Mean anti-Müllerian Hormone Levels Research Articles

AMH levels at central precocious puberty and premature thelarche: is it a parameter?

The possible difference of antimüllerian hormone (AMH) levels at central precocious puberty (CPP) and premature thelarche (PT) has not been properly evaluated. By evaluating AMH levels in girls with diagnosed CPP and PT, we aim to show the change of AMH levels at the pubertal onset. Sixty-five girls who have breast development before the age of 8 years and 25 healthy girls were enrolled in the study. The subjects were divided into two groups as CPP and PT, according to results of GnRH test. AMH levels were determined in the two groups. The mean AMH levels of the CPP group were significantly lower than those in the PT group (13.57±9.85 pmol/L and 58.42±12.78 pmol/L, respectively, p=0.022). These results suggest that the AMH levels decrease in the duration of the hypothalamus-pituitary-ovarian axis activation. We thought that AMH might/may be a marker for distinguishing between CPP and PT.

Serum anti-Müllerian hormone levels in reproductive-age women with relapsing–remitting multiple sclerosis

Background: Fertility might be reduced in women with multiple sclerosis (MS), although only few studies exist and the underlying reasons are not well understood. Similar to other autoimmune diseases, a decreased ovarian reserve may contribute to impaired fertility in women with MS. Anti-Müllerian hormone (AMH) is an established marker of the ovarian reserve and an objective indicator of ovarian function, which is independent of the hypothalamus-pituitary-gonadal axis function. Objective: The purpose of this study was to determine AMH levels in females with relapsing–remitting MS (RRMS) in combination with other reproduction and lifestyle factors. Methods: A total of 76 reproductive-age females with RRMS and 58 healthy controls were included in this case control study. An enzymatically amplified two-site immunoassay was used to measure serum AMH level. Results: Mean AMH level was significantly decreased in females with RRMS (p<0.04), and a higher proportion of females with RRMS showed very low AMH values (<0.4 ng/ml) compared to healthy controls (p<0.05). The majority of these women were currently without any disease modifying treatment. Conclusions: Our data contribute to our understanding of impaired fertility in women with MS. The unexpected finding that the majority of MS subjects with very low AMH levels were currently without medication requires further evaluation.

Anti-Mullerian hormone levels in American girls by age and race/ethnicity.

Anti-Mullerian Hormone (AMH), a proposed indicator of ovarian follicle reserve in adults, has not been characterized in pediatric and adolescent females by race and/or ethnicity. To describe AMH levels in healthy American girls and determine the influence of age and race/ethnicity on AMH. SUBJECTS aged 10-21 years were recruited from primary care settings and emergency departments. Race/ethnicity was characterized as White, Black or Hispanic. Serum for AMH levels (ng/mL) was measured using an enzyme-linked immunosorbent assay. Thirty-one White, 60 Black and 24 Hispanic subjects were recruited. Mean AMH levels were 3.19 ng/mL (22.8 pmol/L) (SD 2.12) for Whites, 3.25 ng/mL (23.2 pmol/L) (SD 2.23) for Blacks and 2.97 ng/mL (21.2 pmol/L) (SD 1.75) for Hispanics. ANCOVA showed no difference in AMH levels among race/ethnicities, controlling for age (p=0.91). Age was significantly associated with AMH (p<0.001, R²=0.12). AMH levels do not vary by race/ethnicity, and AMH levels increase with age.

A retrospective analysis of the effect of salpingectomy on serum antiMüllerian hormone level and ovarian reserve

To determine whether previous salpingectomy is associated with serum antiMüllerian hormone (AMH) level and ovarian reserve in women under 40 years presenting for in vitro fertilization and embryo transfer. We retrospectively compared serum AMH levels measured on the ovulation induction initiation day in patients with unilateral salpingectomy, bilateral salpingectomy, and no tubal surgery, and examined the relationship with length of time after surgery and in vitro fertilization and embryo transfer parameters. A total of 198 women were included; 83 received unilateral salpingectomy, 41 bilateral salpingectomy, and 74 no tubal surgery. The baseline characteristics of the groups were similar. The mean AMH level was significantly higher in women without tubal surgery as compared with those with bilateral salpingectomy (183.48 vs 127.11 fmol/mL; P ≤ .037). The mean follicle stimulation hormone level was significantly lower in women without surgery as compared with those with bilateral salpingectomy (7.85 vs 9.13 mIU/mL; P = .048). No significant differences in duration of gonadotropin therapy, amount of gonadotropin used, estradiol level on the human chorionic gonadotropin injection day, thickness of the endometrium, number of oocytes retrieved, number of 2-pronuclei, viable embryos, and good quality embryos were found between the 3 groups. AMH level was not correlated with the number of oocytes or age in women that had undergone unilateral or bilateral salpingectomy. Salpingectomy is associated with decreased AMH level and increased follicle stimulation hormone in women seeking in vitro fertilization, though AMH level is not correlated with the number of oocytes retrieved in patients that have undergone unilateral or bilateral salpingectomy. These results suggest that salpingectomy is associated with decreased ovarian reserve.

Biological variability in serum anti-Müllerian hormone throughout the menstrual cycle in ovulatory and sporadic anovulatory cycles in eumenorrheic women.

Does serum anti-Müllerian hormone (AMH) vary significantly throughout both ovulatory and sporadic anovulatory menstrual cycles in healthy premenopausal women? Serum AMH levels vary statistically significantly across the menstrual cycle in both ovulatory and sporadic anovulatory cycles of healthy eumenorrheic women. Studies to date evaluating serum AMH levels throughout the menstrual cycle have conflicting results regarding intra-woman cyclicity. No previous studies have evaluated an association between AMH and sporadic anovulation. We conducted a prospective cohort study of 259 regularly menstruating women recruited between 2005 and 2007. Women aged 18-44 years were followed for one (n = 9) or two (n = 250) menstrual cycles. Anovulatory cycles were defined as any cycle with peak progesterone concentration ≤5 ng/ml and no serum LH peak on the mid or late luteal visits. Serum AMH was measured at up to eight-time points throughout each cycle. Geometric mean AMH levels were observed to vary across the menstrual cycle (P < 0.01) with the highest levels observed during the mid-follicular phase at 2.06 ng/ml, decreasing around the time of ovulation to 1.79 ng/ml and increasing thereafter to 1.93 (mid-follicular versus ovulation, P < 0.01; ovulation versus late luteal, P = 0.01; mid-follicular versus late luteal, P = 0.05). Patterns were similar across all age groups and during ovulatory and anovulatory cycles, with higher levels of AMH observed among women with one or more anovulatory cycles (P = 0.03). Ovulatory status was not verified by direct visualization. AMH was analyzed using the original Generation II enzymatically amplified two-site immunoassay, which has been shown to be susceptible to assay interference. Thus, absolute levels should be interpreted with caution, however, patterns and associations remain consistent and any potential bias would be non-differential. This study demonstrates a significant variation in serum AMH levels across the menstrual cycle regardless of ovulatory status. This variability, although statistically significant, is not large enough to warrant a change in current clinical practice to time AMH measurements to cycle day/phase. This research was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD (Contracts # HHSN275200403394C, HHSN275201100002I Task 1 HHSN27500001). The authors have no conflicts of interest to declare.

May AMH levels distinguish LOCAH from PCOS among hirsute women?

ObjectiveTo determine whether women with polycystic ovary syndrome (PCOS) would be distinguishable from women with late onset congenital adrenal hyperplasia (LOCAH) on the basis of antimullerian hormone (AMH) levels. Study designPCOS was diagnosed in 170 women; 105 were polycystic ovary morphology (PCOM)+/oligo-anovulation (OA)+/hyperandrogenism (HA)+, 40 PCOM+/OA−/HA+ and 25 PCOM−/OA+/HA+. These three groups were compared with 25 women in whom LOCAH was diagnosed. ResultsThe mean serum AMH levels were 8.12±1.85ng/ml in PCOM+/OA+/HA+ group, 5.34±1.82ng/ml in PCOM+/OA−/HA+ group, 3.02±1.76ng/ml in PCOM−/OA+/HA+ group and 4.43±1.29ng/ml in LOCAH group. The mean AMH level in PCOM+/OA+/HA+ group was approximately twofold higher than the mean AMH level measured in LOCAH group (p<0.001). Women with PCOM+/OA−/HA+ had higher serum AMH levels than those with LOCAH, women with LOCAH had higher serum AMH levels than those with PCOM−/OA+/HA+ but these differences were not statistically significant (p>0.05). ConclusionsAMH is not suitable for distinguishing LOCAH from all types of hyperandrogenic patterns of PCOS, but is only applicable for a specific subtype, such as PCOS patients with three main diagnostic criteria. Therefore, ACTH stimulation test remains an essential clinical tool to diagnose LOCAH.

Does loop electrosurgical excision procedure of the uterine cervix affect anti-Müllerian hormone levels?

Background. A delayed time to pregnancy was recently reported for women who had a loop electrosurgical excision procedure (LEEP) to remove cervical intraepithelial neoplasia (CIN) grade 2 or 3. The objective of the current study was to determine if treatment of CIN with LEEP is associated with decreased levels of anti-Müllerian hormone (AMH), a marker of ovarian reserve. Methods. AMH levels were measured in 18 women treated with LEEP and 18 age-matched controls, who had colposcopy only and did not require LEEP. Cases and controls had their blood drawn at study entry time zero and again 6 months later. Results. The mean AMH level decreased significantly from baseline to follow-up; however, no significant differences were observed when stratifying by LEEP status, suggesting that both groups experienced a similar decrease in AMH levels during the follow-up period. Although women treated with LEEP had lower overall AMH levels than controls at both baseline and follow-up, these differences were not statistically significant. Conclusion. Overall, the delayed time to pregnancy observed in women treated with LEEP is likely not due to a LEEP-associated decrease in ovarian reserve as measured by AMH; thus, other mechanism are responsible for the delayed time to pregnancy associated with LEEP.

The effects of isotretinoin on the ovarian reserve of females with acne

There are some side effects of isotretinoin in many organs. However, a study investigating the effects of isotretinoin on the human ovarian reserve has not been reported previously. The study was conducted to investigate possible effects of isotretinoin on ovarian reserve. Serum anti-Müllerian hormone (AMH) levels were measured at the beginning and at the end of isotretinoin treatment in 22 patients with acne and in 22 women without. The mean AMH level before treatment was 5.77 ng/mL in the study group and 3.79 ng/mL in the control group (p = 0.008). Following treatment, the mean AMH level was 4.69 ng/mL in the study group. This mean AMH level after treatment was statistically lower than the AMH level before treatment (p = 0.012). There was no significant difference between the mean AMH level at the end of treatment and that of the control group (p = 0.20). The high level of pre-treatment AMH levels could be an evidence of hyperandrogenism in women with acne, even if they are not identified as having polycystic ovary syndrome (PCOS) or hyperandrogenism. Decrease in AMH levels following exposure to isotretinoin may suggest that it has a detrimental effect on the ovaries.

Serum AMH Levels in Women With a History of Preeclampsia Suggest a Role for Vascular Factors in Ovarian Aging

The association between early menopause and vascular disease as a possible causative factor has recently received attention. Preeclampsia (PE) is associated with future cardiovascular risk factors, and this premature vascular aging potentially modifies the ovarian aging process. The purpose of this study was to assess whether women with a history of PE have lower anti-Müllerian hormone (AMH) levels than women with normotensive pregnancies. This was a retrospective cohort study. The study was conducted in a tertiary referral center. Clinical data and blood samples of participants in the Preeclampsia Risk EValuation in FEMales study were used (336 women with a history of PE and 329 women after a normotensive pregnancy). There were no interventions. The relative decrease in AMH levels was assessed after a median follow-up of 10.5 years. The mean AMH level was 2.00 ± 1.87 μg/L in the PE group compared with 2.26 ± 2.56 μg/L in the reference group. Linear regression analysis with censoring for undetectable AMH levels, adjusted for age, smoking, and hormonal contraceptive use, showed a relative reduction in AMH levels of 20.9% at any age (fold change 0.79, 95% confidence interval, 0.67-0.94). We demonstrate that women with a history of PE have significantly lower AMH levels than women with normotensive pregnancies. Calculations based on a reference population indicate advancement of reproductive age of approximately 1.5 years. Because PE is considered a manifestation of impaired vascular health, these results support the hypothesis that compromised vascular health could act as a causative mechanism in early ovarian aging.

Elevated serum levels of anti‐Müllerian hormone can be introduced as a new diagnostic marker for polycystic ovary syndrome

To determine the possible role of anti-Müllerian hormone (AMH) in the diagnosis of polycystic ovary syndrome (PCOS) with a larger population of women and to evaluate its role as a new diagnostic marker. Cross-sectional study. University hospital. A total of 570 women, with PCOS (n = 419) and without PCOS (n = 151). Serum basal hormone; AMH, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and thyroid-stimulating hormone (TSH) levels were measured. Mean hormone levels were compared and the predictive value of serum AMH level was evaluated with the use of the receiver operating characteristic (ROC) curve analysis. No statistically significant differences were found between PCOS women and control groups in terms of age, body mass index and TSH levels. Differences between mean serum, FSH, LH and estradiol levels and LH/FSH ratio were found to be statistically significant (p < 0.001). Mean serum AMH level was higher in PCOS women than in controls (7.34 vs. 2.24 ng/mL, p < 0.001). The area under the ROC curve assay yielded a satisfactory result of 0.916 (95% confidence interval 0.897-0.935, p < 0.0001). The best compromise between 89.8% specificity and 80% sensitivity was obtained with a cut-off value of 3.94 ng/mL for PCOS diagnosis. Serum AMH measurement is very valuable in the diagnosis of PCOS women. The serum AMH level in women with hyperandrogenism or oligo-anovulation could indicate the diagnosis of PCOS when reliable ultrasonography data are not available or when typical clinical and laboratory findings are not available. The serum AMH level is a new and useful diagnostic tool in PCOS diagnosis.

Short-term effects of salpingectomy during laparoscopic hysterectomy on ovarian reserve: a pilot randomized controlled trial

To examine the short-term effects of salpingectomy during laparoscopic hysterectomy on ovarian reserve when ovarian preservation is planned in view of determining the feasibility of conducting the study on a larger scale. Pilot randomized controlled trial. Tertiary care, academic medical center. Thirty premenopausal women aged 18 to 45 years undergoing laparoscopic hysterectomy with ovarian preservation for benign indications from April 2012 to September 2012. Bilateral salpingectomy (n = 15) versus no salpingectomy (n = 15) at the time of laparoscopic hysterectomy with ovarian preservation. Antimüllerian hormone (AMH) measured preoperatively, at 4 to 6 weeks postoperatively, and at 3 months postoperatively, with operative time and estimated blood loss abstracted from the medical records. The mean AMH levels were not statistically significantly different at baseline (2.26 vs. 2.25 ng/ml), 4 to 6 weeks postoperatively (1.03 vs. 1.25 ng/ml), or 3 months postoperatively (1.86 vs. 1.82 ng/ml) among women with salpingectomy versus no salpingectomy, respectively. There was also no statistically significant temporal change in the mean AMH level from baseline to 3 months postoperatively (-0.07 vs. -0.08 ng/ml) between the two groups. No difference in operative time (116 vs. 115 minutes) or estimated blood loss (70 vs. 91 mL) was observed. Salpingectomy at the time of laparoscopic hysterectomy with ovarian preservation is a safe procedure that does not appear to have any short-term deleterious effects on ovarian reserve, as measured by AMH level. Conducting a trial of this nature that is adequately powered with long-term follow-up evaluation would be feasible and is required to definitively confirm these results.

Fertility preservation in female sarcoma patients

ObjectiveTo assess ovarian reserve, after radio-chemotherapy treatments in sarcoma patients that underwent fertility preservation procedures.DesignA retrospective chart review of all eligible patients was done.Materials and MethodsThe research group included 12 sarcoma patients who underwent fertility preservation procedure (“ovarian protection” with GnRh agonist, ovarian tissue cryopreservation, oocytes cryopreservation, and embryos cryopreservation). In most women a combination of several fertility preservation techniques was used.ResultsMean age of patients was 26 years and 67% had no children. 58% had bone sarcoma and 42% had soft tissue sarcoma. Mean LH, FSH and day 3 E2 levels were above the normal range. The number of antral follicles was under the threshold indicating low ovarian reserve and mean Anti-Mullerian Hormone levels were near that threshold. Sub-division of the research group, according to the basic disease, revealed preserved or almost preserved ovarian reserve among soft tissue sarcoma patients and low ovarian reserve among woman with bone sarcoma.ConclusionSoft tissue sarcoma patients demonstrate an ovarian reserve that allows response to fertility treatments after chemotherapy. In this sub-group a surgical procedure like ovarian tissue cryopreservation may not be justified and GnRH analog protective treatment could be sufficient; while bone sarcoma patients demonstrate low post treatment ovarian reserve, a finding that may justify fertility preservation procedure, like IVF and embryos cryopreservation with or without oocyte cryopreservation, before radio-chemotherapy. Every patient should be consulted regarding the potential risks of chemotherapy and choose for herself whether to perform fertility preservation procedure. A multi-centered, prospective study is needed to establish the best fertility preservation aproach. ObjectiveTo assess ovarian reserve, after radio-chemotherapy treatments in sarcoma patients that underwent fertility preservation procedures. To assess ovarian reserve, after radio-chemotherapy treatments in sarcoma patients that underwent fertility preservation procedures. DesignA retrospective chart review of all eligible patients was done. A retrospective chart review of all eligible patients was done. Materials and MethodsThe research group included 12 sarcoma patients who underwent fertility preservation procedure (“ovarian protection” with GnRh agonist, ovarian tissue cryopreservation, oocytes cryopreservation, and embryos cryopreservation). In most women a combination of several fertility preservation techniques was used. The research group included 12 sarcoma patients who underwent fertility preservation procedure (“ovarian protection” with GnRh agonist, ovarian tissue cryopreservation, oocytes cryopreservation, and embryos cryopreservation). In most women a combination of several fertility preservation techniques was used. ResultsMean age of patients was 26 years and 67% had no children. 58% had bone sarcoma and 42% had soft tissue sarcoma. Mean LH, FSH and day 3 E2 levels were above the normal range. The number of antral follicles was under the threshold indicating low ovarian reserve and mean Anti-Mullerian Hormone levels were near that threshold. Sub-division of the research group, according to the basic disease, revealed preserved or almost preserved ovarian reserve among soft tissue sarcoma patients and low ovarian reserve among woman with bone sarcoma. Mean age of patients was 26 years and 67% had no children. 58% had bone sarcoma and 42% had soft tissue sarcoma. Mean LH, FSH and day 3 E2 levels were above the normal range. The number of antral follicles was under the threshold indicating low ovarian reserve and mean Anti-Mullerian Hormone levels were near that threshold. Sub-division of the research group, according to the basic disease, revealed preserved or almost preserved ovarian reserve among soft tissue sarcoma patients and low ovarian reserve among woman with bone sarcoma. ConclusionSoft tissue sarcoma patients demonstrate an ovarian reserve that allows response to fertility treatments after chemotherapy. In this sub-group a surgical procedure like ovarian tissue cryopreservation may not be justified and GnRH analog protective treatment could be sufficient; while bone sarcoma patients demonstrate low post treatment ovarian reserve, a finding that may justify fertility preservation procedure, like IVF and embryos cryopreservation with or without oocyte cryopreservation, before radio-chemotherapy. Every patient should be consulted regarding the potential risks of chemotherapy and choose for herself whether to perform fertility preservation procedure. A multi-centered, prospective study is needed to establish the best fertility preservation aproach. Soft tissue sarcoma patients demonstrate an ovarian reserve that allows response to fertility treatments after chemotherapy. In this sub-group a surgical procedure like ovarian tissue cryopreservation may not be justified and GnRH analog protective treatment could be sufficient; while bone sarcoma patients demonstrate low post treatment ovarian reserve, a finding that may justify fertility preservation procedure, like IVF and embryos cryopreservation with or without oocyte cryopreservation, before radio-chemotherapy. Every patient should be consulted regarding the potential risks of chemotherapy and choose for herself whether to perform fertility preservation procedure. A multi-centered, prospective study is needed to establish the best fertility preservation aproach.

A prospective randomised controlled study of serum anti-mullerian hormone (AMH) as a predictive marker of ovarian hyperstimulation syndrome (OHSS) in IVF-ICSI cycles

A prospective randomised controlled study of serum anti-mullerian hormone (AMH) as a predictive marker of ovarian hyperstimulation syndrome (OHSS) in IVF-ICSI cycles

Study of Anti-Müllerian Hormone and Its Relation to the Subsequent Probability of Pregnancy in 112 Patients With Systemic Lupus Erythematosus, Exposed or Not to Cyclophosphamide

Cyclophosphamide is used for renal and major extrarenal involvement in systemic lupus erythematosus (SLE) and is associated with a risk of premature ovarian failure. There are no data available about the relation between anti-Müllerian hormone (AMH) serum levels and the probability of subsequent pregnancy in SLE patients. We analyzed AMH levels and the probability of pregnancy in SLE women exposed to cyclophosphamide. We conducted a matched cohort study in referral centers for SLE. Fifty-six cyclophosphamide-exposed SLE women younger than 40 years of age and 56 control SLE women matched for age within 6 months participated in the study. AMH was measured in samples from the PLUS study (ClinicalTrials.gov no. NCT00413361). All patients were interviewed in May 2012 regarding their obstetric status. The mean age ± SD of the 112 patients was 31.6 ± 5.8 years. The mean AMH level was low (1.21 ± 1.01 ng/mL) and was significantly lower in patients exposed to cyclophosphamide (P = .03) and in patients older than 30 years (P = .02). During a median follow-up (interval between sampling and the interview) period of 4.2 (range, 2.5-4.8) years, 38 patients sought to become pregnant, and 32 (84.2%) succeeded. In the univariate analysis, the risk of failure was associated with cumulative cyclophosphamide dose (P = .007) and older age (P = .02), but not with AMH. We confirmed that AMH levels are low in SLE patients and decrease significantly with age and cyclophosphamide exposure. Nonetheless, the risk of failure to conceive was low and was predicted by cyclophosphamide exposure and age, but not by AMH levels.

Serum anti-mullerian hormone levels in the main phenotypes of polycystic ovary syndrome

ObjectiveTo characterize the difference in circulating anti-Müllerian hormone (AMH) levels between the main polycystic ovary syndrome (PCOS) phenotypic groups and evaluate the role of AMH in predicting the severity of PCOS. Study designCross-sectional, retrospective study. A total of 251 women were divided into four groups based on the main features of PCOS, as follows: Group 1 (polycystic ovarian morphology [PCOM]+/oligo-anovulation [OA]+/hyperandrogenism [HA]+), Group 2 (PCOM+/OA+/HA−), Group 3 (PCOM+/OA−/HA+), and Group 4 (PCOM−/OA+/HA+). AMH and other hormone levels were measured in serum. The main outcome was serum AMH concentrations in the main phenotypes of PCOS. Result(s)The mean serum AMH levels were 9.50±6.1ng/mL in Group 1; 8.02±6.2ng/mL in Group 2; 6.12±3.6ng/mL in Group 3; and 3.06±2.4ng/mL in Group 4. Circulating AMH levels in Group 1 (PCOM+/OA+/HA+) were three times higher than those in Group 4 (PCOM−/OA+/HA+). ConclusionsThe highest AMH levels were found in cases where all three main diagnostic criteria existed. AMH levels correlate best with PCOM. In addition, oligo-anovulation contributes to increased AMH levels. Hyperandrogenism criteria were found to have less influence on AMH levels. AMH levels seem to have a diagnostic role in determining the severity of PCOS.

Anti-Müllerian hormone as a marker of ovarian reserve in patients with ovarian malignancies who have undergone fertility-preserving surgery and chemotherapy

With proper and careful selection of patients, fertility-preserving surgery may be feasible in patients with ovarian malignancies. However, the loss of follicles by oophorectomy and chemotherapy results in decreased ovarian reserve, which consecutively affects reproductive capacity. We evaluated postoperative levels of serum anti-Müllerian hormone (AMH) in women with ovarian malignancies to assess the impact of the fertility-preserving surgery with or without the administration of chemotherapy on ovarian reserve. In 13 patients who underwent the fertility-preserving surgery with (n = 9) or without (n = 4) the administration of chemotherapy, serum AMH levels were measured and compared with serum AMH levels measured in patients undergone cystectomy for benign ovarian tumors as a control. We found that the mean AMH level in the treatment group measured 0.9 ng/mL, which was significantly lower than that measured in the control group (4.70 ± 3.77 ng/mL). The possibility of decreased ovarian reserve occurring in patients with ovarian malignancies following treatment with fertility-preserving surgery with or without the administration of chemotherapy should be considered for fertility planning.

Can high serum anti-Müllerian hormone levels predict the phenotypes of polycystic ovary syndrome (PCOS) and metabolic disturbances in PCOS patients?

ObjectiveTo evaluate correlations between serum anti-Müllerian hormone (AMH) levels, phenotypes of polycystic ovary syndrome (PCOS), obesity, and metabolic parameters in patients with PCOS.MethodsA total of 175 patients with PCOS were diagnosed according to the Rotterdam Consensus were included. Exclusion criteria were age over 40, FSH>25 mIU/mL, and 17a-OHP>1.5 ng/mL. The Phenotypes of PCOS were divided into a severe form (oligo-anovulation, ANOV/hyperandrogenism/polycystic ovary morphology [PCOM]; n=59) and a mild form without HA (ANOV/PCOM, n=105). The serum AMH levels were classified into 3 groups (<5 vs. 5-10 vs. >10 ng/mL). Obesity was defined as body mass index (BMI) ≥25 kg/m2 (n=34).ResultsThe mean age was 25.9±5.7 year and mean AMH level was 10.1±5.4 ng/mL. The BMI (kg/m2) was higher in group 1 (24.2±6.3) than in group 2 (21.9±4.3, p=0.046) or group 3 (21.6±3.3, p=0.019). There was no difference among the three groups in age, menstrual interval, antral follicle counts, androgens, or other metabolic parameters. The obesity group showed significantly lower AMH (7.7±3.9 ng/mL vs. 10.7±5.6 ng/mL), p=0.004) and low-density lipoprotein levels (93.1±21.2 mg/dL vs. 107.5±39.3 mg/dL, p=0.031), and showed higher total T (0.74±0.59 ng/mL vs. 0.47±0.36 ng/mL, p=0.001), free T (2.01±1.9 vs. 1.04±0.8 pg/mL, p=0.0001), and free androgen index (6.2±7.9 vs. 3.5±3.0, p=0.003). After controlling for age factors and BMI, the serum AMH levles did not show any significant correlations with other hormonal or metabolic parmeters.ConclusionFor PCOS patients under the age 40, serum AMH is not negatively correlated with age. High serum AMH levels can not predict the phenotype of PCOS and metabolic disturbances in PCOS patients in the non-obese group. Further study might be needed to define the relation more clearly.

Impact of breast cancer on anti-mullerian hormone levels in young women

Young women with breast cancer face treatments that impair ovarian function, but it is not known if malignancy itself impacts ovarian reserve. As more breast cancer patients consider future fertility, it is important to determine if ovarian reserve is impacted by cancer, prior to any therapeutic intervention. A cross-sectional study was conducted comparing if ovarian reserve, as measured by anti-mullerian hormone (AMH), follicle stimulating hormone (FSH), and inhibin B (inhB), differed between 108 women with newly diagnosed breast cancer and 99 healthy women without breast cancer. Breast cancer participants were ages 28-44 and were recruited from two clinical breast programs. Healthy women ages 30-44 without a history of infertility were recruited from gynecology clinics and the community. The median age (interquartile range) was 40.2(5.5) years for breast cancer participants and 33.0(4.6) years for healthy controls. The unadjusted geometric mean AMH levels (SD) for breast cancer participants and controls were 0.66(3.6) and 1.1(2.9) ng/mL, respectively. Adjusting for age, body mass index, gravidity, race, menstrual pattern, and smoking, mean AMH levels were not significantly different between breast cancer participants and healthy controls (0.85 vs. 0.76 ng/mL, p = 0.60). FSH and inhB levels did not differ by breast cancer status. In exploratory analysis, the association between AMH and breast cancer status differed by age (p-interaction = 0.02). AMH may be lower with breast cancer status in women older than 37. In younger women, AMH levels did not differ significantly by breast cancer status. Among the youngest of breast cancer patients, ovarian reserve as measured by AMH, FSH, and inhibin B did not differ significantly from healthy women of similar age. In older breast cancer patients, ovarian reserve may be adversely impacted by cancer status. These findings support the potential success and need for fertility preservation strategies prior to institution of cancer treatment.

LB011-SUN PLASMA ANTI-MÜLLERIAN HORMONE (AMH) LEVELS CORRELATE AND PREDICT THE RESPONSE TO LIFESTYLE INTERVENTION IN POLYCYSTIC OVARIAN SYNDROME

Rationale: Polycystic Ovary Syndrome (PCOS) has a prevalence of 6 10% of the women in fertile age. The disease criteria constituting diagnosis and symptoms include menstrual dysfunction, hirsutism, acne and obesity. PCOS treatment in our study aims at lifestyle interventions such as dietary management and physical exercise. Women with PCOS have increased serum levels of Anti-Mullerian Hormone (AMH) compared with controls. Methods: 57 obese women with PCOS were randomized into three groups either to dietary management with low calorie diet, physical exercise or in combination with diet and exercise. Serum AMH as well as ovulatory and metabolic variables were assessed at baseline and after the four months study period. Results: Lower baseline AMH predicts the menstrual response to lifestyle intervention (p = 0.029, OR 0.98, 95%CI 0.96 1.00). The mean AMH level before the intervention was 66.2±42.0 pmol/L for the total study population with no statistical difference between the three groups (p = 0.86). There was a significant overall change in AMH in response to lifestyle intervention (p < 0.05). In the diet group, there was a decrease in AMH (p < 0.01) but not in the exercise group (p = 0.48) or in the combined group (p = 0.32). Levels of AMH were significantly lower in the diet group than in the exercise group after intervention (p < 0.01). Conclusion: Our findings support that the low calorie diet and the weight reduction for obese women with PCOS affects the AMH and the use of AMH as a biomarker of the severity of PCOS and a predictor of response to lifestyle intervention in PCOS patients, and a direct link between AMH and the severity of PCOS is suggested.

Age‐related distributions of anti‐Müllerian hormone level and anti‐Müllerian hormone models

To determine age-specific reference values for anti-Müllerian hormone (AMH) and to set up an optimal model for AMH changes by age for infertility investigations. Prospective study. Several infertility clinics and two university hospitals. A total of 21 226 AMH samples were obtained. Data on patients' age, race/ethnicity, and AMH levels were available from the laboratory center data registry between November 2008 and January 2011. The distribution of AMH levels by age. From 16 972 women aged between 25 and 45 years, we established and validated five AMH-age regression models. The overall mean AMH level was 4.09 ± 3.71 ng/mL (median: 3.13 ng/mL). There was an inverse relation between AMH level and age. Among multiple regression models, the quadratic model was most appropriate to describe AMH-age relation (log AMH = 0.205 × age - 0.005 × age(2) - 0.047). AMH levels show a progressive decline with increasing age. Age-specific AMH values may provide more specific information useful for patients and clinicians. AMH-age models could play a role as a basic step to approach more accurate ovarian reserve estimation.