Normal anti-Müllerian Hormone Research Articles

Evaluation of the therapeutic effect of very small stem cells from peripheral blood on the treatment of Premature Ovarian Failure: A pilot study.

Premature ovary failure (POF) is a severe health condition with multiple negative outcomes, which deteriorate a patient's life. The current study aimed to evaluate the therapeutic effect of mesenchymal stem cells (MSCs) derived from peripheral blood in the treatment of women with the POF background. The current study was a pilot study carried-out on women younger than 40 with premature ovarian failure. Study participants underwent 4-months cell therapy using Mesenchymal stem cells extracted from peripheral bloods. Serum level of Follicle-stimulating hormone (FSH), Estradiol (E2), Anti-mullerian hormone (AMH), and Antral follicle count (AFC) were the main investigated outcomes that were assessed at baseline, month two and month four of the very small stem cell intervention. Average serum level of FSH was 45.0 (12.1) mIU/mL at baseline and continually decreased during the study and reached 33.2 (12.4) mIU/mL in the fourth month. The average AMH level was 0.10 ng/mL prior to the intervention and increased to 0.13 ng/mL in the 2nd month and 0.15 ng/mL in the fourth month. The level E2 was 85.7 (23.6) pg/ml on average at baseline, while the average E2 reduced to 77.2 (25.6) pg/ml in the fourth month. Average number of AFC was 2.0 (0.8) at baseline. We observed a gradual increase in the second month (Mean AFC=2.2) and after four months it increased to 3.1 (1.8) as the highest menstrual restoration and pregnancy was observed in 10% of our study participants. MSCs could significantly improve hormone secretion in women with POF. Implantation of MSCs in women with POF background was associated with an increase in AMH and AFC, while it downed the serum level of E2 and FSH. MSCs could also lead to menstrual restoration and pregnancy in women with POF.

A retrospective study of ovarian tissue cryopreservation in female patients with hematological diseases for fertility preservation.

To investigate the effect and safety of ovarian tissue cryopreservation (OTC) for fertility preservation in female patients with hematological diseases. We designed a retrospective study. The clinical data of patients with hematological diseases undergoing OTC admitted to Peking University People's Hospital from April 2017 to January 2023 were analyzed and summarized. A total of 24 patients were included in the study, including 19 patients with malignant hematological diseases and 5 patients with non-malignant hematological diseases. The former included 14 patients with acute leukemia, 1 patient with chronic leukemia, and 4 patients with myelodysplastic syndrome, while the latter 5 patients were aplastic anemia (AA). 16 patients had received chemotherapy before OTC. The average age of 24 patients was 22.80 ± 6.81years. The average anti-Mullerian hormone (AMH) was 1.97 ± 2.12ng/mL, and the average follicle-stimulating hormone (FSH) was 7.01 ± 4.24IU/L in examination before OTC. FSH was greater than 10.0IU/L in 4 cases. The pre-OTC laboratory tests showed that the average white blood cell (WBC) count was (3.33 ± 1.35) × 109/L, the average hemoglobin was 91.42 ± 22.84g/L, and the average platelet was (147.38 ± 114.46) × 109/L. After injection of recombinant human granulocyte colony-stimulating factor (rhG-CSF), blood transfusion, and iron supplementation in pre-OTC treatment, the average WBC count was (4.91 ± 3.07) × 109/L, the average hemoglobin was 98.67 ± 15.43g/L, and the average platelet was (156.38 ± 103.22) × 109/L. Of the 24 patients, 22 underwent laparoscopic bilateral partial oophorectomy and oophoroplasty, and 2 underwent laparoscopic unilateral oophorectomy. The average duration of OTC was 59.54 ± 17.58min, and the average blood loss was 32.1 ± 41.6mL. The maximum blood loss was 200mL. There was no significant difference in WBC count and hemoglobin concentration after OTC compared to pre-OTC period. Only the platelet count after OTC surgery was significantly different from that before surgery ([134.54 ± 80.84 vs. 156.38 ± 103.22] × 109/L, p < 0.05). None of the 24 patients had serious complications after OTC. 2 patients had mild infection symptoms, but both recovered well. 23 patients underwent hematopoietic stem cell transplantation (HSCT) after OTC. The median and interquartile range from OTC to the pretreatment of HSCT was 33 (57) days, and the median and interquartile range from OTC to HSCT was 41 (57) days. Seven of them began pretreatment of HSCT within 20days and began HSCT within 30days after OTC. All patients were followed up. Of the 23 patients who underwent HSCT after surgery, 22 presented with amenorrhea and 1 with scanty menstrual episodes. Seven patients underwent hormone replacement therapy (HRT) after HSCT. A patient with AA underwent ovarian tissue transplantation (OTT) 3years after HSCT and resumed regular menstruation 6months after OTT. Ovarian tissue cryopreservation has a promising future in fertility protection in patients with hematological diseases. However, patients with hematological malignancies often have received gonadotoxic therapy before OTC, which may be accompanied by myelosuppression while patients with non-malignant hematological diseases often present with severe hemocytopenia. So perioperative complete blood count of patients should be paid attention to. There was no significant difference in the WBC count and hemoglobin concentration in patients with hematological diseases before and after OTC surgery, and the platelet count decreased slightly within the normal range. Infection is the most common post-OTC complication, and HSCT pretreatment can be accepted as early as the 10th day after OTC. OTC has no adverse effects on patients with hematological diseases and does not delay HSCT treatment. For young patients with hematological diseases, OTC is an effective method of fertility preservation.

Anti-Müllerian hormone, testicular descent and cryptorchidism.

Anti-Müllerian hormone (AMH) is a Sertoli cell-secreted glycoprotein involved in male fetal sex differentiation: it provokes the regression of Müllerian ducts, which otherwise give rise to the Fallopian tubes, the uterus and the upper part of the vagina. In the first trimester of fetal life, AMH is expressed independently of gonadotropins, whereas from the second trimester onwards AMH testicular production is stimulated by FSH and oestrogens; at puberty, AMH expression is inhibited by androgens. AMH has also been suggested to participate in testicular descent during fetal life, but its role remains unclear. Serum AMH is a well-recognized biomarker of testicular function from birth to the first stages of puberty. Especially in boys with nonpalpable gonads, serum AMH is the most useful marker of the existence of testicular tissue. In boys with cryptorchidism, serum AMH levels reflect the mass of functional Sertoli cells: they are lower in patients with bilateral than in those with unilateral cryptorchidism. Interestingly, serum AMH increases after testis relocation to the scrotum, suggesting that the ectopic position result in testicular dysfunction, which may be at least partially reversible. In boys with cryptorchidism associated with micropenis, low AMH and FSH are indicative of central hypogonadism, and serum AMH is a good marker of effective FSH treatment. In patients with cryptorchidism in the context of disorders of sex development, low serum AMH is suggestive of gonadal dysgenesis, whereas normal or high AMH is found in patients with isolated androgen synthesis defects or with androgen insensitivity. In syndromic disorders, assessment of serum AMH has shown that Sertoli cell function is preserved in boys with Klinefelter syndrome until mid-puberty, while it is affected in patients with Noonan, Prader-Willi or Down syndromes.

The Correlation between Sex Hormone-Binding Globulin and Clinical Characteristics According to Anti-Müllerian Hormone in Women with Regular Menstrual Cycles: A Prospective Study.

Polycystic ovarian syndrome (PCOS) can be diagnosed when the anti-Müllerian hormone (AMH) levels are high, but in clinic, women who do not meet the diagnosis of PCOS but have elevated AMH levels are often seen. This study aimed to compare the differences in menstrual cycle patterns and hormone levels in women with regular menstrual cycles, but not PCOS, by dividing them into high and low AMH groups. This multicenter prospective study included 68 healthy women. Participants with regular menstrual cycles were divided into two groups according to their AMH levels. The main outcome measures were menstrual cycle pattern, body mass index, and hormone levels (thyroid stimulating hormone, prolactin, testosterone, sex hormone-binding globulin, and free androgen index), which were compared between the groups according to AMH levels. The ovulation was assessed by performing pelvic ultrasound, and by assessing the hormone levels of the luteinizing hormone and progesterone. The criteria for determining normal and high AMH levels were based on previous literatures. The participants were divided into normal (39 people) and high (29 people) AMH group. No differences were found in age or BMI between the two groups, and no other differences were observed in TSH, prolactin, testosterone, or free androgen index. However, the high AMH group had significantly higher SHBG levels than the normal group (normal group: 65.46 ± 25.78 nmol/L; high group: 87.08 ± 45.05 nmol/L) (p = 0.025). This study is the first to analyze the association between SHBG and AMH levels in women with regular menstrual cycles. Elevated AMH levels are associated with increased levels of SHBG levels.

Use of transdermal testosterone in women Poseidon IV group under high complexity assisted reproduction treatment

Poor ovarian reserve (POR) is considered a frequent cause of infertility and is still considered one of the significant challenges in reproductive medicine. Numerous studies have suggested that androgens (dehydroepiandrosterone and testosterone) may play a critical role in follicular development by increasing the number of follicles and, consequently, the number of oocytes, ultimately leading to an increased pregnancy rate. Testosterone is a sex steroid hormone that originates from cholesterol and is considered an obligatory precursor of estradiol biosynthesis. It contributes to greater follicular recruitment, leading to the consideration that exogenous administration could increase the number of recovered oocytes. Methodology A historical, quantitative, observational, longitudinal, retrolective cohort study was carried out in the clinical area of assisted reproduction; 2 groups were formed where all women over 35 with primary or secondary infertility who met the criteria were included. Classification criteria of the POSEIDON IV group (age &gt; 35 years with CFA &lt; 5 follicles and/or AMH &lt; 1.2 ng/mL), during the period from October 2021 to September 2022, the first group of patients had received supplementation with transdermal Testosterone 50mg daily one month before ovarian stimulation, the second group did not receive any treatment before ovarian stimulation. Women with a history of diagnosis of endometriosis, pelvic surgery or oophorectomy were excluded. This study has the approval of the ethics committee of the HISPAREP clinic. Each patient was given an informed consent which they signed before the study. We declare that we have no conflict of interest. The data from the records of all the patients who met the inclusion criteria were collected, including the antral follicle count on the first three days of the menstrual cycle by transvaginal ultrasound one month before ovarian stimulation and after one month of supplementation and without supplementation when starting controlled ovarian stimulation. The number of metaphase II oocytes obtained in each group was also analyzed. Results A total of 20 women were included; 10 underwent controlled ovarian stimulation with prior administration of transdermal testosterone at a dose of 50 mg every 24 hours for one month. The other 10 patients did not receive any supplementation or treatment before ovarian stimulation for highly complex assisted reproduction treatment due to various causes of infertility. The average age of the women was 40.2 ± 2.5 years in the study group and 43.3 ± 2 in the control group; normal weight in 80% of the group with testosterone and 90% without testosterone. The baseline conditions of the patients revealed an average anti-Müllerian hormone (AMH) level of 0.65 ± 0.28 ng/dL in the testosterone group and 0.84 ± 0.49 ng/dL in the non-testosterone group. The infertility factor was ovarian endocrine dysfunction, present in 60% of the testosterone group and 40% of the non-testosterone group; this factor was the predominant cause in both groups. The most common protocol stimulation was with (300/150 U) FSH/LH recombinant (Pergoveris, Merck) and GnRH antagonist (Cetrotide, Merck). The antral follicular count observed by ultrasound in each group after treatment with testosterone was 6.4 ± 2.4, and without testosterone was 6 ± 3.47; p&lt;0.778. Without observing significant differences. The number of metaphase II oocytes obtained (mean ± standard deviation) after testosterone administration was 4.5 ± 2.37 and 1.5 ± 1.62 in participants who did not receive testosterone; p=0.04886, that is p&lt;0.05, so the results were statistically significant in favor of testosterone administration. Conclusions Transdermal testosterone supplementation can be used as an adjuvant in controlled ovarian stimulation treatments in women of the POSEIDON IV group to improve the reproductive prognosis of this group of women. The 50mg dose of transdermal testosterone every 24 hours 1 month prior to the ovarian stimulation in highly complex treatments increases the number of metaphase II oocytes recovered statistically.

Correlation of Serum TSH with Ovarian Reserve in Patient of Infertility. A Retrospective Study

Background: Various hormones have different impact in fertility either to predict, to investigate or to treat infertility. Due to hindrance in follicular growth, embryo development, implantation and placental formation thyroid dysfunction affects fertility. Studies suggest that thyroid disorder affecting follicular process is associated with ovarian reserve. Similarly serum FSH is directly related to AMH depicting strong correlation of age with each other. This study was conducted to see the association between thyroid dysfunction and serum Anti Mullerian Hormone (AMH) level. Methods: All the female having infertility between age of 20 to 45 were included in the study. Those who did not undergo hormonal assay were excluded from study. All the data were taken from Opd record and their serum Thyroid Stimulating Hormone, AMH and Day2 Follicle Stimulating Hormone Luteinizing Hormone, Prolactin, Estradiol and Progesterone were evaluated. Result: A total of 292 patients visited infertility clinic at our institution over a period of 1.5 yrs and of them only 80 had undergone all hormonal assay. Majority of women enrolled for the study were in the age group 21-30 and the mean age was 29.98±5.4 yrs. Hypothyroidism was seen in 27.5% (n=22) females while we found no cases of hyperthyroidism in our study. Though 35% of females had TSH &lt;2.5. Low serum AMH levels (&lt;1.6 ng/ml) were noted in 25% (n=20). Among women of age less than 35 yrs and low AMH (&lt;1.6) mean TSH was 7.27±6.93 and with normal AMH (&gt;1.6) mean TSH was 3.61±1.73 which was statistically significant (p-value &lt;0.001). Similarly mean FSH in women with low AMH (&lt;1.6) was 8.66±2.89 and with normal AMH (&gt;1.6) was 5.81±1.36 which was statistically significant (p-value &lt;0.001). Conclusion: TSH and FSH level is inversely related to ovarian reserve infertile women.

Antimüllerian hormone level predicts ovulation in women with polycystic ovary syndrome treated with clomiphene and metformin

ObjectiveTo describe serum anti-Müllerian hormone (AMH) concentrations in a large, well-phenotyped cohort of women with polycystic ovary syndrome (PCOS) and evaluate whether AMH predicts successful ovulation induction (OI) in women treated with clomiphene and metformin. DesignSecondary analysis of randomized controlled trial Subjects333 women with anovulatory infertility attributed to PCOS who participated in thedouble blind randomized trial entitled The Pregnancy in Polycystic Ovary Syndrome I (PPCOSI) study (registration number NCT00068861) who had serum samples from baselinelaboratory testing available for further serum analysis were studied. Main Outcome MeasuresThe association between baseline AMH concentration in each of the three treatment groups and ovulation rates, pregnancy rates and live birth rates were assessed. Results322 individuals had a baseline AMH concentration available, of which the mean AMH was 11.7 ± 8.3 ng/mL with a range from 0.1 to 43.0 ng/mL. With each unit (1 ng/mL) increase in baseline AMH, the odds of ovulation decreased by 10 percent (OR 0.90, 95% CI 0.86-0.93); this effect did not differ by treatment group. Women with a high baseline AMH concentration (>8 ng/mL) were significantly less likely to ovulate compared to those with a normal baseline AMH concentration (<4 ng/mL) (OR 0.23, 95% CI 0.05-0.68). This remained statistically significant when controlling for confounders, including age, body mass index, time in study, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) score (p=0.008). Ovulation occurred even at very high AMH concentrations; there was no maximum level noted at which no ovulation events occurred. Baseline AMH concentration was not associated with pregnancy or live birth rates when controlling for confounders (p=0.947 and p=0.848, respectively). ConclusionThese AMH values of well-phenotyped individuals with PCOS adds to the literature and will aid in identifying AMH criteria for the diagnosis of PCOS. In women with infertility and PCOS, a higher AMH concentration was associated with reduced odds of ovulation with OI with clomiphene, clomiphene+metformin and metformin.

Elevated Thyroglobulin Antibody Level is Associated with Decreased Anti-Müllerian Hormone in Women of Reproductive Age.

Women with Hashimoto's thyroiditis (HT) have an increased risk of ovarian insufficiency. However, whether thyroid antibodies affect the ovarian reserve remains controversial. The aim of this study was to explore the possible relationship between anti-Müllerian hormone (AMH) and thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels in women of reproductive age. A total of 483 women between 18 and 45 years old who had their TPOAb, TgAb, thyroid-stimulating hormone (TSH), free thyroxine (FT4), and AMH levels measured on the same day were enrolled in this study. The levels of TSH, FT4, TPOAb, and TgAb, the prevalence of overt and subclinical hypothyroidism, and the positive rate of TPOAb and TgAb were compared between patients with low (below the 10th percentile), normal (10th to 90th percentile), and high (higher than the 90th percentile) AMH levels. The median AMH level was 1.72 (0.33-4.27) ng/mL. A total of 9.9% of patients had low AMH levels. The TgAb levels and the prevalence of TgAb positivity were higher in the low AMH group (37.62 (13.10-232.68) IU/mL, 35.42%) than in the normal (12.46 (10.0-67.04) IU/mL, 19.59%) and high (13.61 (10.0-95.74) IU/mL, 23.4%) AMH groups (p=0.001, p=0.040, respectively). Serum AMH levels were inversely correlated with TgAb levels (r = -0.114, p=0.013). The AMH of women of reproductive age is affected by HT. Furthermore, women with the lowest AMH level had higher levels of TgAb and a positive rate of TgAb, and high TgAb levels may cause autoimmune damage to the ovaries.

Effect of radical trachelectomy on ovarian reserve: A single-institute prospective study.

Reduced responses to controlled ovarian stimulation (COS) after radical trachelectomy (RT) have been previously reported. We aimed to assess the effect of RT on ovarian reserve by measuring anti-Müllerian hormone (AMH) levels before and after the procedure in this prospective study. We included 12 patients who underwent RT between September 2019 and December 2021 in this study. Serum AMH levels were measured preoperatively, 1 month postoperatively, and 6 months postoperatively. Differences in the AMH levels were assessed using a paired t-test. The median age of the patients was 30.6 years, and the median follow-up time was 30.1 months. AMH levels at 1 and 6 months postoperatively did not show a consistent trend. At 1 month postoperatively, the average AMH level decreased insignificantly but returned to preoperative levels at 6 months. The differences in AMH levels before and after RT were insignificant. Our findings indicate that RT did not affect ovarian reserve as measured by AMH levels. However, the relationship between unchanged ovarian reserve and reduced response to COS remains unclear. Further research with larger sample sizes and additional measures of ovarian function is needed to corroborate these results and investigate the long-term effects of RT on ovarian reserve. Understanding these mechanisms will help guide surgical practices and provide patients with valuable information about their reproductive outcomes after RT.

Multiple sclerosis and fecundity: a study of anti-mullerian hormone level in Egyptian patients

BackgroundMultiple sclerosis (MS) is a neurological disease that affects people aged 20–40 years on average. It classically affects young females of reproductive age. The prevalence of MS for females to males has increased markedly in recent years (from 2.3 to 3.5:1). Females with MS seem to use infertility treatments more frequently and fecundity could be affected years before making an MS diagnosis. The anti-Müllerian hormone (AMH) level is the strongest marker of ovarian reserve. Although recent studies suggest that patients with MS have lower ovarian reserve, there is no definite data to conclude that females with MS suffer from impaired fertility. This study aimed to investigate fertility and fecundity among female patients with MS by assessing AMH level. This study included 100 patients with MS and 60 healthy controls (HC). Both groups were assessed for AMH levels, activities of daily living (ADL) were assessed using the Kurtzke Expanded Disability Status Scale (EDSS) and the reproductive history of both groups was assessed via a self-administered questionnaire.ResultsAMH levels among the HCs (0.34–2 ng/ml with a mean of 1.03 ± 0.41 ng/ml) were significantly higher than in patients with MS (0.15–2 ng/ml with a mean of 0.68 ± 0.31 ng/ml). The use of disease-modifying therapies (DMT) was the only predictor of below normal AMH among patients, but there was no significant correlation with age, duration of disease or type of DMT.ConclusionsLevels of AMH were significantly lower in MS patients than in healthy controls.

FRI379 The Gonadotoxic Effects Of Cyclophosphamide And Busulfan On Ovaries In CD-1 Mouse Model

Abstract Disclosure: M. Thonen: None. H. Jiang: None. Y. Luan: None. R. Dong: None. A. Wadhwa: None. S. Kim: None. Hematopoietic stem cell transplantation (HSCT) involves the transfer of healthy donor stem cells to replace a recipient's dysfunctional bone marrow. It can be used for both malignant diseases (eg lymphoma or leukemia) and non-malignant diseases (eg sickle cell anemia). Chemotherapy and/or radiation are usually required to deplete the recipient's bone marrow before transplant, also known as conditioning regimens. Alkylating agents including cyclophosphamide (CY) and busulfan (BU) are frequently involved in these regimens. Primary ovarian insufficiency in young female patients secondary to conditioning regimens presents a challenging fertility complication. Studies show that there may be unbalanced ovarian hormonal levels and decreased ovarian function in young female cancer survivors, however, limited studies have explained the mechanism of medication-induced ovarian toxicity in an animal model. This study aimed to investigate the gonadotoxic effects of CY and BU in CD-1 strain mice and to delineate the underlying mechanism of the gonadotoxic outcomes, eventually suggesting possible fertoprotectants for HSCT recipients’ fertility preservation.Sixteen one-month-old female CD-1 mice (n=4/group) were subcutaneously injected with solvent, BU, CY, or BU+CY, respectively, over the course of six days. The doses (144 mg/Kg BU and 300 mg/Kg CY) and injection plan were adjusted to clinical doses. One week after the last administration, the ovaries and female reproductive tracts were harvested. The samples were embedded in paraffin, then continuously sectioned into 5 μm thickness. The specimen was stained with hematoxylin and eosin (H&amp;E) and TUNEL assays. Different stages of follicles were counted individually by two team members. The serum levels of anti-Mullerian hormone (AMH), 17-β-estradiol, and follicle-stimulating hormone (FSH) were measured. Additional immunofluorescence staining for AMH, inhibin α, and Ki-67 was also performed. All mice survived treatment and appeared grossly normal. The average ovary weight was significantly lower in BU-based treatment groups compared to control and CY alone groups. The primordial (p&amp;lt;0.0001) and primary follicles (p=0.01) in BU, CY, and BU+CY groups were lower than the control group. The average AMH level in the BU-based treatment groups was also significantly lower than in the control and CY-alone group. Our results indicate CY and BU regimens individually were gonadotoxic, reducing the ovarian reserve in CD-1 mice with a synergistic toxic effect when used in combination. Decreased AMH reveals the conditioning regimens are toxic to granulosa cells and the ovarian reserve. Future studies are needed to elaborate possible pathways of chemotherapy-induced ovarian follicle death and the toxicities of other regimens to improve fertility outcomes and better care for female patients receiving HSCT. Presentation: Friday, June 16, 2023

The effect of radioactive iodine therapy on anti-Müllerian hormone changes in women with thyroid cancer at reproductive age: a prospective study

BackgroundThyroid cancer is one of the common cancers that, depending on the need for treatment, patients are treated with radioactive iodine after thyroidectomy surgery. The purpose of this study is to investigate the effect of iodine therapy on the ovarian reserve of women at reproductive ages.MethodsIn this prospective study, 60 patients with thyroid cancer aged 18 to 35 who were undergoing iodine therapy for the first time in 2018–2019 were included in the study. Patients with underlying diseases and any ovarian disorders and patients who needed repeated iodine treatment were excluded from the study. Anti-Müllerian hormone (AMH) level of patients was evaluated 4 times before, 3, 6, and 12 months after iodine therapy. The significance level of the P-value study was considered less than 0.05.ResultsThe average age of the patients was 29.53 ± 4.53 years. With aging, AMH level decreases significantly. No significant correlation was observed between smoking, menarche age, and abnormal uterine bleeding with AMH level. The average AMH before, 3, 6, and 12 months after iodine therapy was 2.25 ± 0.55 ng/ml, 1.15 ± 0.35 ng/ml, 1.58 ± 0.47 ng/ml, and 1.94 ± 0.58 ng/ml, which has a significant decrease respectively 49.05%, 29.55%, and 13.58% compared to the amount before iodine therapy (P-value < 0.001).ConclusionConsidering the effect of iodine therapy on the reduction of AMH levels, it is recommended that women of reproductive age group should be evaluated prior to iodine therapy to determine their ovarian reserve level so that if their AMH level is not suitable, they may need to consult with a fertility preservation specialist.

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.

Follicle Stimulating Hormone (FSH) as a Predictor of Decreased Oocyte Yield in Patients with Normal Anti-Müllerian Hormone (AMH) and Antral Follicle Count (AFC).

The purpose of the current study was to determine the utility of early follicular phase follicle-stimulating hormone (FSH) testing in patients undergoing in vitro fertilization (IVF). This was a retrospective review of patients from 2012 to 2015 at Mayo Clinic in Rochester, Minnesota, USA. Included subjects had a normal anti-Müllerian hormone (AMH) of 1 to 9 ng/ml and antral follicle count (AFC) of 10 to 29. Patients were stratified by FSH level when associated estradiol was less than 50 ng/ml. In total, 225 patients were categorized into three groups: high FSH (FSH ≥10 IU/L; n= 36), normal FSH (>5 IU/L and <10 IU/L; n=170), and low FSH (FSH ≤5 IU/L; n= 19). ANOVA and multiple logistic regression were used for statistical comparisons and for evaluation of the relationships between variables; significance level was set at <0.05. There were no significant differences in demographics, IVF cycle type, or peak estradiol level between the groups. Patients with a high basal FSH level had a similar clinical pregnancy rate and live birth rate compared to controls and patients with low FSH. High FSH level was associated with decreased follicular development (17 versus 22; p<0.01), oocyte yield (15 versus 18; p=0.02), and embryo yield (8 versus 10; p=0.04) despite higher total doses of gonadotropins. Patients with normal AMH and AFC levels could be further stratified into lower responders and starting doses of medications can be adjusted based on high basal FSH levels. Therefore, it is suggested to counsel patients on pregnancy outcomes which seem to be quite similar regardless of the FSH level.

Female Reproductive Health Outcomes after Hematopoietic Cell Transplantation for Sickle Cell Disease: Is Reduced Intensity Better Than Myeloablative Conditioning?

Curative therapy for sickle cell disease (SCD) through hematopoietic cell transplantation (HCT) is associated with a high level of risk for treatment-related gonadal dysfunction and future infertility. Both the myeloablative conditioning (MAC) and reduced-intensity conditioning (RIC) regimens used for SCD HCT are considered to carry a high risk for ovarian damage. Cyclophosphamide equivalent doses (CEDs) are thought to correlate with the degree of gonadal damage in pediatric oncology patients. We aimed to evaluate ovarian outcomes previously reported from our center, characterize the conditioning regimens as MAC or RIC, and calculate the CED for each regimen. The ovarian outcomes diminished ovarian reserve (DOR), as determined by an anti-Müllerian hormone (AMH) below the normal limits for age and assay or <5%, and premature ovarian insufficiency (POI), defined as a follicle-stimulating hormone (FSH) level >40 mIU/ML, are presented by conditioning regimen from 3 clinical studies from our center (2 published and 1 presented as an abstract in 2022). The studies were not mutually exclusive of patients. CEDs were calculated for each regimen. The CED ranged from 3388 to 9705 mg/m2 for MAC regimens and from 5600 to 18,750 mg/m2 for RIC regimens. DOR was observed in all regimens; however, in one study 2 patients had normal AMH levels after a fludarabine/melphalan regimen, and 1 patient had a normal AMH level after a fludarabine/melphalan/thiotepa regimen. Rates of POI were more variable and ranged from 40% to 100% after MAC regimens and from 0 to 100% after RIC regimens. Female patients with SCD who undergo HCT have very high rates of DOR after both MAC HCT and RIC HCT. Two of the 3 RIC regimens evaluated had higher CEDs than were seen in any of the MAC regimens evaluated. Rates of POI were more variable but may increase with time from transplantation. All SCD patients need to be counseled about the risk of infertility and provided information about fertility preservation.

Assisted reproductive technology and interactions between serum basal FSH/LH and ovarian sensitivity index.

This study aimed to investigate whether the FSH (follicle-stimulating hormone)/LH (Luteinizing hormone) ratio correlates with ovarian response in a cross-sectional retrospective study of a population with normal levels of anti-Müllerian hormone (AMH). This was a retrospective cross-sectional study with data obtained from medical records from March 2019 to December 2019 at the reproductive center in the Affiliated Hospital of Southwest Medical University. The Spearmans correlation test evaluated correlations between Ovarian sensitivity index (OSI) and other parameters. The relationship between basal FSH/LH and ovarian response was analyzed using smoothed curve fitting to find the threshold or saturation point for the population with mean AMH level (1.1<AMH<6μg/L). The enrolled cases were divided into two groups according to AMH threshold. Cycle characteristics, cycle information and cycle outcomes were compared. The Mann-Whitney U test was used to compare different parameters between two groups separated by basal FSH/LH in the AMH normal group. Univariate logistic regression analysis and multivariate logistic regression analysis were performed to find the risk factor for OSI. A total of 428 patients were included in the study. A significant negative correlation was observed between OSI and age, FSH, basal FSH/LH, Gn total dose, and Gn total days, while a positive correlation was found with AMH, AFC, retrieved oocytes, and MII egg. In patients with AMH <1.1 ug/L, OSI values decreased as basal FSH/LH levels increased, while in patients with 1.1<AMH<6 ug/L, OSI values remained stable with increasing basal FSH/LH levels. Logistic regression analysis identified age, AMH, AFC, and basal FSH/LH as significant independent risk factors for OSI. We conclude that increased basal FSH/LH in the AMH normal group reduces the ovarian response to exogenous Gn. Meanwhile, basal FSH/LH of 3.5 was found to be a useful diagnostic threshold for assessing ovarian response in people with normal AMH levels. OSI can be used as an indicator of ovarian response in ART treatment.

Effects of ABVD chemotherapy on ovarian function: epidemiology, hormonal dosages and ultrasound morphologic analyses in 270 patients with Hodgkin's disease.

Classical Hodgkin Lymphoma (HL) is a lymphoproliferative disease typically diagnosed in the young. The excellent results obtained with current treatment lead to long survival with age-related complications affecting patients' survival and quality of life. One issue affecting HL patients is infertility. This problem can be easily overcome in males with seminal liquid cryopreservation, however, in females it is more complex either in terms of the quality of the cryopreserved material or the patients' age at diagnosis. Moreover, not all chemo- or radio-therapies have the same negative impact on fertility.The main objectives of this study was to collect epidemiological information on HL patients involved in fertility preservation counseling and to analyze the impact of ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine), the standard treatment for HL, on ovarian function, hormonal levels and ovarian and uterine tissue morphologies. Patterns of fertility preservation were also reported. Data were obtained from 270 female patients at HL onset who were interested in fertility counseling prior to therapy initiation. Each patient was assessed at HL diagnosis for levels of Anti-Mullerian Hormone (AMH), Follicle Stimulating Hormone (FSH), and 17β-oestradiol (17β-oe), with additional assessments at 6 and 12 months after chemotherapy. Patients were evaluated with ultrasound scans to study the number of ovarian follicles and the degree of uterine thickness at the same timepoints. The average patient AMH level showed a statistically significant reduction at 6 months after chemotherapy (p=0.05) and by the 12 month time point returned to near pre-chemotherapy values. FSH and 17β-oe levels did not significantly vary throughout the study period. ABVD chemotherapy was associated with a significant reduction of both ovarian follicles and endometrial thickness at the 6 month time point followed by a recovery at the 12 time point in both ovaries. Different results were observed when patients changed treatment to a more intensive one. Based on the results from the hormonal measurements and the follicle echography, it appears that the toxic effect of ABVD on fertility is transient, whereas, in contrast, more intensive therapies may potentially be more harmful and long-lasting.

Ovarian reserve of infertile women in Libreville: A retrospective analysis of 124 cases at the University Mother and Child Hospital in Libreville, Gabon.

There has been an increasing number of sub-fertile women in Gabon during the last 20 years. Antral follicle count (AFC) and serum anti-Mullerian hormone (AMH) are known as the most accurate markers of ovarian reserve in women and are related to age and weight. Therefore, the current study examines the relationship between AFC and serum AMH with age and weight among sub fertile Gabonese women. This is a retrospective study carried out in the assisted reproduction department of the Mother and Child University Hospital of Libreville. Over a period of 2 years, from 1st June 2019 to 30th May 2021. From the patient records we collected the following data, age, weight CFA and AMH of 124 women who had consulted for infertility. We excluded incomplete files. The average age and weight of women participating in the current study were 38 (±5.74) years and 76.3 (±14.59) kg. The average serum AMH concentration was 2.33 (±2.17) ng/mL) while the average AFC was 14.63 (±11.37). Significant negative correlation between the age and the serum AMH (r2= -0.368; p <0.0001) and between the age and the CFA (r2=-0.560; p <0.0001) were observed in the current study. This study suggests that sub-infertile women residing in Gabon generally have normal serum AMH concentration and AFC levels. Age significantly impact serum AMH and AFC levels.

Low anti-mullerian hormone decreased clinical pregnancy and increased risk of poor ovarian response in women over 35 years of age.

Low anti-mullerian hormone decreased clinical pregnancy and increased risk of poor ovarian response in women over 35 years of age.

P171 Subfertility in young patients with Crohn′s disease. A case-control study.

Abstract Background Inflammatory bowel disease (IBD) commonly affects women and men during the reproductive years.The effect of the disease burden on fertility in these patients is a common concern for them. ECCO guidelines establish that active disease is associated with decreased fertility in women but studies regarding this topic are of low quality and outdated. Aims to investigate the effect of CD on fertility, studying ovarian reserve in women as well as global Sertoli cell function in men, - To compare these results of CD patients with the healthy control group. (HC) - To assess the related factors to subfertility in women and males with CD. Methods This was a cross-sectional, prospective and case-control study, including CD patients, aged 18-40 years-old, and HC matched by gender and age (ratio 2:1). Morning baseline IB was measured in men using ELISA. Serum anti-Müllerian hormone (AMH) was measured by ECLIA. Sociodemographic and phenotypic features of CD patients and controls were collected.Subfertility was defined as IB &amp;lt; 89pg/mL, AMH &amp;lt;1.66 ug/L in 0-24 years old group; &amp;lt;1.18 ug/L in 25-29 years old group; &amp;lt;0.67 ug/L in 30-34 years old group; &amp;lt;0.77 ug/L in 35-39 years old group; and &amp;lt;0.01 ug/L in 40-44 years old group. AMH &amp;lt;2 ug/L in women under 40 was considered low. Results A total of 163 individuals were included: 83 men (58 CD, median 28 years old, RIQ 24-36; 25 HC, median 31 years old, RIQ 26-37) and 80 women (50 CD, median 26 years old, RIQ 21-36; 30 HC, median 28, RIQ 26-32). Sedentary lifestyle was more frequent in women with CD vs HC (46% vs 3,3%, p&amp;lt;0,001). 24% of women with CD and 8% of males had clinical activity (IHB &amp;gt;4). Low AMH (&amp;lt;2ug/L) in women older than 30 was more frequent in CD vs HC: 95% (18/19) vs 44% (4/9) p=0.001, with an OR of presenting AMH &amp;lt; 2 ug/L of 3.28 (IC 95%, 1.6-6.4) for women with CD &amp;gt;30 years old. The average AMH serum level was similar between women with CD and HC [1.83 (1.04-3.34) vs. 2.74 (1.05-4.12) g/L, p=0.4]. Abnormal AMH rate by age rank was not different between groups in global population (11/50, 22% EC vs. 7/30, 23% in CS, p=0.9,). IB levels were significantly lower in men with CD vs HC [169 (140-217) vs 232 ug/L (178-274) p=0.001]. IB &amp;lt;89 pg/mL was not detected in any control vs 6% (n=3) in CD. In multivariate analysis, only AMH was associated with lower levels of IB in CD men, no association with clinical activity or treatments in CD was found. Conclusion Women with CD and &amp;gt;30 years old have a higher risk than general population of presenting low AMH (&amp;lt;2).These data could be helpful at council of women with CD that desire to have progeny. IB concentration was lower in men with CD compared to HC.