Mean anti-Müllerian Hormone Levels Research Articles

P-699 High levels of total FSH during COS is detrimental to oocyte development in good responders: results from a three-year retrospective, multicenter study

Abstract Study question Are elevated doses of follicle stimulating hormone (FSH) detrimental to oocyte maturation and the efficacy of ovarian stimulation in good responders? Summary answer Elevated FSH levels reduce the number of oocytes collected from good responders. Patients receiving lower total FSH doses had optimal and higher maturation rates. What is known already There is an inverse relationship between the dose of exogeneous follicle stimulating hormone (FSH) and the number of oocytes retrieved. This relationship is independent of patient age or health and implies that excessive FSH doses administered during artificial reproductive technologies (ART) may be detrimental to oocyte maturation. Study design, size, duration This three-year retrospective, multicenter study included 1,075 oocyte donor cycles performed in three IVF clinics between January 2020 and December 2023 with at least a six-month interval between each cycle. Donors were all considered good responders and divided according to the total dose of FSH received per cycle (n = 289 cycles with <1,700 IU FSH; 400 cycles with 1,700 to 2,900 IU FSH; and 386 cycles with >2,900 IU FSH). Participants/materials, setting, methods The mean oocyte donor age was between 26.13 and 27.45 years old. The mean BMI for all three groups was 21. The association between the total FSH dose and serum anti-Müllerian hormone (AMH) level, follicle-to-oocyte index (FOI), number of oocytes retrieved, and oocyte maturation was assessed using the Student’s t-test (parametric) or Mann-Whitney-U test (non-parametric). Main results and the role of chance There were no significant differences in the mean serum AMH levels (5.31 vs. 5.27 vs. 5.13 ng/mL, respectively) and FOI (81.1 vs. 80.2 vs. 81.5, respectively) of patients who received different total doses of FSH. However, the number of oocytes retrieved from each group was inversely related to the total dose of FSH received (24.4 vs. 22.9 vs. 21.01 oocytes, respectively; p < 0.05) Limitations, reasons for caution Full characterization of the oocytes and their developmental potential was outside the scope of this retrospective study. Wider implications of the findings Gaining a better understanding of the complex interplay of gonadotropins throughout folliculogenesis can help optimize ovarian stimulation protocols to maximize the number of mature and developmentally competent oocytes recovered for clinical use. Trial registration number non applicable

The effect of dienogest treatment on anti-Mullerian hormone in patients with endometrioma: a 12-month follow-up study.

To assess the effect of dienogest treatment on endometrioma (OMA) size, serum anti-Mullerian hormone (AMH) levels and associated pain over a 12-month follow-up period. A longitudinal cohort study of 104 patients with OMA who were treated with dienogest, between January 2017 and January 2020. Of the included patients, each had a 12-month follow-up period with transvaginal or pelvic ultrasound and measurement of serum AMH concentration at the sixth and twelfth months of follow-up. The alteration in OMA size in the sixth and twelfth months of treatment was the primary outcome measure and the alteration in AMH concentration over the same period was the secondary outcome measure. The only exclusion criterion was having surgical intervention for OMA during the follow-up period (n=44). In patients with bilateral OMA (n=21), the change in size of the largest OMA was considered in the analysis. A total of 60 patients with a mean ± standard deviation (SD) age of 31.5±8.0 years were included. The mean ± SD OMA size on the day the dienogest was started was 46.3±17.4 mm and the mean AMH level was 3.6±2.4 ng/mL. After six months, the mean OMA size had decreased to 38.6±14.0 mm, with a median difference of 7.8 mm [95% confidence interval (CI): 3.0 to 12.6; p=0.003]. The mean AMH level was 3.3±2.7 ng/mL at 6 months follow-up (95% CI: -0.2 to 0.8; p=0.23) and the average difference was 0.3 ng/mL. At the 12th-month visit, when compared with the beginning of the treatment, OMA size had again significantly decreased by a median of -8.9 mm (95% CI: -2.9 to -14.9; p=0.005), and the decline in median AMH was also significant (-0.9 ng/mL, 95% CI: -0.1 to -1.7; p=0.045). The initial mean ± SD visual analog scale pain score at the commencement of dienogest treatment was 6.3±3.4. The mean values at the sixth and twelfth months of dienogest therapy were 1.08±1.8 and 0.75±1.5, respectively (both p<0.001 compared to baseline). At the sixth and twelfth months of dienogest treatment a significant decrease in OMA size and reported pain scores were observed, whereas the AMH concentrations did not change significantly.

AMH levels after initial cycles of chemotherapy in female adolescents with Ewing sarcoma and implications for preservation of fertility.

10067 Background: Anti-Müllerian hormone (AMH) has been recommended as the primary surveillance modality for evaluation of ovarian insufficiency in females. Patients with Ewing sarcoma receive VDC-IE chemotherapy which is estimated high risk of gonadotoxic injury. Previous studies have shown that only a small part of female patients with Ewing sarcoma show signs of ovarian recovery during long-term follow-up, similar to those treated with SCT or abdominal radiotherapy. Time to start preservation of fertility should be defined in this group of patients. Methods: In this observational study, we prospectively investigated AMH as a measure of ovarian function in female adolescents (less than 18 years old) with Ewing sarcoma who received initial chemotherapy in our hospital. Patients previously treated with systemic treatment were excluded. Serum levels of AMH were measured at the laboratory of Peking University People’s Hospital. Blood samples were collected at the first day of the initial two cycles of VDC-IE treatment, before local therapy including surgical resection and radial radiation, and at the end of chemotherapy. All statistical analyses were performed using SPSS 19.0 version. Results: A total of 53 female adolescents with Ewing sarcoma who received initial chemotherapy in our hospital were analyzed from February 1, 2021 to December 31, 2023, including 35 patients aging from 6 to 12 (group 1), 18 patients aging from 12 to 18 (group 2). 255 blood samples from unique time points were measured. The baseline mean AMH were 4.16 (90% CI, 1.88 – 9.42) ng/mL in all patients, 3.58 (90% CI, 1.40 – 6.91) ng/mL for group1 and 5.28 (90% CI, 3.10 – 9.48) ng/mL for group 2. The mean AMH level after first cycle of chemotherapy was 0.43 (90% CI, 0.03 – 0.81) ng/mL in all patients, 0.40 (90% CI, 0.03 – 0.69) ng/mL and 0.47 (90% CI, 0.12 – 1.09) ng/mL for each group at a mean time of 16.5 days after initial chemotherapy. The mean AMH level before local therapy was 0.17 (90% CI, 0.03 – 0.37) ng/mL and 0.07 (90% CI, 0.01 – 0.32) ng/mL at the end of chemotherapy. Conclusions: Female adolescents with Ewing sarcoma treated by VDC-IE regimen showed a rapid reduction of AMH after initial cycles. Methods for preservation of fertility should be implemented as soon as possible but not at the same time of local therapy.

Associations of anti-Müllerian hormone levels among women in their mid-30s with menopausal symptoms ~14 years later.

The aim of this study was to examine associations of anti-Müllerian hormone (AMH) levels in gravid women in their mid-30s with menopausal symptoms ~14 years later and age at natural menopause. In this prospective analysis, 474 participants in Project Viva, a longitudinal cohort, were enrolled during pregnancy between 1999 and 2002. AMH levels were determined using plasma samples collected 3 years postpartum. Participants completed the Menopause Rating Scale (MRS) and self-reported age at and reason for menopause at the 17 years postpartum visit (Mid-Life Visit). Primary outcomes were individual MRS item responses and total MRS score. To examine associations between AMH levels and menopausal outcomes, we performed linear and logistic regressions, and survival analyses, adjusting for confounding variables. Mean (SD) AMH level was 2.80 (2.74) ng/mL, measured at 38.2 (3.9) years. At the Mid-Life Visit, mean (SD) age was 52.3 (3.9) years and total MRS score was 8.0 (5.7). During follow-up, 50% had experienced natural menopause, and self-reported mean (SD) age at natural menopause was 50.4 (3.6) years. AMH in the lowest tertile (mean [SD]: 0.47 [0.32] ng/mL) was associated with higher odds of moderate to severe vaginal dryness (adjusted odds ratio: 2.58; 95% CI: 1.16 to 5.73), a lower MRS psychological subscale (adjusted β: -0.71; 95% CI: -1.35 to -0.07), and earlier attainment of natural menopause (adjusted hazards ratio: 7.1; 95% CI: 4.6 to 11.0) compared with AMH in the highest tertile (mean [SD]: 6.01 [2.37] ng/mL). Lower AMH in the mid-30s was associated with earlier menopause and increased odds of vaginal dryness but fewer psychological symptoms ~14 years later.

Impact of bariatric surgery on ovarian reserve markers and its correlation with nutritional parameters and adipokines.

A reduction in anti-müllerian hormone (AMH) levels at short-term after bariatric surgery (BS) has been previously described. However, an assessment of ovarian reserve at longer-follow up, and a comprehensive evaluation of the potentially implicated factors has not been reported. Prospective cohort study. Twenty women aged 18-40 years with BMI 43.95 kg/m2 undergoing BS were studied at baseline (BS0), and at 1 month (BS1), 4 months (BS2), 12 months (BS3), and 24-36 months (BS4) after the surgery. Anthropometrics, reproductive hormones (AMH, FSH, LH, estradiol, testosterone, SHBG, androstenedione), metabolic parameters (adiponectin, leptin, ghrelin, insulin), and nutritional blood parameters (markers of nutritional status, vitamins, and minerals) were obtained at each study time point. Antral follicular count (AFC) was assessed by ultrasonography at BS0, BS3, and BS4. Mixed models were used for analysis of longitudinal data. The mean AMH level was 3.88 ng/mL at BS0, decreased at BS3 (mean= 2.59 ng/mL; p=0.009), and remained stable between BS3 and BS4 (mean= 2.96 ng/mL; p=0.409). We also observed a non-significant decrease in AFC at BS3 (mean=26.14 at BS0, mean 16.81 at BS3; p=0.088) that remained stable at BS4 (mean= 17.86; p=0.731). Mixed models analysis showed: (a) a decrease in 10kg of body weight was associated with an average decrease of 0.357 ng/mL in AMH (p=0.014); (b) a decrease in 1 BMI point was associated with an average decrease of 0.109 ng/mL in AMH (p=0.005); (c) an increase in 1 µg/mL of adiponectin was associated with an average decrease of 0.091 ng/ml in AMH (p=0.041) Significant positive correlations were found between the AMH levels after BS and plasma concentrations of testosterone, free androgen index, insulin and HOMA index. No significant correlations were detected between AMH levels and nutritional parameters. Our results were in line with previous observations, showing that AMH levels decreased significantly at 12 months after bariatric surgery, in parallel with a non-significant reduction in AFC. Both ovarian reserve markers showed a later stabilization up to the end of the study. Of note, postoperative AMH levels were positively correlated with key androgen and insulin resistance-related parameters.

Minimally Invasive Method of Measuring Anti-Müllerian Hormone Level in Dried Blood Spots of Indonesian Infertile Population

This study aims to evaluate the certainty of anti-Müllerian hormone (AMH) levels in dried blood spots (DBS) compared to serum AMH. A total of 109 infertile women who planned to undergo their controlled ovarian stimulation cycle were recruited. Serum and DBS samples were collected from each patient for the quantification of AMH levels. Serum AMH was measured with an automated clinical chemistry assay (Roche) while DBS AMH was measured using the Ansh Labs DBS AMH ELISA reagent kit. Mean AMH level in DBS was [Formula: see text][Formula: see text]ng/mL, which ranged from 0.01 to 17.3[Formula: see text]ng/mL, while the mean AMH in serum samples was [Formula: see text][Formula: see text]ng/mL (0.01–10.8[Formula: see text]ng/mL). Comparable accuracy for low AMH quantification was observed between the two methods over basal antral follicle counts (AFC) as a clinical comparator (AUC 86%, cutoff [Formula: see text][Formula: see text]ng/mL, [Formula: see text], [Formula: see text] vs. 85%, cutoff [Formula: see text][Formula: see text]ng/mL, [Formula: see text], [Formula: see text], respectively for DBS and serum sample). Likewise, DBS AMH achieved high concordance for low AMH discrimination in comparison to serum AMH method (AUC 99% vs. 93%, respectively). A strong linear Spearman regression ([Formula: see text], [Formula: see text]) and sufficient agreement (94.5%, mean difference of −1.6, 2.7 to −5.9) was demonstrated among studied groups with mathematical Passing and Bablok regression equation of [Formula: see text]. The confidence interval of intercept (−0.12, 95% CI [−0.29 to −0.01]) and slope (1.80, 95% CI [1.66–1.94]) indicated a constant and proportional difference between the two methods but it was not significant ([Formula: see text]). AMH measurement in DBS could be useful as an alternative approach to screening ovarian reserve through a more convenient remote sample collection.

Anti-Müllerian hormone: A novel biomarker for detecting bovine freemartinism.

The anti-Müllerian hormone (AMH) indicates ovarian reserve in cattle, maintaining a consistent trajectory post-puberty. In heterosexual pregnancies, the development of the Müllerian duct in female foetuses is inhibited, resulting in an anticipated minimal or absent ovarian reserve capacity. This investigation aimed to compare AMH levels in healthy Holstein heifers that had reached puberty with those of freemartin animals of the same breed and age. The study incorporated Holstein heifers reaching puberty between 11 and 15 months of age in Group 1 (G1, n = 20) and freemartin animals in Group 2 (G2, n = 19, 16). AMH measurements (AMH-1/AMH-2) were recorded at 12-day intervals for the study participants. Notably, AMH levels in three freemartin animals could not be detected, prompting statistical analysis based on measurements from the remaining 16 freemartin animals in G2. A statistically significant correlation was observed between two separate measurements in G1 and G2 (p < .001). Furthermore, AMH-1 and AMH-2 levels were statistically higher in G1 than in G2 (p < .001). In G1, AMH-1 levels ranged from 227 to 677 pg/mL, with an average of 367.3 ± 25.5 pg/mL, and AMH-2 levels ranged from 234 to 645 pg/mL, with an average of 380.8 ± 24.4 pg/mL. Conversely, in G2, AMH-1 levels ranged from 10 to 72 pg/mL, with an average of 26.8 ± 4.44 pg/mL, and AMH-2 levels ranged from 12 to 68 pg/mL, with an average of 28.75 ± 4.18 pg/mL. The mean AMH levels in G1 were approximately 14 times higher than in G2 (p < .001). Consequently, ROC analysis utilizing AMH-1 and AMH-2 data established cut-off values of ≤72 and ≤ 68 pg/mL respectively for distinguishing freemartin animals. In conclusion, AMH could be used as a reliable biomarker for identifying Holstein freemartin animals.

Serum anti-Müllerian hormone is lower in patients with multiple radioiodine dose for treatment of pediatric thyroid cancer.

Treatment of patients with pediatric differentiated thyroid cancer (DTC) often involves radioiodine (RAI), which is associated with increased risks of short- and long-term adverse outcomes. The impact of RAI treatment on the female reproductive system remains uncertain. Anti-Müllerian hormone (AMH) is a marker of ovarian reserve and is related to fertility. The aim was to analyze the association between RAI and serum AMH level in women treated with RAI. We evaluated women with pediatric DTC treated with RAI at the age of ≤19 years. Serum AMH was measured. The study included 47 patients with a mean age of 25.1 years (12.4-50.8) at AMH measurement and follow-up of 11.8 ± 8.4 years. The mean RAI administered was 235 mCi (30-1150). Sixteen (34%) received multiple RAI doses (471 ± 215 mCi). Mean AMH level was 2.49 ng/mL (0.01-7.81); the level was 1.57 ng/mL (0.01-7.81) after multiple RAI doses and 2.99 ng/mL (0.01-6.63) after a single RAI dose (P = 0.01). Patients who received a cumulative RAI lower than 200 mCi had higher AMH levels (2.23 ng/mL, 0.39-7.81) than those who received more (1.0 ng/mL, 0.01-6.63; P = 0.02). In patients with similar cumulative RAI activities, administration of multiple RAI doses was significantly and independently associated with AMH level lower than the reference range for age (HR: 5.9, 1.55-52.2, P = 0.014) after age adjustments. Levels of AMH were lower after multiple RAI doses, especially after a cumulative RAI dose above 200 mCi. More studies are needed to clarify the impact of RAI on fertility considering its cumulative activity and treatment strategy.

Effect of radiation on serum anti-Müllerian hormone during hysterosalpingography in female infertility

Research questionDoes radiation exposure during hysterosalpingography (HSG) negatively affect serum anti-Müllerian hormone (AMH) levels in infertile women? DesignProspective cohort study conducted at Songklanagarind Hospital, Thailand, between April 2021 and May 2023. Thirty-two infertile women and 34 control participants were enrolled. Serum AMH levels were assessed in the infertile group at baseline before the HSG procedure and at 1 and 3 months after the procedure. Control participants, who self-reported no medical conditions, underwent the same AMH level assessments. Changes in serum AMH levels were compared. ResultsInfertile women had a mean age of 32.4 ± 3.8 years, body mass index of 21.2 ± 2.0 kg/m2 and baseline mean AMH level of 3.66 ng/ml (95% CI 3.00 to 4.32), which did not significantly differ from the control group. One month after HSG, mean AMH level significantly declined (0.33 ng/ml, 95% CI –0.65 to –0.01; P = 0.045) in the infertile group. The change in serum AMH levels between baseline and 1 month was significantly different in the HSG group compared with controls (–0.33 ng/ml, 95% CI –0.65 to –0.01 versus 0.36 ng/ml, 95% CI 0.06 to 0.67; P = 0.002). Changes in serum AMH levels from baseline to 3 months did not differ between the two groups. ConclusionsOne month after the HSG, infertile women experienced a significant decrease in serum AMH levels compared with controls. The change in serum AMH levels between baseline and 3 months after HSG did not significantly differ from that of the control group.

The impact of follicular fluid phthalate metabolites on the ovarian reserve and ovarian function in Indian women undergoing intracytoplasmic sperm injection

To investigate the adverse effects of phthalate-induced ovarian toxicity on the ovarian reserve and ovarian function. To assess whether the accumulation of higher levels of selected phthalate metabolites in the follicular fluid (FF) of Indian women undergoing intracytoplasmic sperm injection (ICSI) was associated with a decline in their antral follicle count (AFC) and/or serum antimüllerian hormone (AMH) levels, suggesting a negative impact on the ovarian reserve. To evaluate the effects of follicular phthalate metabolites on peak serum estradiol (E2) levels and the total number of oocytes and mature metaphase II (MII) stage oocytes retrieved to assess the impact of phthalate toxicity on ovarian function. A subanalysis of an ongoing prospective cohort study was conducted to examine the association between the levels of six phthalate metabolites, namely, mono-n-butyl phthalate (MBP), mono-ethyl phthalate (MEP), mono-isononyl phthalate (MiNP), mono-isodecyl phthalate (MiDP), mono(2-ethyl-5-oxohexyl) phthalate, and mono(2-ethyl-5-hydroxyhexyl) phthalate, in the FF of Indian women undergoing ICSI and their ovarian reserve markers (AFC and serum AMH levels). To investigate the association of these follicular phthalate metabolite levels with the peak E2 levels and the total number of oocytes and number of MII stage oocytes retrieved. Invitro fertilization center in a referral hospital in India. A total of 245 consenting Indian women who had undergone oocyte retrieval between April 2017 and mid-March 2020 were included. Each woman contributed one FF sample to the study. This was screened for six phthalate metabolites. The samples were collected before the coronavirus disease 2019 pandemic. Using liquid chromatography-tandem mass spectrometry, the total levels of six phthalate metabolites were quantified in the FF of 245 women. Using linear regression models that were unadjusted and adjusted for maternal age and body mass index (BMI), we evaluated the association between the follicular metabolites in these women and their AFC, serum AMH levels, peak E2 levels, total number of oocytes, and MII stage oocytes. To evaluate the impact of phthalate-induced ovarian toxicity on the ovarian reserve and ovarian function in Indian women undergoing ICSI by studying their accumulated levels in their FF. For MiNP (a metabolite of di-isononyl phthalate), in linear regression models adjusted for age and BMI, we found that with increasing quartiles of follicular MiNP, there was a significant trend in the decrease in mean AFC (P-trend = 0.023) and a suggestive trend in the decrease in mean serum AMH levels (P-trend = 0.077). For MiDP (a metabolite of di-isodecyl phthalate), in the unadjusted regression model, we found that with increasing quartiles of follicular MiDP, there was a significant trend in the decrease in mean serum AMH levels (P-trend = 0.045). For MBP (a metabolite of dibutyl phthalate), in linear regression models adjusted for age and BMI, we found that with increasing quartiles of follicular MBP, there were significant trends in the decrease in the mean number of total oocytes retrieved (P-trend = 0.003), a decrease in the mean number of MII stage oocytes retrieved, (P-trend = 0.003) and a decrease in the mean peak E2 levels (P-trend = 0.016). Although we found that with increasing quartiles of follicular mono(2-ethyl-5-oxohexyl) phthalate there was a decrease in the mean number of total and MII stage oocytes retrieved and higher follicular MEP levels were negatively associated with the mean AFC and serum AMH levels, neither trend was statistically significant. We also found that although follicular MEP levels did not show an adverse impact on ovarian function, follicular mono(2-ethyl-5-hydroxyhexyl) phthalate levels did not show an adverse impact on both the ovarian reserve and function. In this study of 245 Indian women, higher accumulated FF levels of MiNP and MiDP were negatively associated with AFC and serum AMH levels, suggesting an adverse effect on the ovarian reserve. Higher accumulated FF levels of MBP were negatively associated with the total number of oocytes, MII stage oocytes, and peak E2 values, suggesting a negative impact on ovarian function. Although we found that phthalate-induced ovarian toxicity was statistically significant for selected phthalate metabolites, the role of the cumulative effect of multiple phthalates in the ovarian microenvironment cannot be ruled out and needs to be investigated further.

Ovarian reserve markers of women with superficial endometriosis.

Endometriosis affects up to 10% of reproductive age women and is associated with pelvic pain and subfertility. While previous studies have shown an association between deep and ovarian endometriosis to reduced ovarian reserve, there is no data on the effect of superficial endometriosis on ovarian reserve markers. Hence, we aimed to compare ovarian reserve markers of women with superficial endometriosis to that of women without endometriosis. This was a case control study in a tertiary medical center. The study group included women aged 18-40 with surgically and histopathology-proven superficial endometriosis with no deep lesions or ovarian involvement. The control group included women with no known or suspected endometriosis and was matched to the study group by age, BMI and parity. We excluded women with other known risk factors for ovarian failure and with other gynecological disorders. Participants completed a questionnaire with demographic, medical and gynecological data. Each patient underwent anti-Mullerian hormone (AMH) testing and an ultrasound to assess their antral follicular count (AFC). AMH and AFC were then compared between groups. A total of 124 women participated in the study. Of these, 50% (n = 62) had surgically proven superficial endometriosis and 50% (n = 62) were without known or suspected endometriosis. Mean AMH levels of women with and without superficial endometriosis was 3.0 ± 2.8 ng/mL and 2.8 ± 1.9 ng/mL, respectively (P = 0.71). AFC also did not differ between groups (women with superficial endometriosis: 12.0 ± 6.6; women without endometriosis: 10.2 ± 5.0, P = 0.15). In our cohort, superficial endometriosis was not associated with diminished ovarian reserve. While further studies are needed, to date, it does not appear to be justified to assess ovarian reserve for patients with superficial endometriosis.

Association of exposure to ozone and fine particulate matter with ovarian reserve among women with infertility

Evidence linking diminished ovarian reserve, a significant cause of female infertility, and exposure to particulate matter with aerodynamic diameters ≤2.5 μm (PM2.5) or O3 exposure remains a critical knowledge gap in female fertility. This study investigated the association between ambient PM2.5, O3 pollution, and anti-Müllerian hormone (AMH), a sensitive marker of ovarian reserve, in reproductive-aged Chinese women. We enrolled 2212 women with spontaneous menstrual cycles who underwent AMH measurements at a reproductive medicine center between 2018 and 2021. The daily mean concentrations of outdoor PM2.5 and O3 were estimated using a validated spatiotemporal model, followed by matching the participants' residential addresses. Three exposure periods were designed according to AMH expression patterns during follicle development. A generalized linear model was used to investigate changes in AMH associated with air pollution. The results showed a mean AMH level of 3.47 ± 2.61 ng/mL. During the six months from primary to early antral follicle stage (Period 1), each 10 μg/m3 increase in PM2.5 and O3 exposure was associated with AMH changes of −0.21 (95% confidence interval [CI]: −0.48, 0.06) ng/mL and −0.31 (95% CI: −0.50, −0.12) ng/mL, respectively. Further analyses indicated that the reduced ovarian reserve measured by AMH level was only significantly associated with PM2.5 exposure during follicle development from the primary to preantral follicle stage (Period 2) but was significantly associated with O3 exposure during Periods 1, 2, and 3. These observations were robust in the dual-pollutant model considering co-exposure to PM2.5 and O3. The results indicated an inverse association between ovarian reserve and ambient O3 exposure and suggested distinct susceptibility windows for O3 and PM2.5 for reduced ovarian reserve. These findings highlight the need to control ambient air pollution to reduce invisible risks to women's fertility, especially at high O3 concentrations.

Impact of baseline luteinizing hormone (LH) level and anti-Müllerian hormone (AMH) on pregnancy outcomes in polycystic ovary syndrome (PCOS) patients undergoing IVF/ICSI cycle in antagonist protocol

Introduction: Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder often associated with infertility. There are several factors that could impair the pregnancy outcomes of PCOS patients. The latter endocrine profile along with high baseline luteinizing hormone (LH), high LH/follicle-stimulating hormone ratio, as well as high anti-Müllerian hormone (AMH) levels appear detrimental for patients undergoing In vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). The objective of this study is to evaluate the impact of baseline LH and AMH levels on pregnancy outcomes in PCOS patients performing IVF/ICSI cycles in an antagonist protocol. Materials and methods: The current investigation is a retrospective cohort study conducted at IVF Tiziri Center in Algiers on PCOS patients undergoing IVF/ICSI from January 2017 to March 2021. According to the Rotterdam criteria, patients aged between 23 and 42 years were divided into 2 groups: group 1 (G1) =91 patients; group 2 (G2) =100 all patients had an LH level &gt;10 IU/L. Both groups had AMH levels &gt;5 ng/mL. Controlled ovarian stimulation was done with a fixed antagonist protocol, as for the ovulation it was triggered with human chorionic gonadotropin or gonadotropin-releasing hormone agonist. Fresh and frozen embryo transfers were, thereafter, evaluated. Concerning the statistical analysis, it was done with SPSS software. Results: The mean LH level was 15.16±7.08 for G1 versus 5.7±1.86 for G2 (P=10−6), mean LH/follicle-stimulating hormone ratio 2.71±1.36 in G1 versus 1.05±0.44 (P=10−6) and mean AMH level was 9.27±3.90 for G1 versus 7.53±2.76 for G2 with (P&lt;10−3). The mean follicles over 11 mm in diameter, estradiol (E2) level, and progesterone level on the trigger day did not differ significantly between G1 and G2. Also, the mean of oocytes and metaphase II oocytes retrieved fertilization, and blastulation rate were similar for both groups. The pregnancy rate for G1 was 40.6% versus 54% (P&gt;0.05); the ongoing pregnancy rate (OPR) was 28.6% in G1 versus 47% in G2 (P=0.078); and the miscarriage rate was 32.4% for G1 versus 12.9 for G2 (P=0.072). A univariate analysis was performed with all confounder factors supposed to impact pregnancy outcomes: AMH level did not impact pregnancy outcomes, whereas LH level &lt;11 IU/L has been determined as a threshold impacting positively on OPR with odds ratio=2.01 (95% CI: 1.05–3.87). After a multivariate logistic regression including con-founders, 3 factors significantly influence OPR: LH, E2, and infertility with known etiology. Conclusion: The high baseline LH level impairs pregnancy outcomes in PCOs patients undergoing an antagonist protocol IVF/ICSI cycle. The identification of PCOS patients by their endocrine profile enables the establishment of a prognosis for council patients and a plan for an individualized therapeutic strategy.

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.

Assessment of the ovarian reserve in patients with beta-thalassemia major: a prospective longitudinal study

Repeated blood transfusions in women with beta-thalassemia major (BTM) may lead to iron overload and increase oxidative stress, consequently resulting in ovarian damage. The aim was to evaluate alterations in ovarian reserve in transfusion-dependent BTM patients over a time period of one year and to compare levels of anti-Mullerian hormone (AMH) in women with BTM and their healthy peers. This longitudinal prospective study was conducted in women with transfusion-dependent BTM at a tertiary level hospital. The hospital database was interogated for women diagnosed with BTM between 1996 and 2021. AMH levels were assessed at baseline and one year later. Forty-one women with BTM were identified, of whom 25 (60.9%) had amenorrhea and 16 (39.1%) had normal cycles. The mean AMH level of all women was 2.7±1.8 ng/mL at baseline, significantly lower than the age-matched nomogram value of 4.0±0.4 ng/mL for a healthy population (p=0.001). The baseline AMH level of patients with amenorrhea were significantly lower than patients with normal menstrual cycles (2.1±1.8 vs. 3.6±1.5 ng/mL, p=0.009). After one-year follow-up, there was a trend towards a decrease in the AMH levels of patients with normal menstrual cycles. Serum AMH values are decreased in patients with transfusion-dependent BTM. BTM patients should be educated about the possible effects of repeated blood transfusions on fertility.

Diagnostic Role of Anti-Mullerian hormone in Polycystic Ovarian Syndrome

Objective: To evaluate if the elevated levels of Anti-Mullerian hormone (AMH) could serve as an indicator of polycystic ovarian syndrome (PCOS) in patients presenting with infertility. Method: The present study was conducted at Institute of Molecular Biology and Biotechnology, The University ofLahore andAustralianConceptInfertilityMedicalCenter(ACIMC),Lahore. It was a case control study. Atotal of 101 females aged between 20-40 years presenting with infertility were included in this study. Among study participants, 51 infertile females had PCOS and 50 were non-PCOS infertile subjects. After taking informed consent, medical history and anthropometric indices were recorded on standardized proforma.Transvaginal ultrasound was done to assess ovarian morphology. Serum AMH, follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH) and prolactin levels were measured by commercially available ELISAkits. Serum AMH levels were measured in 10 healthy, fertile females having normal menstrual cycle as normal reference values in our population. Results: Mean AMH levels were significantly higher (9.9±1.1ng/ml) in females with polycystic ovarian syndrome as compared to subjects without this syndrome (1.0± 0.3ng/ml). Mean FSH levels were significantly lower in females with PCOS (p value 0.001) but LH: FSH ratio, serum luteinizing hormone and prolactin level were not significantly different in two groups. Conclusion: The study provides evidence that raised serum levels of AMH are associated with the presence of PCOS and therefore can serve as useful marker in diagnosis of PCOS

The role of anti-Mullerian hormone and other correlates in patients with polycystic ovary syndrome

ABSTRACT Background Anti-Müllerian hormone (AMH) has recently emerged as a promising biomarker for the detection of polycystic ovarian morphology. In polycystic ovary syndrome (PCOS), an elevated level of AMH has been suggested to add value to the Rotterdam criteria in cases of diagnostic uncertainty. In this study, we evaluated the correlation between AMH and PCOS, and the potential role of AMH in PCOS diagnosis. Methods A case-control study was performed on a total of 200 females, 100 of which were diagnosed with PCOS as per Rotterdam revised criteria (2003) and 100 as the control (non-PCOS group). Patient medical records were therefore retrieved for clinical, biochemical and ultrasound markers for PCOS diagnosis. Sensitivity, specificity, area under receiver operating characteristic (AUROC) curve, and multivariate linear regression models were applied to analyze our data. Results Mean serum levels of LH and AMH, and LH/FSH ratio were significantly different between compared groups. In the PCOS group, the mean serum AMH level was 6.78 ng/mL and LH/FSH ratio was 1.53 while those of controls were 2.73 ng/mL and 0.53, respectively (p < .001). The most suitable compromise between 81% specificity and 79% sensitivity was obtained with a cutoff value of 3.75 ng/mL (26.78 pmol/L) serum AMH concentration for PCOS prediction, with an AUROC curve of 0.9691. Conclusion Serum AMH cutoff level of 3.75 ng/mL was identified as a convenient gauge for the prediction of PCOS and an adjuvant to the Rotterdam criteria.

Neopterin and the anti-Mullerian hormone's role in Unexplained Recurrent Pregnancy Loss

Background: Recurrent pregnancy loss were prevalent complications in pregnancy. Immunological biomarkers as Neopterin used as a marker in recurrent pregnancy loss. Anti-Mullerian hormone is a reliable marker of the ovarian reserve. Therefore, was also considered as a marker to evaluate its role in the recurrent pregnancy losses. This study was conducted to assess whether neopterin and Anti- Mullerian hormone can be used as a marker in the condition of unexplained recurrent pregnancy loss. Material’s and Methods: A case control study was done in the Department of Obstetrics and Gynecology Salahdeen general hospital in Tikrit city from first January to thirty of August 2020. One hundred patient enrolled in the study. Study contains two groups:1- Group A as cases. 2- Group B as control group. The data collection done through:1-Designed closed and open-ended questionnaire, 2- Laboratory investigations of : Serum Neopterin and Anti-Mullerian hormone levels using enzyme-linked immunosorbent assay. Results: Mean Neopterin level was significantly higher among cases (24.3±10.7)nml/l than control group (2.9±1.1) nml/l. Mean Neopterin level increased with increasing abortion number. It was significantly higher among those with ≥5 abortions (30.02±10.04) nml/l than those with (3-4) and 2 abortions (28.7±15.29) nml/l and (20.1±0.03) nml/l. The mean Neopterin level increased with increasing age among cases and controls. Among cases was (28.7±12.03) nmol/L among those aged (31- 35) year, which was higher than those aged (18-25), and those aged (26-35) years Mean Anti-Mullerian hormone level was significantly lower among cases (0.8±0.6) ng/ml than control group (5.01±2.7) ng/ml. Mean Anti-Mullerian hormone level was significantly higher among those with 2 abortions (1.06±0.7) ng/ml than those with (3-4) and 5 abortions (0.6±0.56) ng/ml and (0.97±0.4) ng/ml respectively. Among case the mean AMH level was lower among those aged (31-35) years (0.5±0.31) ng/ml than those aged (26-30), and (18-25) years (0.8±0.7) ng/ml, (0.97±0.7) ng/ml, respectively Conclusions: A statistically significant high Mean Neopterin level among cases and its increased mean Neopterin level with increasing abortion number. A statistically significant low levels of mean Anti-Mullerian hormone level among cases, more reduction in its level with increasing abortion. This pioneer study in Iraq, determined the significant association between the unexplained recurrent pregnancy loss with the increased levels of Neopterin and its effect on Anti-Mullerian hormone that lead to recurrent pregnancy loss.

Using serum anti-Müllerian hormone levels to predict the chance of live birth after spontaneous or assisted conception: a systematic review and meta-analysis.

Is serum anti-Müllerian hormone (AMH) level predictive of cumulative live birth (CLB) rate after ART or in women trying to conceive naturally? Serum AMH level is linked to CLB after IVF/ICSI but data are lacking after IUI or in women trying to conceive without ART. Serum AMH level is a marker of ovarian reserve and a good predictor of ovarian response after controlled ovarian stimulation. It is unclear whether AMH measurement can predict CLB in spontaneous or assisted conception. A systematic review and meta-analysis was undertaken to assess whether serum AMH level may predict chances of CLB in infertile women undergoing IVF/ICSI or IUI and/or chances of live birth in women having conceived naturally. A systematic review and meta-analysis was performed using the following keywords: 'AMH', 'anti-mullerian hormone', 'live-birth', 'cumulative live birth'. Searches were conducted from January 2004 to April 2021 on PubMed and Embase. Two independent reviewers carried out study selection, quality, and risk of bias assessment as well as data extraction. Odds ratios were estimated using a random-effect model. Pre-specified sensitivity analyses and subgroup analyses were performed. The primary outcome was CLB. A total of 32 studies were included in the meta-analysis. Overall, 27 articles were included in the meta-analysis of the relation between AMH and CLB or AMH and LB after IVF/ICSI. A non-linear positive relation was found in both cases. A polynomial fraction was the best model to describe it but no discriminant AMH threshold was shown, especially no serum AMH level threshold below which live birth could not be achieved after IVF/ICSI. After IVF-ICSI, only four studies reported CLB rate according to AMH level. No statistically significant differences in mean serum AMH levels were shown between patients with and without CLB, but with a high heterogeneity. After exclusion of two studies with high risks of bias, there was no more heterogeneity [I2 = 0%] and the mean AMH level was statistically significantly higher in women with CLB. There were not enough articles/data to assess the ability of AMH to predict CLB rate or find an AMH threshold after IUI or in women without history of infertility trying to conceive without ART. The systematic review and meta-analysis had some limitations owing to the limits and bias of the studies included. In the present meta-analysis, heterogeneity may have been caused by different baseline characteristics in study participants, different stimulating protocols for ART, different serum AMH level thresholds used and the use of various assays for serum AMH. This could explain, in part, the absence of a discriminating AMH threshold found in this analysis. Serum AMH level is linked to CLB rate after IVF/ICSI but no discriminating threshold can be established, therefore low serum AMH level should not be used as the sole criterion for rejecting IVF treatment, especially in young patients. Data are lacking concerning its predictive value after IUI or in women trying to conceive without ART. Our findings may be helpful to counsel candidate couples to IVF-ICSI. No external funding was obtained for this study. There are no conflicts of interest. PROSPERO CRD42021269332.

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.