Differences In anti-Mullerian Hormone Research Articles

Relationship Between Anti-Mullerian Hormone (AMH) and Other Influencing Factors with in Vitro Fertilization (IVF) Outcome of Iraqi Infertile Women

The clinical application of Anti-Mullerian Hormone (AMH) measurement has been proposed in the prediction of qualitative and quantitative aspects of assisted reproductive technologies (ART). The aim of this study is to investigate the role of AMH level and other influencing factors in the outcomes of in vitro fertilization (IVF) treatment. The study focused on AMH and its association with infertile women undergoing IVF. The population included in this study was 131 infertile women who sought therapy for infertility at Kamal Al-Samarra'ay Specialized Hospital. They were divided into three groups according to the level of AMH hormone; group A (0.5-1.5 ng/mL, n=52), group B (1.6-4 ng/mL, n=70), and group C (> 4 ng/mL, n=9). Data collection was performed by means of a specially designed questionnaire, independent of demographic data. It included questions related to infertility. Statistical analysis was performed with SPSS 26. Clinical parameters of infertile women, infertility hormones and their relationship with AMH, as well as FMS-like Tyrosine kinase 1 levels, were all investigated. The study findings revealed a significant difference in the concentration of AMH between infertile women (p<0.01). Our analysis further demonstrated that the level of AMH reduces with advancing age in infertile women. Additionally, a positive correlation was observed between the number of oocytes obtained and AMH levels in infertile women. Furthermore, the study found that AMH levels had an effect on clinical pregnancy outcomes. Specifically, the highest success rates for IVF were observed in women with normal AMH levels falling within the ranges of group B (6-4 ng/mL(. Additionally, the study demonstrated significant differences in AMH and TSH levels among infertile groups (p<0.05). Our study concluded that there is a significant correlation between clinical parameters and IVF outcomes, which can provide information for future clinical interventions aimed at improving success rates. Our analysis highlighted the role of FMS-like Tyrosine kinase 1 in infertility, where higher FMS-like Tyrosine kinase 1 levels were associated with higher success rates in IVF. The results indicate that the FMS-like Tyrosine kinase 1 level is a valuable marker for confirming the success or failure of IVF and can help determine the appropriate treatment plan.

Anti-Müllerian hormone and HOMA-IR in different phenotypes of polycystic ovary syndrome on insulin resistance

Aims: To examine the link between serum anti-mullerian hormone (AMH) levels and homeostatic model assessment of insulin resistance (HOMA-IR) in different phenotypes of polycystic ovary syndrome (PCOS).
 Methods: This retrospective study included 120 patients aged 18-30 who visited our polyclinics between June 2021 and December 2022. Patients were divided into four groups based on the Rotterdam criteria for PCOS phenotypes. A control group of 24 individuals was also included. Clinical data, hormonal profiles, and metabolic parameters were obtained from medical records.
 Results: There were significant differences in AMH, follicle stimulating hormone (FSH), luteinizing hormone (LH), and high-density lipoprotein (HDL) levels among the PCOS phenotypes and control group. AMH levels were highest in phenotype 1 (oligo/anovulation + hyperandrogenism + polycystic ovaries) and lowest in the control group. FSH were highest in phenotype 4 (oligo/anovulation + polycystic ovaries) and lowest in the control group. LH were highest in phenotype 2 (oligo/anovulation + hyperandrogenism). HOMA-IR was highest in phenotype 1. However, there were no significant differences in AMH or HOMA-IR levels among the PCOS phenotypes.
 Conclusion: Our study found hormone level differences among PCOS phenotypes but no significant differences in AMH or HOMA-IR. This suggests AMH may not distinguish between phenotypes and insulin resistance may not differ significantly among phenotypes.

Contemporary Anti-Retroviral Drugs (ARVDs) Disrupt Follicular Development in Female Wistar Rats.

There are genuine concerns that long-term use of anti-retroviral drugs may be associated with reproductive complications in females. This study aimed to ascertain the effect of highly active anti-retroviral drugs on the ovarian reserve and reproductive potential of female Wistar rats and by extension to HIV-positive human females. A total of 25 female Wistar rats, weighing between 140g and 162g, were randomly allotted into non-intervention and intervention groups, receiving the anti-retroviral drugs, Efavirenz (EFV), Tenofovir Disoproxil Fumarate (TDF), Lamivudine (3TC), and a fixed-dose combination (FDC). The dosage was administered orally at 8 am daily for 4 weeks. Serum concentrations of anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinising hormone (LH), and estradiol were measured using standard biochemical techniques (ELISA). Follicular counts were made on fixed ovarian tissue from the sacrificed rats. The mean AMH level for the control group and the EFV, TDF, 3TC, and FDC groups were 11.20, 6.75, 7.30, 8.27, and 6.60 pmol/L, respectively. The EFV and FDC groups had the lowest AMH, compared to the other groups, but there was no statistically significant difference in AMH across the groups. The mean count of antral follicles was significantly lower in the group that received EFV when compared to the other groups. The corpus luteal count was significantly higher in the control group than in the intervention groups. The study demonstrated a disruption in the reproductive hormones of female Wistar rats receiving anti-retroviral regimens containing EFV. Clinical studies are required to determine if these changes are seen in women receiving EFV-based treatment, as this may compromise reproductive function and predispose them to early menopause.

Abstract 3210: Monoclonal antibodies targeting PD-1, LAG-3, and TIM-3 do not cause reproductive or endocrine toxicity in a syngeneic model of triple negative breast cancer

Abstract Background: Few targeted treatments exist for triple negative breast cancer (TNBC), an aggressive form of breast cancer that is diagnosed more frequently in reproductive-age women. As a result, most patients receive frontline chemotherapies and often experience infertility and endocrine disruption. Immunotherapies are a promising option for less toxic therapeutic approaches, but little is known about their effects on reproductive and endocrine function. Methods: E0771 cells were injected into the bilateral mammary pads of 8-week-old female C57Bl/6J mice. After tumor development (14 days post-implantation), E0771 mice received 200 ug doses of immunotherapy (anti-PD-1, anti-LAG-3, or anti-TIM-3 antibodies) or IgG isotype control every four days, with treatments ceasing after the third dose. 8 days after the final dose, estrus cycling was monitored via vaginal cytology. 11-15 days after the final dose, mice were euthanized during proestrus stage, and serum and ovaries were collected. Serum levels of anti-Mullerian hormone (AMH), luteinizing hormone (LH), and follicle stimulating hormone (FSH) were quantified via ELISA. Ovaries were fixed in formalin and embedded in paraffin, then sectioned serially. Follicle staging and abundance was quantified via hematoxylin and eosin staining. Follicle health and apoptosis was evaluated via TUNEL staining. Results: There were no significant differences between any of the treatment and control groups in the percentage of time spent in each stage of the estrus cycle, indicating that treatment with the selected immunotherapies does not cause perturbations in reproductive cyclicity. Serum hormone analysis revealed no significant differences in AMH, LH, or FSH levels between treatment and control groups, indicating that these immunotherapies do not cause endocrine toxicity. There were no significant differences in follicle abundance between any of the treatment and control groups, suggesting that the immunotherapies are not toxic to the ovarian reserve or developing follicles. TUNEL staining revealed no significant differences in granulosa cell or oocyte apoptosis between treatment groups. Conclusion: Treatment with anti-PD-1, anti-LAG-3, or anti-TIM-3 monoclonal antibodies does not cause reproductive or endocrine toxicity in a tumor-bearing mouse model. These results demonstrate that immunotherapy may be a promising component of fertility-sparing therapeutic regimens for patients who wish to maintain ovarian and endocrine function after cancer treatment. Citation Format: Payton De La Cruz, Jennifer Ribeiro, Kathryn Grive. Monoclonal antibodies targeting PD-1, LAG-3, and TIM-3 do not cause reproductive or endocrine toxicity in a syngeneic model of triple negative breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3210.

RF02 | PSAT119 AMH and Spontaneous Puberty in a Diverse US Turner Syndrome Clinic Cohort: A Cross-sectional study

Abstract Background Turner syndrome (TS) is caused by the absence of whole/part of the second X-chromosome. Primary ovarian insufficiency (POI) is common in TS and serum anti-Mullerian hormone (AMH) of <4 pmol/L (0.56 ng/mL) is suggestive of POI and lack of spontaneous puberty. Objective To describe the distribution of AMH and spontaneous puberty in a cross-sectional cohort of patients in a newly-established pediatric TS specialty clinic. Methods Data on all TS patients seen in the multidisciplinary clinic between 1/1/2019 and 10/27/2021 were abstracted from retrospective chart review into a REDCap database. Descriptive analysis, one way ANOVA and two sample t-tests for pair-wise comparisons was completed (SPSSv28.0 and Excelv2102), with statistical significance set at p<0.05. Results Ninety-six patients (9% Asian, 13.5% African American and 37.5% Caucasian, and rest unknown/other self-reported race, and 29.2% Hispanic ethnicity) were enrolled in our clinic. While the majority were diagnosed postnatally (74%, median age 5 years), 6% were prenatal and 20% had positive prenatal screen with postnatal confirmation. Karyotype distribution: 41% non-mosaic monosomy X, 17% Xq (including 14% isochromosome Xq) and 14% Xp structural abnormalities, 10% ringX, 7% 45,X/46,XX mosaicism and 9% with Y-chromosome. Median age at first TS clinic visit was 10 years (IQR 9.7) with median height at 2%ile, weight 31%ile and BMI 73%ile. AMH was measured in 88 patients and only 33 (37.5%) had detectable (>0.015 ng/mL) AMH; 8 (9%) had AMH >0.56ng/mL. Mean AMH was significantly lower in 45,×monosomy (0.03+/- 0.14) vs. other karyotypes (0.44+/-1.13)(p=0.01). A one-way ANOVA revealed a statistically significant difference in AMH between 45,X, structural abnormalities in Xp/Xq and, mosaic 45,X/46,XX karyotypes (p<0.001). Pair-wise comparisons confirmed mean AMH in 45,X/46,XX was significantly higher (3.1ng/mL) (p<0.001) compared with 45,×(0.03ng/mL), Xq (0.02ng/mL) and Xp (0.08ng/mL) abnormalities but no other comparisons were statistically significant. Spontaneous thelarche was reported in 23/58 (39.6%) pubertal patients with mean AMH (0.65ng/mL +/-1.3) compared to absent spontaneous thelarche (N=35, 0.02 +/- 0.04) (p=0.03). Spontaneous menarche was reported in 9 patients, with mean AMH 1.8+/- 1.7ng/mL; 4/9 had 45,X/46, XX karyotype and 1 each had 45,X, Xp, Xq, isoXq, and ringX karyotypes. The mean age at spontaneous thelarche was lower than age at thelarche with hormonal induction (11 + 1 years vs. 14 + 2 years, p < 0.001). Median age at estrogen initiation was 12 years (IQR 3); 86% received transdermal estradiol with menarche at a median age of 15 years. While 78/96 (81%) received fertility preservation counseling at a mean age of 11 + 6 years, only 4 utilized fertility preservation options (1 oocyte cryopreservation and 3 ovarian tissue cryopreservation). Although cross-sectional data limit inferences on AMH as a marker of puberty, our data represents a large and diverse cohort of TS patients in the US. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Saturday, June 11, 2022 1:24 p.m. - 1:29 p.m., Saturday, June 11, 2022 1:24 p.m. - 1:29 p.m.

Menstrual blood CD146+ mesenchymal stem cells reduced fibrosis rate in the rat model of premature ovarian failure.

Here, the regenerative potential of menstrual blood-derived mesenchymal stem cells (MenSCs) was examined on restoration of premature ovarian failure (POF) ovaries in rats' POF model. Freshly isolated CD146+ MenSCs using magnetic-activated cell storing method were immediately injected into ovaries of POF rats. Four and eight weeks after cell administration, both ovarian tissues were sampled for histological examination and the expression of fibrosis-related genes. Serum samples were also prepared for hormonal analysis. At the endpoint, mating trials were performed to assess the fertility of POF rats following MenSC transplantation. Histopathological examination revealed the induction of POF after Ceftriaxone injection by increasing atretic follicles and abnormal morphologies. MenSCs transplantation increased the number of normal follicles and coincided with the reduction of follicular atresia. Biochemical analyses exhibited the reduction and increase of systemic follicle-stimulating hormone (FSH) and E2 respectively after MenSCs transplantation compared to the POF rats (P < .05). No significant differences in anti-mullerian hormone (AMH) blood levels were detected in this study between POF controls and MenSCs-treated rats. We noted moreover the transcriptional up-regulation of Smad 2, 4, and TGF-β1 in POF rats, and these values were decreased after MenSCs transplantation (P < .01). By contrast, the RNA expression of Smad 6 remained increased in both pre- and post-treatment with MenSCs groups (P < .05). Finally, we found an increase in neonate births in POF rats treated with MenSCs, and that this feature was associated with ovarian rejuvenation through amelioration of fibrosis. These data showed that MenSCs are promising cell lineage for the alleviation of POF in the rat model by controlling the fibrosis rate.

Moxibustion improves ovarian function based on the regulation of the androgen balance.

The effect of androgens on follicular development and female reproduction has become an active research topic. Moxibustion is a Traditional Chinese Medicine therapy that has been reported to be able to prevent and treat numerous ovary-related problems. However, studies on the effect of moxibustion for diminished ovarian reserve (DOR) on androgen balance are still lacking. The present study aimed to assess the efficacy of moxibustion intervention prior to disease onset and at the early stage of disease in a rat model of DOR and explore the mechanisms of its effect on ovarian function. A total of 32 rats were randomly divided into four groups: Blank group, Model group (a drug-induced model of DOR), Moxibustion group 1 and Moxibustion group 2. Moxibustion was performed on the BL23 and RN4 acupoints of female rats daily for a total of 20 days (once a day, five times a week for a total of 4 weeks). The two moxibustion groups were established with different intervention times: One group was subjected to pre-disease intervention and the other group to early-disease intervention. The ovarian function was evaluated by detecting anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), estradiol (E2), testosterone (T), dehydroepiandrosterone (DHEA), dihydrotestosterone (DHT) and androgen receptor (AR) levels in the serum or the ovary samples. To further investigate the downstream regulatory factors for AR after moxibustion treatment for pre-disease or early-disease intervention, FSH receptor (FSHR) and microRNA (miR)-125b expression in ovaries were also analyzed. The results indicated that AMH and DHT levels were reduced in the model group compared with those in the blank group, while FSH, T and DHEA levels were increased. AMH and DHT levels were increased in Moxibustion group 1 compared with those in the model group, while FSH, T and DHEA levels were reduced. There was no difference in E2 levels between Moxibustion group 1 and the model group. Compared with that in the model group, the AR content in the ovary was increased in Moxibustion group 1. There was no difference in FSHR mRNA in the ovaries between Moxibustion group 1 and the model group. miR-125b levels were significantly increased in Moxibustion group 1 as compared with those in the model group. Furthermore, AMH and DHT levels were increased in Moxibustion group 2 compared with those in the model group, while FSH, T and DHEA levels were reduced. E2 levels were significantly decreased in Moxibustion group 2 compared with those in the model group. The relative mRNA expression of AR, FSHR and miR-125b was decreased following establishment of the model. Compared with that in the model group, the AR content in the ovary was increased in Moxibustion group 2. In comparison with the blank and model groups, the FSHR content in the ovary of Moxibustion group 2 was significantly increased. miR-125b levels were not obviously altered in Moxibustion group 2 as compared with those in the model group. In addition, there was no significant difference in AMH, FSH, T and DHEA levels between the two moxibustion groups. E2 and DHT levels were higher in Moxibustion group 1 than in Moxibustion group 2. There was no difference in AR mRNA expression between the two moxibustion groups. FSHR mRNA levels were lower in Moxibustion group 1 than in Moxibustion group 2, while miR-125b mRNA levels were higher in Moxibustion group 1 than in Moxibustion group 2. In conclusion, the present study suggested that moxibustion intervention prior to disease onset and at the early disease stage was able to improve ovarian function via modulation of the AR-mediated stable equilibrium of androgens. However, the effects and mechanisms of moxibustion intervention for pre-disease and early-disease intervention of DOR appear to be different. The appropriate duration of treatment and the time-effect relationship require to be further studied.

Hydroxyurea Is a Potential Risk Factor for Diminished Ovarian Reserve in Young Adults with Sickle Cell Anemia

Introduction: Females are born with a set number of ovarian follicles. Ovarian reserve, defined by the number of primordial follicles, decreases with age. Diminished ovarian reserve (DOR) is a risk factor for shortened reproductive lifespan, infertility and poor assisted reproductive technology outcomes. Young women with sickle cell anemia (SCA) are at risk for DOR1,2. Whether hydroxyurea (HU) use contributes to this risk is not established. Antimullerian hormone (AMH), a biomarker of the ovarian follicle pool, is used with antral follicle count (AFC) and follicle stimulating hormone (FSH), to estimate ovarian reserve. The extent to which AMH corresponds with visualized AFC in SCA, and thus serves as a reasonable surrogate biomarker, is unknown. The purpose of this study was to test the hypothesis that young women with SCA have lower AMH than age and race matched controls and that HU exposure is a risk for DOR. Methods: Subjects from our Adult Sickle Cell Center had ovarian reserve measured on day 3-5 of the menstrual cycle or at any time if on menses-suppressing contraception. We measured serum AMH, FSH, estradiol and AFC by ultrasound. Subjects' demographic, reproductive and SCA treatment history were obtained. HU exposure variables included (1) age at first exposure, (2) use at time of study visit, (3) markers of adherence (MCV and ANC), and (4) refill data. Ferritin was used to assess iron overload. We compared AMH levels in subjects ages 19-25 and 26-31 years to AMH levels in age-matched African American women controls with tubal factor infertility and no chemotherapy exposure, and age-matched levels from the historic Multicenter Study of Hydroxyurea (MSH) cohort2. We then compared subject characteristics by the presence of DOR (AMH &amp;lt;1.1ng/mL ± FSH &amp;gt; 10 - 40IU) or primary ovarian insufficiency (POI), (AMH &amp;lt; 1.1ng/mL and FSH ≧ 40IU). The chi-squared and Mann Whitney U test was used for categorical and continuous variables, respectively, to determine associations with DOR. Results: Sixteen women with SCA participated with a median age of 25.5 years (IQR 21,29), hemoglobin 8.8g/dL (IQR 8,9.2), MCV 96.9fL (IQR 88.6, 101.1), ANC 5.7K/mcl (IQR 3.4, 8.4), and ferritin 857ng/mL (IQR 246, 1957). All had prior HU exposure. The median age at first HU exposure was 17.5 years (IQR 14.5, 21), median months of HU exposure was 23 (IQR 2.8, 38.5). Twelve subjects were taking HU at the study visit and, by refills, 7 took continuous HU in the previous 6-months, median dose 1715mg (IQR 1000, 2000). Lower AMH and AFC was observed in older subjects as expected. AMH was lower in study subjects compared to controls in both age groups: 19 - 25 years [2.48ng/mL (IQR 1.7, 3.4) vs 7.45ng/mL (IQR 6.5, 10.7), p&amp;lt;.001], 26- 31 years [1.34ng/mL (IQR 0.87,2.2) vs 2.04ng/mL (IQR 1.7,3.2), p=0.08]. The JHU and MSH cohorts had no difference in AMH (p&amp;gt;0.05)1. Younger women (19-25yo) had higher median AFC than older women (26-31yo), a difference that was not statistically significant (14(IQR 8, 35) vs 9(IQR 7,12) follicles). Four of 16 subjects had DOR; all four were taking HU and &amp;gt;25yo. In those with or without DOR, there was no difference in median BMI (21.1(20.7, 22.4) vs 24.7 (IQR 20.8, 26.2), hemoglobin (8.7 (IQR 8.4, 8.9) vs 8.8 (7.9, 9.8) g/dL), or ferritin (602 (IQR 131, 1529) vs 875 (IQR 303, 1975). DOR was associated with a lower median AFC (5.5(IQR 4, 7) vs 12 (IQR 9,24) oocytes p=0.04) and higher MCV (112 vs 92fL, p=0.02). Table 1 compares DOR and HU exposure our cohort, the MSH2 and a pediatric cohort1. In all cohorts, some young women exposed to HU have DOR. Conclusions In this pilot study of ovarian reserve in young adult women with SCA, AMH is significantly lower in age- and race-matched controls and levels are similar to an historic SCA cohort. AMH and AFC were both lower in older subjects, suggesting that AMH is a reasonable ovarian reserve marker in SCA. No women had POI. DOR was associated with lower AFC and higher MCV. In young adult women of reproductive age with SCA, taking HU may be a risk for DOR. This data forms the basis for ongoing research on the pathobiological mechanisms and clinical significance of DOR in women with SCA. References 1Pecker, LH et al. Hydroxycarbamide and ovarian reserve in the Multicenter Study of Hydroxycarbamide. British Journal of Haematology. 2020. 2Elchuri, SV et al. The effects of hydroxyurea and bone marrow transplant on AMH levels in females with SCA. Blood Cells Mol Dis. 2015. Disclosures Pecker: Forma Therapeutics: Consultancy. Lanzkron:GBT: Research Funding; HRSA: Research Funding; Ironwood: Research Funding; NHLBI: Research Funding; PCORI: Research Funding; Pfizer: Research Funding; Pharmacy Times Continuing Education: Honoraria; Prolong: Research Funding.

Ovarian Reserve and Serum Concentration of Thyroid Peroxidase Antibodies in Euthyroid Women With Different Polycystic Ovary Syndrome Phenotypes.

Objective: It has been shown that women with polycystic ovary syndrome (PCOS), as well as Hashimoto's thyroiditis (HT), are characterized by increased incidence of infertility. Serum anti-Müllerian hormone (AMH), which reflects ovarian reserve, is elevated in PCOS women and is decreased in women with HT. The Rotterdam criteria recognize four clinical PCOS phenotypes, i.e., phenotypes A, B, C, and D. The aim of the present study was to investigate the relation between serum concentrations of thyroid peroxidase antibodies (TPOAbs) and ovarian reserve in different PCOS phenotypes.Patients and methods: We examined 141 women with PCOS [phenotype A was diagnosed in 67 (47.5%) women, phenotype B in 30 (21.3%), phenotype C in 28 (19.9%), and phenotype D in 16 (11.3%)] and 88 control subjects of similar age; all women were euthyroid. Serum concentrations of AMH, thyroid-stimulating hormone (TSH), thyroid hormones, and TPOAbs were assessed.Results: We observed positive serum TPOAbs in 21.9% women with PCOS and in 23.9% controls (p = 0.07). We did not find differences in the frequency of detection of positive serum TPOAbs between phenotypes A, B, and C and the control group (p > 0.05). We did not observe a difference in AMH levels between TPOAbs-positive and TPOAbs-negative women, both in the control group and the PCOS women (all p > 0.05). However, serum AMH concentration was markedly higher in the whole PCOS group (p < 0.01) and in phenotype A (p < 0.01) vs. controls when the serum concentration of TPOAbs was negative. In the groups with positive serum levels of TPOAbs, serum concentration of AMH did not differ between PCOS phenotypes and controls (p = 0.23). Additionally, we observed that serum AMH concentration was related to the level of TPOAbs in the PCOS group (r = −0.4, p = 0.02).Conclusions: The frequency of serum detection of positive TPOAbs did not differ between PCOS phenotypes with clinical/biochemical hyperandrogenism and the control group. The observation of the difference in serum AMH between the PCOS and control groups only in TPOAbs negative women together with the inverse relation of TPOAbs with serum AMH only in the PCOS group might suggest that ovarian reserve is influenced by TPOAbs in PCOS.

Ethnic discordance in serum anti-Müllerian hormone in healthy women: a population study from China and Europe.

Chinese women are known to have an earlier age of natural menopause than their European counterparts, but whether they also have a lower functional ovarian reserve is unknown. This study was designed to assess whether there are ethnic differences in anti-Müllerian hormone (AMH) concentrations in women of reproductive age. Women in China and Europe with regular menstrual cycles, not on hormonal contraception and with no medical history of note, were recruited to provide a day 2-5 early follicular phase sample. AMH concentration was determined using the Roche Elecsys assay. Decline in AMH was modelled with linear, quadratic and quadratic with interaction on age equations to assess the impact of ethnicity. A total of 887 European and 461 Chinese women participated in the study. Despite the Chinese population being slightly younger (34.1±8.4 years) than their European counterparts (34.8±8.9 years), their median AMH was lower, at 1.87ng/ml (interquartile range [IQR] 0.28-3.64) compared with 2.11ng/ml (IQR 0.73-3.96), with evidence of increasing discordance from age 25 years. In all regression models of the age-related decline in AMH, there was evidence of a difference between Chinese and European women. Although AMH was 28.1% (95% confidence interval [CI] 18.2-36.7%) lower in the Chinese population at age 30, this decline increased to 79.4% (95% CI 75.4- 82.9%) at age 45. There were independent effects of age and ethnicity on serum AMH concentrations, with Chinese women having a substantially lower AMH in adult life than their European counterparts from age 25 onwards.

Impacts of endometrioma type and two-different techniques of laparoscopic cystectomyon ovarian reserve by measuring anti-mullerian hormone concentration

 Purpose: This study aims to understand the impact of the type of endometrioma and two different laparoscopic cystectomy excision techniques (“stripping” or complete excision vs partial excision) on the ovarian reserve by measuring the anti-mullerian hormone (AMH) levels in patients with endometrioma.Method: This is an experimental study in the form of “pre test – post test group design”. The subjects were patients with &gt;3 cm endometrioma detected via transvaginal USG which were classified into two different groups, i.e. the “stripping” laparoscopic cystectomy group as control and partial excision laparoscopic cystectomy as a intervention group. Cystectomy techniques were chosen based on “formuted block sampling”. The AMH levels measurements were performed before the operation (pre-test) and post-operation levels were measured at one and three months after the procedures on both groups. The study was conducted in Bali Royal Hospital (BROS), Denpasar, Indonesia, between January 2012 and January 2018. T-independent test was used to analyse the collected data.Results: No significant difference in the age and length of marriage between the two groups (p&gt;0.05). Unilateral endometrioma had higher concentration of AMH compared to bilateral endometrioma before the laparoscopy (2.09±1.33 vs 1.99±1.25 ng/ml; p=0.768), 1 month after the laparoscopy (1.20±0.59 vs 1.12±0.72 ng/ml; p=0.647), as well as 3 months after the laparoscopy (1.79±0.97 vs 1.44±0.87 ng/ml; p=0.148), but they were not statistically significant (p&gt;0.05). Based on the laparoscopy techniques, AMH concentration in partial excision laparoscopic cystectomy was significantly greater (p&lt;0.05) than in the stripping laparoscopic cystectomy, whether before laparoscopy (1.87±1.23 vs 2.36±1.13; p= 0.119), 1 month after (1.33±0.62 vs 0.98±0.67 ng/ml; p=0.038), as well as 3 months (1.88±0.97 vs 1.29±0.77; p=0.011) after the surgery.Conclusion: Unilateral and bilateral endometriomas have no significant difference in AMH levels. The partial excision laparoscopic cystectomy had significantly less effect on the AMH level compared with stripping laparoscopic cystectomy. Â

Busulfan Treatment Effects on Testicular Tissue and Serum Levels of Anti- Mullerian Hormone and Testosterone in Adult Mice

BACKGROUND: Busulfan, a chemotherapeutic drug, is an alkylating antineoplastic agent that belongs to the class of alkyl sulfonates and has some side effects on fertility. This research was aimed to investigate the effects of busulfan on testicular tissue and serum levels of anti-Mullerian hormone (AMH) and testosterone in adult mice.METHODS: Eighteen adult male Balb/C mice were collected randomly and were assigned in three groups including; control, azoospermia and spontaneous recovery. The groups, except for control group, received two injections of busulfan (10 mg/kg) intraperitoneally with 21-days interval in order to induce azoospermia. Thirty-five and 140 days after the last injection, the effects of busulfan on testicular tissue were evaluated by histologic, histomorphometric and hormonal changes. AMH and testosterone were measured by enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay (RIA) kits, respectively.RESULTS: Hormonal analyses showed no significant differences in AMH and testosterone serum levels. Histologic and histomorphometric evaluation showed disrupted spermatogenesis in azoospermia group, and restoration of spermatogenesis spontaneously in spontaneous recovery group.CONCLUSION: Busulfan at doses was used had no effect on AMH and testosterone serum levels. Busulfan can also induce azoospermia on a temporary basis however, in long term, spontaneous recovery can occur. The results indicated that some side effects are reversible and may depend on the dose applied.KEYWORDS: Busulfan, anti-Mullerian hormone, testosterone, mouse, testis

Ethnic differences in ovarian reserve and assisted reproductive technology outcomes

Ethnic disparities in access to assisted reproduction and treatment outcomes are well discussed in literature (1). But data regarding ethnic variations in ovarian reserve are limited. Our study evaluates influence of ethnicity on ovarian reserve markers and assisted reproductive technology (ART) outcomes. Retrospective cohort study. We reviewed data of women who underwent IVF in our fertility clinic between 2008 and 2015. Antral Follicle Counts (AFC), Anti Mullerian Hormone (AMH) level, basal Follicle Stimulating Hormone (FSH) level, number of oocytes retrieved, clinical pregnancy rate and live birth outcome data were compared between ethnic groups (White, Black, Hispanic and Asians). Parameters of white ethnicity were taken as reference value for comparison. Statistical significance of difference tested with Chi-square and ANOVA. Adjusted odds ratio (AOR) calculated with logistic regression analysis using the Statistical Package for the Social Sciences (SPSS), version 23. Out of 2792 women, there were 12% (n=334) Asian, 7.2% (n=201) Black, 14% (n=390) Hispanic and 66.8% (n=1867) White. The mean age was higher in Hispanics (35.6 ± 5.1, p= 0.002). Black women had higher BMI (27.7 ± 4.9, p < 0.001) and high incidence of tubal factor infertility (20.4%). Asian women had lower BMI (24.2 ± 4.7) and higher E2 levels (1805 ± 1384). There was statistical significant difference in AMH, AFC and basal FSH among the groups as shown in table 1. In logistic regression analysis, ovarian reserve correlated significantly with ethnic group even after adjusting for age, smoking, BMI (AOR 1.59, 95% CI 1.29 - 1.99, P < 0.01). In comparison to white women, further adjusting for number of embryos transferred, odds of clinical pregnancy and live birth were reduced for Asians (AOR 0.40; 95% CI 0.36-0.44), Hispanics ( AOR 0.40 ; 95% CI 0.36-0.44). Black race was an independent risk factor for reduced live birth rate (AOR 0.41; 95% CI, 0.12 - 0.99). Our study showed significant difference in ovarian reserve and IVF outcomes between different ethnic groups. In multivariate regression analysis, these differences persisted even after controlling for potential confounding factors. Further research with larger representative dataset is warranted to confirm these findings.

Assessment of ovarian reserve: Anti-Mullerian hormone versus follicle stimulating hormone.

Background:This study aimed to evaluate the strength of anti-Mullerian hormone (AMH) and follicle stimulating hormone (FSH) in reflecting the antral follicle count (AFC) in infertile females.Materials and Methods:This cross-sectional study was conducted on 160 females, visiting infertility clinic for assisted reproduction. Serum samples collected on the 3rd day of the cycle were assayed for FSH, luteinizing hormone, and AMH while AFC was assessed via transvaginal ultrasound. The study cohort was segregated into three groups based on AFC.Results:Chronological age and FSH was significantly high in females with very low AFC (P < 0.01 and 0.009, respectively), yet they failed to discriminate patients with normal and higher follicle count (P = 0.65 and 0.84). Conversely, AMH reported highly significant difference between very low AFC and with those having either normal AFC (P = 0.002) or higher AFC (P = 0.001). Moreover, a significant difference in AMH was observed between normal and higher AFC group (P = 0.04).Conclusion:Compared to female’s age and FSH, AMH is superior in clustering study cohort on the bases of antral follicular pool, especially in setups with nonavailability of technological expertise to assess AFC. Incorporation of AMH along with other biomarkers improves estimation of baseline ovarian reserve, required to standardize dose for optimum response; avoiding the risk of failure to retrieve oocyte or inappropriate stimulation leading to ovarian hyperstimulation syndrome. Further prospective studies are required to ascertain its role in predicting the outcomes of ART in such patients.

Anti-Müllerian hormone in women with polycystic ovary syndrome

Objective The aim of this study is to investigate the relationship between anti-Mullerian hormone (AMH) and parameters related to polycystic ovary syndrome (PCOS). Methods We measured serum AMH levels in 100 women with PCOS by Rotterdam European Society for Human Reproduction and Embryology criteria. We conducted somatometry, blood test and transvaginal or transrectal ultrasound test. We compared and analyzed AMH and parameters in terms of insulin resistance according to PCOS related phenotypes. We divided phenotypes into four groups by polycystic ovarian morphology (PCOM) and hyperandrogenemia (total testosterone [TT], free testosterone [fT]). Results AMH levels ranged from 4.1 to 21.0 ng/mL and the mean level was 10.4 ± 4.1 ng/mL. Signifi cant differences in parameters of insulin resistance were not observed among low (4 to 8 ng/mL), moderate (8 to 12 ng/mL), and high (>12 ng/mL) levels of AMH. Significant differences in AMH were not observed among groups according to PCOS related phenotypes. Weight, body mass index, waist-hip ratio, TT, fT, sex hormone binding globulin, 2-hour insulin and homeostasis model assessment of insulin resistance index were different signifi cantly according to PCOS related phenotypes. TT, ovarian volume and follicle number were positively correlated with AMH.

Antimullerian hormone and obesity: insights in oral contraceptive users

Background The study was conducted to examine the impact of oral contraceptives (OCs) on serum antimullerian hormone (AMH) levels by obesity status in reproductive-age women. Study Design Ovulatory women, ages 18–35 years, of normal (<25 kg/m 2; n=10) and obese (>30 kg/m 2; n=10) body mass index (BMI) received a low-dose OC (20 mcg ethinyl estradiol/100 mcg levonorgestrel) for two cycles. Serum samples obtained at several time points during active pill use and hormone-free intervals were analyzed for AMH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol and inhibin B. Results AMH levels did not differ by OC cycle day in either BMI group. On average, AMH levels were 34% lower in the obese group (2.9±2.1 vs. 4.4±1.8 ng/mL, p<.05). Modeling to determine differences in AMH throughout the cycle based on obesity status demonstrated significantly lower levels (p<.05), whereas serum AMH, FSH, LH, estradiol and inhibin B levels revealed no correlations when all time points were included. Conclusions In reproductive-age women, serum AMH levels do not appear to fluctuate during OC use, but AMH levels are significantly lower in obese women. Lower levels do not appear to be due to differences in gonadotropin levels or ovarian activity.