Low anti-Müllerian Hormone Research Articles

Effect of Reproductive and Lifestyle Factors on Anti-Mullerian Hormone Levels in Women of Indian Origin.

Infertility is a world-wide problem and one third females. Over the years, anti-mullerian hormone (AMH) has emerged as a major marker of ovarian reserve. There is also increasing interest in determining the factors which can impact AMH levels. To correlate the association of reproductive and lifestyle factors on AMH levels in women of Indian origin. Multicentric cross sectional study. The study was conducted using data extracted from the patient records of seven private fertility practices located in North India. Women who were attending these clinics for fertility treatment were requested to fill the questionnaire related to reproductive and lifestyle factors. Our outcome variable was level of AMH measured in the past 3 months, and was assessed as normal or low. All analyses were conducted using STATA 17. We found a direct association of low AMH with increasing age, short cycles, amenorrhea and women with family history of premature menopause. We found a direct correlation of high AMH and women with polycystic ovary syndrome and those whose partners had Oligoasthenoteratozoospermia (OATS) or azoospermia. There was no correlation with smoking, sleep, diet, body mass index, cell phone or laptop use in our study. Reproductive and lifestyle factors may affect ovarian reserve and but there was a dearth of human studies in this area. To the best of our knowledge this is the first human study on the effect of AMH on Laptop and Cell phone use. We urgently need more studies to confirm or refute our findings so that we can counsel our patients well.

Evaluation of Ovarian Reserve among Newly Diagnosed Hashimoto’s Thyroiditis Related Subclinical and Overt Hypothyroid Reproductive Women: A Cross-sectional Study

Introduction: Thyroid autoimmunity is amore common autoimmune disease among reproductive women. It is proposed that, thyroid peroxidase antibodies pass through the blood follicle barrier during follicular development which damages the growing follicles and oocytes. Previous studies have demonstrated the association between thyroid autoimmunity and ovarian failure. Serum Anti-Müllerian Hormone (AMH) levels are used as a marker of ovarian reserve in clinical practice. Aim: To evaluate ovarian reserve among newly diagnosed Hashimoto’s Thyroiditis (HT) related subclinical and overt hypothyroid women. Materials and Methods: A cross-sectional study was conducted at the Department of Biochemistry, Government Medical College Nalgonda, Telangana, India, from August 2020 to July 2021. The study included 180 subjects, 60 in each Overt Hypothyroid (OH group), Subclinical Hypothyroid (SCH group) and Euthyroid subjects (EU group). Socio-demographic details and other parameters age, Body Mass Index (BMI), AMH, Thyroid Stimulating Hormone (TSH), free T4 (fT4), Thyroid Peroxidase Antibodies (TPOAb), Follicular Stimulating Hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2), Antral Follicular Count (AFC) were evaluated and compared in all the three groups. The above data were recorded and analysed using Statistical Package for Social Sciences (SPSS) version 20.0 and the Analysis of Variance (ANOVA) test, Chi-square test, and Spearman’s correlation test were performed for statistical analysis. Results: The median age, BMI, and total AFC were not statistically significant (p-value >0.05). Serum TPOAb levels were significantly (p-value <0.001) high in the OH group and SCH group when compared to the EU group. The AMH levels were significantly (p-value=0.015) high inthe EU group compared to the OH group, but there were no statistically significant differences among other groups. The AMH values were negatively correlated with age among all the three groups. There was no significant correlation between AMH and other parameters analysed among different groups. Conclusion: The AMH levels were significantly low in the OH group when compared to the EU group. There were no statistically significant differences among other groups. Age was found to be an independent factor for low AMH levels among all the three groups.

Female parental consanguinity is associated with a reduced ovarian reserve

Research questionIs parental consanguinity associated with a reduced ovarian reserve in women from the Arabian Peninsula, comparing anti-Müllerian hormone (AMH) and antral follicle count (AFC)? DesignRetrospective large-scale observational study including 2482 women from the Arabian Peninsula, aged 19–49 years, who had their serum AMH and AFC measured as part of their fertility assessment, from May 2015 to November 2019. Consanguinity was defined as women whose parents were first-degree or second-degree cousins. Serum AMH was measured for all participants. ResultsA total of 2198 women were included: 605 in the consanguine group (27.53%), 1593 (72.47%) in the non-consanguine group. There were no significant differences between groups in terms of body mass index, years of infertility or smoking status. Women from the consanguine group were significantly younger (mean age 33.74 ± 6.64 years) compared with the non-consanguine group (mean age 34.78 ± 6.64 years, P < 0.0001). Median AMH and AFC for the consanguine group were 1.90 ng/ml (min–max: 0.01–23.8) and 11 (0–80), respectively, and for the non-consanguine group 1.84 ng/ml (min–max: 0.01–23.0) and 11 (0–60), respectively. AMH and AFC exhibit an age-dependent decline. As both parameters are age-dependent, the multivariate analysis showed that women from the consanguine group presented significantly lower AMH (coefficient of variation [CV] –0.07 ± 0.03, P = 0.036) and AFC (CV –0.16 ± 0.06, P = 0.003) compared with non-consanguine women, and the highest differences were found for women below 35 years of age (AMH median [min–max]: 2.82 ng/ml (0.01–23.80) versus 2.92 ng/ml (0.01–23.00); P = 0.035; AFC median [min–max]: 15 (0–80) versus 14 (0–80); P = 0.001). ConclusionThe adjusted analysis by age indicates that female parental consanguinity is associated with reduced ovarian reserve in the studied population. Clinical evaluation should include extensive family history and subsequent counselling of the affected couples.

Surgical management and molecular diagnosis of persistent Müllerian duct syndrome in Chinese patients.

Persistent Müllerian duct syndrome (PMDS) is a rare clinically and genetically overlapping disorder caused by mutations in the anti-Müllerian hormone (AMH) gene or the anti-Müllerian hormone receptor type 2 (AMHR2) gene. Affected individuals present uterus and tubes in normally virilized males and are discovered unexpectedly during other surgeries. Since it is rare and complex, a definitive clinical diagnosis can be missed, and there are no guidelines regarding how to deal with the uterus. In the present study, exome sequencing and Sanger verification were performed for causal variants in 12 PMDS patients. Preoperative diagnoses were made by positive exome sequencing in 8 patients. Of them, 7 patients evoked on the basis of ultrasound indicating bilateral testes on the same side of the body. Twelve different AMH variants (2 frameshift/nonsense, 1 deletion, 8 missense, and 1 in-frame) in 9 patients and 6 different AMHR2 variants (5 missense and 1 splicing) in 3 patients were identified. Seven variants were classified as “pathogenic” or “likely pathogenic”, and 4 of them were novel. All but two patients with AMH defects showed low serum AMH concentrations, but all patients with AMHR2 defects showed elevated AMH levels. During surgery, an abnormal vas deferens was observed in half of the patients. Eight patients underwent orchidopexy with uterine preservation. Of them, 2 patients presented complications including irreducible cryptorchidism, and 3 patients developed Müllerian remnant cysts. Three patients underwent subtotal hysterectomy. Of them, one patient had complication of injury to the vas deferens, and one had hemorrhage after operation. This is the first report of PMDS involving a large Chinese population. The present study not only expands the variation spectrum but also provides clinical experience about the management of the uterus.

The Value of Anti-Müllerian Hormone in the Prediction of Spontaneous Pregnancy: A Systematic Review and Meta-Analysis.

ObjectiveTo determine whether serum anti-Müllerian hormone (AMH) level is a predictor of clinical pregnancy in women trying to achieve a natural conception.MethodsThe PubMed, Embase, and Cochrane Library databases were searched for articles published until August 2020. Studies that met the inclusion and exclusion criteria were included in the meta-analysis; no language limitations were imposed. Quality was appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 checklist. Heterogeneity due to the threshold effect was identified; thus, we plotted a summary receiver operating characteristic curve and calculated its area under the summary receiver operating characteristic curve (AUC) and Cochran’s Q index to assess whether AMH level is a predictor of spontaneous pregnancy. Publication bias and sensitivity were also assessed.ResultsEleven studies (4,388 women) were ultimately included in this meta-analysis. The AUC and Cochran’s Q indices were 0.5932 and 0.5702, respectively. For women younger than 35 years, the AUC was 0.6355 and the Q index was 0.6025. For those older than 35 years, the AUC was 0.5536 and the Q index was 0.5403. Subgroup analyses by study type and population characteristics showed results similar to the overall outcome. No publication bias was identified, and the sensitivity analysis confirmed the robustness of the final result.ConclusionsSerum AMH levels have poor predictive value for natural pregnancy. The predictive value of AMH was poor in the younger and older subgroups. Our findings suggest that low serum AMH levels are not associated with reduced fertility.IntroductionThis study investigated the predictive value of anti-Müllerian hormone (AMH) level for natural pregnancy. Other than age, few factors can predict the chances of natural fertility. AMH is an established biomarker of ovarian reserve that is widely used to predict oocyte yield in cases of in vitro fertilization (IVF) and menopause. In clinical practice, the applications of AMH are increasing. However, its predictive value for natural conception remains controversial. In this study, since AMH is closely related with ovarian reserve, we evaluated whether it has predictive value for natural pregnancy. Our findings will fine-tune the clinical application of AMH in pre-pregnancy counseling. The topic should be of wide interest to investigators in the reproductive endocrinology and gynecology fields.Systematic Review RegistrationPROSPERO 2020 CRD42020216265, Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020216265.

Long‐term reproductive evaluation of a bitch neonatally treated with a gonadotropin‐releasing hormone agonist

AbstractIn mammals, high concentrations of gonadotropins are necessary early in life to reach a full‐sized pool of ovarian follicles at the age of puberty. This case report describes the reproductive status of a 28‐month‐old, 9.1 kg, crossbred bitch (Bitch 1) which had been treated neonatally with 18.8 deslorelin acetate subcutaneously for contraceptive purposes. The female had just passed pubertal oestrus when hormones were measured and then spayed. The ovaries were histologically assessed. Two crossbred bitches were used for comparisons. Bitch 1's anti‐Müllerian hormone (AMH) and progesterone serum concentrations were 0.35 and 16.7 ng/ml, respectively. The total number of ovarian follicles and proportions were normal and the number of primary and antral follicles was increased. These findings might suggest an enhanced recruitment of the follicle pool to the growing population which could be related to the relatively low AMH concentrations.

Predictors of low ovarian reserve in cART-treated women living with HIV.

Ovarian dysfunction and lower circulating anti-Müllerian hormone (AMH) feature women living with HIV (WLWH). Because treated human immunodeficiency virus (HIV) infection is characterized by a pro-inflammatory/oxidative phenotype resulting in residual comorbidity, we sought to investigate possible associations between plasma AMH and markers of inflammation, immune activation/senescence/exhaustion, oxidative stress as well as comorbidities in a cohort of combined anti-retroviral therapy (cART)-treated WLWH versus age-matched HIV-uninfected, healthy women.Eighty WLWH on effective cART aged 25 to 50 years and 66 age-matched healthy women were enrolled. We measured: plasma AMH, IL-6, reactive oxygen species modulator 1 (ROMO1) (ELISA); plasma tumor necrosis factor α, IL-10, soluble vascular cell adhesion molecule 1, osteopontin (Luminex); CD4/CD8 activation (CD38/CD69), apoptosis (CD95), exhaustion (PD1), maturation (CD45RA/CD45R0/CD127/CCR7), recent thymic emigrants (CD31/CD103) (flow cytometry). Mann Whitney and chi-squared tests were used. Univariate and multivariate logistic regression analyses were used to assess factors associated with low AMH (≤1 ng/mL).Compared to healthy women, WLWH were more frequently non-Caucasian, drug/alcohol abusers, with history of late menarche, lower hormonal contraceptive use, with higher gravidity and lower parity. WLWH showed significantly lower AMH (P = .004) as well as higher ROMO1 (P = .0003) and tumor necrosis factor α (P < .0001). The multivariate analyses revealed ROMO1 (adjusted odds ratio [AOR]: 1.42, P = .03) and HIV infection (AOR: 8.1, P = .0001) as independently associated with low AMH. The logistic regression model with both HIV status and ROMO1 (a marker of oxidative stress) confirmed HIV as the only predictor of low AMH (AOR: 17, P = .0003).Despite effective cART, WLWH showed lower AMH compared to age-matched peers, indicating pre-mature ovarian ageing. Both HIV and oxidative stress are independently associated with low AMH, emphasizing the impact of HIV-associated oxidative stress on reproductive aging.

Outdoor air pollution and anti-Müllerian hormone concentrations in the Sister Study.

Anti-Müllerian hormone (AMH) concentrations are a marker of ovarian reserve and are indicative of a woman's reproductive lifespan. Exposure to tobacco smoke has been associated with lower AMH concentrations; however, less is known about the association between ambient air pollution and ovarian reserve. For 883 premenopausal Sister Study participants recruited between 2003 and 2009 in the United States, adult residential annual average concentrations of PM2.5, PM10, and NO2 were estimated using validated universal kriging models incorporating land-use regression. We estimated the distance in meters to the nearest major road for both adult enrollment and childhood residences. Serum AMH was measured using an ultrasensitive ELISA assay. Samples with AMH concentrations below the detection limit were analyzed using a picoAMH ELISA assay. Multivariable-adjusted linear regression was used to estimate the percent change in AMH in relation to ambient residential air pollution, categorized in quartiles and per interquartile range increase, and distance to a major roadway. Overall, we observed little to no evidence of associations between AMH and air pollution concentrations or proximity to roadways. Women in the highest quartile of NO2 exposure, a traffic-related pollutant, had higher estimated AMH concentrations (Q4 vs. Q1, 42.9%; 95% CI = -3.4, 111.4) compared with the lowest quartile. However, lower mean AMH concentrations were observed for women living closer to a major roadway (<50 m to nearest roadway vs. ≥200 m = -32.9%; 95% CI = -56.1, 2.6). We saw little consistent evidence to support an association between outdoor air pollution and diminished ovarian reserve in US women ages 35-54.

A comparison of cleavage-stage embryo transfer and blastocyst transfers in patients with low anti-Mullerian hormone levels

Aim: Decreased ovarian reserve is a common problem that many women struggle with and seek help by assisted reproductive techniques (ART). Embryo transfer (ET) is an important step in ART that can be performed on cleavage-stage (day 2 or 3) or blastocyst stage (day 5 or 6). This study aims to investigate the effect of ET day on pregnancy results in patients with low levels of anti-Mullerian hormone (AMH).&#x0D; Material and Method: This retrospective study enrolled 239 women with low AMH levels referred to the Bahçeşehir University, Göztepe Medikal Park Hospital In-vitro Fertilization (IVF) Clinic from May 2015 to April 2020. The patients were divided into two groups: blastocyst transfer group and cleavage-stage transfer group. Among the participants, blastocyst transfer was performed in 30 women and cleavage-stage ET on 209 women,respectively.&#x0D; Results: Among 239 participants, 30 (12.6%) were in the blastocyst group, and 209 (87.4%) were in the cleavage-stage group. There was no significant difference in the total number of retrieved oocytes between the two groups (p=0.1). The number of mature oocytes (MII) was significantly different between the two groups (p=0.006). Examining pregnancy results between the two groups showed no significant difference between positive and negative pregnancy tests (p=0.4). Even though a higher live birth rate for the blastocyst transfer group was observed with 15(50%), no significant difference was found between the number of live births and miscarriages in the two groups (p=0.1).&#x0D; Conclusion: The transfer day does not affect the pregnancy results in women with low AMH levels.

Assessment of cardiovascular dysfunction in Egyptian women with diminished ovarian reserve: A single-center study

BackgroundMenopause is widely regarded as associated with cardiovascular disease (CVD) risk. One of the hormones which play a crucial role in preserving the ovarian reserve, is Anti-Müllerian hormone (AMH). This study investigates any relation between AMH and markers of CVD risk such as total cholesterol (TC) triglyceride (TG), low & high-density lipoproteins (LDL and HDL), fasting blood sugar (FBS) and endocan in Egyptian women with low ovarian reserve and to determine their cutoff values as predictors of low AMH. Methods and resultsNinety women with diminished ovarian reserve (DOR) and ninety age-matched women who had normal ovarian reserve (NOR) were included in the study. AMH level and Markers of CVD risk such as total cholesterol (TC) triglyceride (TG), low & high-density lipoproteins (LDL and HDL) and fasting blood sugar (FBS) were estimated. Endocan gene expression (mRNA) was assessed using real-time quantitative reverse transcription-polymerase chain reaction (RT–qPCR). Among the low AMH level group, there were negative correlations between AMH level and treatment duration (p = 0.029) and endocan level (p = 0.01). Contrarily, the AMH level positively correlates with the HDL level (p < 0.001). TG[Cutoff value ≥127.5 mg/dL, p = 0.01], LDL [Cutoff value ≥112.5 mg/dL, p = 0.009], HDL [Cutoff value ≤49.5 mg/dL, p = 0.021], TC/HDL ratio [Cutoff value ≥3.85,p = 0.001], LDL/HDL ratio[Cutoff value ≥2.35, p = 0.007] were found to be predictors of low AMH levels. ConclusionsLow and very low AMH levels in young Egyptian women with DOR may be linked to CVD risk markers.

Effect of Genetic Variation in CYP450 on Gonadal Impairment in a European Cohort of Female Childhood Cancer Survivors, Based on a Candidate Gene Approach: Results from the PanCareLIFE Study.

Simple SummaryChildhood cancer patients receiving treatment containing alkylating agents are at risk of infertility, yet inter-individual variability in treatment-related ovarian damage is observed. Alkylating agents are metabolized by cytochrome P450 (CYP450) enzymes and polymorphisms in these CYP450 enzymes may explain this variability in ovarian damage. This study on genetic variation in CYP450 enzymes of chemotherapy-induced gonadotoxicity, using anti-Müllerian hormone (AMH) levels as a proxy for ovarian reserve, in female childhood cancer survivors (CCSs) may identify patients at risk of infertility. This unique global collaboration of two large CCS studies shows the significant gonadotoxic effect of enzyme CYP3A4*3 and significant protective effect of CYP2B6*2 on gonadal function in CCSs receiving alkylating agents. Genetic variation in CYP3A4 and CYP2B6 have previously been associated with gonadotoxicity after cancer treatment. These findings could guide risk prediction models determining patients at risk of chemotherapy-induced gonadal impairment.Background: Female childhood cancer survivors (CCSs) carry a risk of therapy-related gonadal dysfunction. Alkylating agents (AA) are well-established risk factors, yet inter-individual variability in ovarian function is observed. Polymorphisms in CYP450 enzymes may explain this variability in AA-induced ovarian damage. We aimed to evaluate associations between previously identified genetic polymorphisms in CYP450 enzymes and AA-related ovarian function among adult CCSs. Methods: Anti-Müllerian hormone (AMH) levels served as a proxy for ovarian function in a discovery cohort of adult female CCSs, from the pan-European PanCareLIFE cohort (n = 743; age (years): median 25.8, interquartile range (IQR) 22.1–30.6). Using two additive genetic models in linear and logistic regression, nine genetic variants in three CYP450 enzymes were analyzed in relation to cyclophosphamide equivalent dose (CED) score and their impact on AMH levels. The main model evaluated the effect of the variant on AMH and the interaction model evaluated the modifying effect of the variant on the impact of CED score on log-transformed AMH levels. Results were validated, and meta-analysis performed, using the USA-based St. Jude Lifetime Cohort (n = 391; age (years): median 31.3, IQR 26.6–37.4). Results: CYP3A4*3 was significantly associated with AMH levels in the discovery and replication cohort. Meta-analysis revealed a significant main deleterious effect (Beta (95% CI): −0.706 (−1.11–−0.298), p-value = 7 × 10−4) of CYP3A4*3 (rs4986910) on log-transformed AMH levels. CYP2B6*2 (rs8192709) showed a significant protective interaction effect (Beta (95% CI): 0.527 (0.126–0.928), p-value = 0.01) on log-transformed AMH levels in CCSs receiving more than 8000 mg/m2 CED. Conclusions: Female CCSs CYP3A4*3 carriers had significantly lower AMH levels, and CYP2B6*2 may have a protective effect on AMH levels. Identification of risk-contributing variants may improve individualized counselling regarding the treatment-related risk of infertility and fertility preservation options.

Diagnosis of Male Central Hypogonadism During Childhood.

The diagnosis of male central (or hypogonadotropic) hypogonadism, typically based on low luteinizing hormone (LH) and testosterone levels, is challenging during childhood since both hormones are physiologically low from the sixth month until the onset of puberty. Conversely, follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH), which show higher circulating levels during infancy and childhood, are not used as biomarkers for the condition. We report the case of a 7-year-old boy with a history of bilateral cryptorchidism who showed repeatedly low FSH and AMH serum levels during prepuberty. Unfortunately, the diagnosis could not be ascertained until he presented with delayed puberty at the age of 14 years. A gonadotropin-releasing hormone (GnRH) test showed impaired LH and FSH response. By then, his growth and bone mineralization were partially impaired. Gene panel sequencing identified a variant in exon 15 of FGFR1, affecting the tyrosine kinase domain of the receptor, involved in GnRH neuron migration and olfactory bulb morphogenesis. Testosterone replacement was started, which resulted in the development of secondary sexual characteristics and partial improvement of bone mineral density. This case illustrates the difficulty in making the diagnosis of central hypogonadism in boys during childhood based on classical criteria, and how serum FSH and AMH assessment may be helpful if it is suspected before the age of puberty, and confirm it using next-generation sequencing. The possibility of making an early diagnosis of central hypogonadism may be useful for a timely start of hormone replacement therapy, and to avoid delays that could affect growth and bone health as well as psychosocial adjustment.

ASSOCIATION BETWEEN ANTI-MULLERIAN HORMONE AND MOTHER'S AGE AT MENOPAUSE

To assess the association between anti-müllerian hormone (AMH) and mother’s age at natural menopause. We hypothesized that AMH levels in the daughter would be directly associated with the mother’s age at menopause. In this secondary analysis of data from the Time to Conceive (TTC) study, which was a prospective time-to-pregnancy study of women aged 30 to 44, women provided a serum sample on cycle day 2, 3, 4, or 5 that was analyzed for AMH (Ultrasensitive AMH ELISA, Ansh Labs). Time to mother’s age at menopause was the primary outcome. Censoring occurred at time of hysterectomy, endometrial ablation or uterine embolization, chemotherapy, or at age of interview if premenopausal. AMH was utilized as both a continuous variable and categorical: low (<10th percentile, 0.62 ng/ml), normal, or high (≥90th percentile, 8.86 ng/ml). A Cox proportional hazards model was used to assess the independent association between AMH and mother’s age at menopause while controlling for age, race, body mass index, education, birth control use, coffee and alcohol intake, and marijuana use. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were presented. A HR <1 suggested a likelihood of later age at menopause while a HR >1 indicated an earlier age at menopause. Of the 689 women with a blood sample who were asked about mother’s age at menopause, 352 (51%) were not aware of their mother’s age at last menstrual period, leaving 337 women in the analysis. There were no significant differences in characteristics between those women included in the analysis and those that were not included. Median maternal age at menopause was 52 years (95% CI 52-53). There was no significant association between AMH (continuous) and mother’s age at menopause (aHR 0.97; 95% CI 0.93-1.02, p=0.21). Compared to normal AMH, a low AMH was associated with an earlier age at menopause in the mother (aHR 1.78; 95% CI 0.99-3.19, p=0.05). There was not a statistically significant association between high AMH and mother’s age at menopause (aHR 0.76; 95% CI 0.46-1.27, p=0.30). Among women in their thirties and early forties, ovarian reserve, as measured by continuous AMH, is not associated with mother’s age at menopause. However, low ovarian reserve (AMH <.62) is associated with an earlier age of menopause in the mother.

ANTI-MULLERIAN HORMONE AND BASAL ANTRAL FOLLICLE COUNT AS PREDICTORS FOR OVARIAN RESERVE AND OVARIAN RESPONSE IN WOMEN WITH HYPOGONADOTROPIC HYPOGONADISM

To evaluate the use of anti-mullerian hormone (AMH) and basal antral follicle count (AFC) as a predictor of ovarian reserve and ovarian response to controlled ovarian hyperstimulation (COH) in women with hypogonadotropic hypogonadism (HH). This is a retrospective cohort study consisted of the files of 40 women attended a university IVF center during the past 4 years. Nineteen patients has been diagnosed as HH, compared to 21 patients diagnosed as premature ovarian failure (POF). We evaluated the use of AMH value and basal AFC to predict the ovarian reserve and ovarian response to COH in HH women; women with POF have been involved as a control group. We reviewed the recorded AMH and basal AFC, and the total number of retrieved oocytes and fertilized ones in both groups. We used unpaired student t-test for statistical comparison. P<0.05 was considered for statistical significance. Both groups were similar in age, BMI, AMH and basal AFC. Basal FSH and LH were higher in the POF group. Despite the low AMH and the low basal AFC in women with HH ( average 0.46 and 1.6 respectively), we report significant high number of retrieved oocytes and fertilized ones in response to high dose of gonadotropins stimulation compared to the reverse in the POF group. (Table 1) Pregnancy has been reported in 9 women (out of 19) in the HH group. Only one woman (out of 21) got pregnant in the POF group.Table 1Baseline characters and response to COH in women with HH Vs. POF.HH (n=19)POF (n=21)P valueAge26.3323.550.15BMI22.724.90.08FSH0.8724.9<0.001LH0.7521.5<0.001AMH0.460.290.11AFC1.60.910.34Total gonadotrophin dose560040810.03Peak E23344.4427.3<0.001Total retrieved oocytes12.81.3<0.001Total fertilized oocytes8.10.45<0.001 Open table in a new tab AMH and basal AFC has limited value in women with HH regarding prediction of ovarian reserve and ovarian response to COH. Higher doses of gonadotropins can be used rather than early giving up.

LIVE BIRTH DIFFERENCES IN WOMEN WITH SIGNIFICANTLY ABOVE AVERAGE AMH LEVEL UNDERGOING IVF

It is well characterized that low anti-mullerian hormone (AMH) levels are associated with poorer in-vitro fertilization (IVF) outcomes, but the impact of slightly and very elevated AMH on IVF outcomes including live birth rate (LBR) is less well understood. It is unclear whether the positive correlation between AMH and LBR continues linearly, with higher and higher AMH associated with higher and higher LBR, whether there are diminishing returns, or whether at a certain point, elevated AMH is detrimental to LBR.

THE RELATIONSHIP BETWEEN ANTI-MULLERIAN HORMONE AND ANEUPLOIDY IN PATIENTS UNDERGOING IN VITRO FERTILIZATION WITH PREIMPLANTATION GENETIC TESTING

Polycystic ovary syndrome (PCOS) has been associated with higher miscarriage rates in patients undergoing in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Elevated anti-mullerian hormone (AMH) in PCOS patients has been associated with a more severe phenotype. This study seeks to determine whether subjects with a high AMH undergoing IVF/ICSI with preimplantation genetic testing for aneuploidy (PGT-A) have aneuploidy rates that differ from cohorts with low or normal AMH levels and whether this relationship is modified by PCOS.

Anti-Mullerian Hormone (AMH) as a Predictor of Ovarian Response to Clomiphene Citrate in Polycystic Ovarian Syndrome

Background: Serum Anti-Mullerian hormone (AMH) levels in women with polycystic ovary syndrome (PCOS) are two- to threefold higher than in ovulatory women with normal ovaries, corresponding to the two- to threefold increase in the number of small follicles in PCOS. The increased AMH has been hypothesized to reduce follicle sensitivity to follicle stimulating hormone (FSH) and estradiol production, thus preventing follicle selection, resulting in follicular arrest at the small antral phase with failure of dominance. Objective: The study was undertaken to test the hypothesis that high AMH level is associated with poor response to ovulation induction in PCOS women. Methods: This was a cross-sectional comparative study of 50 infertile women with PCOS, grouped into those with AMH level &lt;8 ng/mL and those with AMH level [Formula: see text] 8 ng/mL. All participants received an initial dose of 100 mg/day of clomiphene citrate from 2nd to 6th day of menstrual cycle. Ovarian response (follicle size) was assessed by transvaginal monitoring on 12th day of cycle. Results: A total of 50 women were recruited, of which 4 dropped out. Women with AMH [Formula: see text] 8 ng/mL comprised only 23.91% of the PCOS women. AMH and day 12 follicle size had a statistically significant association. Adjusting for other confounding variables in linear, logarithmic, and logistic analysis, serum AMH had significant negative relationship with follicle size (r = 0.511, p &lt; 0.001). AMH was also positively correlated with serum LH, testosterone and negatively correlated with serum follicle stimulating hormone (FSH), serum TSH and BMI. Conclusion: We observed that higher AMH level women had poor response to ovulation induction compared to women with low AMH level.

Maternal Obesity and the Risk of Selected Foetal Abnormalities (Neural Tube Defects and Orofacial Clefts) In Malaysia: A Retrospective Observational Study

Background: Clomiphene citrate (CC) is first choice as an ovulation-stimulating drug in polycystic ovarian syndrome. Anovulation problems could occur in some patients presenting with CC resistance. In PCOS patients, very high levels of AMH were observed. The role of anti-Müllerian hormone (AMH) in the prediction of ovarian response to CC in women with the polycystic ovarian syndrome (PCOS) is investigated in this study. Objective: To assess the predictive value of Anti Mullerian hormone (AMH) in Clomiphene citrate response in patients with polycystic ovary syndrome. Methods: This cross-sectional study was conducted at Tanta University Hospitals, Egypt. The study included 120 anovulatory PCOS women who underwent ovarian stimulation with clomiphene citrate. Day 3 measurement of AMH concentrations was done. Results: Cycles with poor response had significantly (p&lt;0.0001) higher basal serum AMH concentration compared to that of cycles with normal response. AMH area under receiver operating characteristic curve (ROCAUC) 0.88; (p&lt;0.001) and 0.81; (p&lt;0.007) respectively. Using a cut-off level of 6.3 ng/ml, the good response rate was significantly (p &lt; .001) higher in cycles with lower AMH (&lt;6.3 ng/ml) compared to that in those with AMH (&gt; = 6.3) ng/ml. Conclusion: AMH levels could predict the ovarian response to clomiphene citrate in PCO women.

Low Antimullerian Hormone Levels Improve Fertility Outcome in Patients with Polycystic Ovary Syndrome

Background: It was known that polycystic ovary syndrome (PCOS) patients have high AMH levels. The aim of this study is to show whether low AMH levels are associated with better clinical pregnancy rates in patients with PCOS. Methods: This retrospective study was performed on 443 patients with PCOS referred to BAU MedicalparkGoztepe Hospital IVF Clinic from January 2015 to October 2020. Participants ranged in age from 18 to 40, had their first two IVF trials, had performed frozen-thawed embryo transfer (FET) cycle at day 5. The diagnosis of PCOS was made using the Rotterdam criteria. Data related to patients' AMH were compared with each other, and based on the value, participants were divided into two groups: the first group was AMH≥7 (N = 49); The second group was AMH &lt;7 (N = 394). Results: The pregnancy test was positive for 288 (65%) participants. Of these participants, 214 had livebirth, 71 had miscarriages, and 3 had stillbirths. There was no significant difference in age and BMI between the two groups. There were no significant differences between the two groups in the number of stimulation days, the total number of oocytes, and MII oocytes. The numbers of frozen embryos were higher in the AMH≥7 group (p = 0.005). The positive pregnancy results were significantly higher in the AMH&lt;7 group than in the AMH≥ 7 group (P= 0.02). There was no significant difference in live birth, stillbirth, and miscarriage rates between the two groups. Conclusion: Low levels of circulating AMH are associated with better clinical pregnancy rates in patients with PCOS.

Therapeutic Efficacy of Catheter-directed Ethanol Sclerotherapy and Its Impact on Ovarian Reserve in Patients with Ovarian Endometrioma at Risk of Decreased Ovarian Reserve: A Preliminary Study

To investigate the therapeutic efficacy of catheter-directed ethanol sclerotherapy (CDS) and its effect on ovarian reserve in patients with endometrioma at risk of decreased ovarian reserve. Retrospective study. Teaching hospital. We evaluated 18 patients with ovarian endometrioma measuring ≥3 cm and preprocedural serum antimüllerian hormone (AMH) levels of <2 ng/mL. An 8.5-F catheter was inserted either transabdominally or transvaginally into the endometrioma. After aspiration, sclerotherapy with 99% ethanol was performed, with a subsequent 20-minute ethanol retention. Ultrasonography was performed preprocedurally and 6 months after CDS to evaluate any recurrence or changes in cyst size. Furthermore, serum AMH levels, cancer antigen 125 (CA-125) levels, and the visual analog scale scores for dysmenorrhea were obtained to analyze the ovarian reserve and treatment efficacy, preprocedurally and at 6 months after CDS. The mean cyst size on ultrasonography and serum CA-125 levels decreased 6 months after CDS (p <.001 and p = .001, respectively). All patients reported a decreased visual analog scale score for dysmenorrhea (p <.001). However, the difference in serum AMH levels before and after CDS was statistically insignificant (p = .875). CDS was efficacious in reducing pain and serum CA-125 levels in patients with low AMH levels without adversely affecting their ovarian reserve.