to women with the non-androgenic (D) phenotype. No differences in the AMH level between anovulatory (B) and ovulatory (C) phenotypes have been established. Ultrasound parameters of the ovaries (volume, number of antral follicles in the section, average diameter of the follicles) of women with PCOS of the main (A), ovulatory (C) and non-androgenic (D) phenotypes were statistically significantly larger than healthy ones. With anovulatory (B) phenotype these figures did not differ from the control group. When comparing phenotypes by ultrasound parameters of the ovaries the main (A), ovulatory (C) and non-androgenic (D) phenotypes did not have any differences among themselves. Anovulatory phenotype (B) had lower ultrasound indices. Conclusion The study of indicators of ovarian reserve in women of early reproductive age with PCOS is a promising direction that will allow to more accurately determine the reproductive potential of each particular woman and influence the choice of treatment tactics.

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.

Does the anti-Müllerian hormone truly reflect ovarian response in women with endometrioma?

In this study, our aim was to determine which factor is more correlated with the number of oocytes retrieved in patients with endometrioma compared with controls undergoing in vitro fertilisation–intracytoplasmic sperm injection (IVF–ICSI) cycles: antral follicle count (AFC) or anti-Müllerian hormone (AMH). A total of 60 women with endometrioma and a control population of 60 women without endometrioma in the same period were randomly selected underwent the injection IVF–ICSI treatment. No significant differences were found between the groups in terms of age (28.78 ± 3.49 vs. 29.52 ± 2.47, p = .187), body mass index (23.62 ± 2.05 vs. 23.91 ± 2.11, p = .449), duration of infertility [(3 (2–4) vs. 3 (2–3), p = .139)], AMH level (1.52 ± 0.51 vs. 1.32 ± 0.92, p = .133), duration of stimulation [(9 (9–10) vs. 10 (9–10), p = .135)], total gonadotropin dose [(2750 (2262.5–3337.5) vs. 2770 (2680–3562.5), p = .125)], endometrial thickness [(10 (10–11) vs. 10 (9–11), p = .463)], fertilisation rates (67.20 ± 18.04 vs. 62.28 ± 17.13, p = .123), grade I embryo (43.3% vs. 30%, p = .185), clinical pregnancy rates (40% vs. 26.7%, p = .123), and the perinatal outcomes between the groups. The AFC was higher in the controls than in those with endometrioma (9.20 ± 1.80 vs. 6.32 ± 2.04, p < .001). The number of oocytes retrieved was also higher in the controls than in those with endometrioma [(7 (6–8) vs. 4 (4–5.75), p < .001)]. We found that women with endometrioma had a significantly lower number of oocytes retrieved than the controls despite the same AMH levels in both groups. AFC is a better marker of ovarian response than AMH in women with endometrioma undergoing IVF-ICSI.Impact statementWhat is already known on this subject? Utilising the ovarian reserve is important in the success of ovarian stimulation and in evaluating the success of assisted reproductive technologies. The anti-Müllerian hormone (AMH) level and the antral follicle count (AFC) are widely used in the prediction of ovarian functional reserve and response. However, no perfect marker exists in the evaluation of ovarian reserve and ovarian response.What do the results of this study add? Our study demonstrated that women with endometrioma have a significantly lower number of oocytes retrieved than the controls, despite the same AMH levels in both groups; which strongly suggests that AFC is a better reflection of ovarian response than AMH in women with endometrioma undergoing an in vitro fertilisation–intracytoplasmic sperm injection (IVF-ICSI).What are the implications of these findings for clinical practice and/or further research? This important issue has been reviewed and discussed for years, however, the conclusions are still controversial. Additional research is needed to understand which ovarian reserve test could better predict ovarian response outcome?