Serum anti-Müllerian Hormone Levels Research Articles

Serum Anti-Mullerian Hormone Levels Might Indicate Premenopausal Endometrial Lesions.

Endometrial proliferative lesions (EPL) usually refer to endometrial hyperplasia (EH) and endometrial cancer (EC). Among patients with premenopausal EPL who wish to preserve their fertility, only those with EH and early-stage EC have the possibility to undergo fertility preservation therapy. However, there is currently a lack of specific and reliable screening criteria and models for identifying these patients. This study utilized a retrospective diagnostic study design. The training set included medical record information that met the criteria between August 2017 and October 2022, while the validation set consisted of medical record information that met the criteria from November 2022 to May 2023. The endometrial pathological test served as the gold standard. The serum anti-Mullerian hormone (AMH) level before endometrial sampling and a regression model were employed to predict EPL. The study included a total of 1209 patients with PCOS (1119 in the control group and 90 in the endometrial proliferative lesion group) and 5366 women without PCOS (5249 in the control group and 117 in the proliferative lesion group). In the case of PCOS patients aged 20-39 years, the most effective screening threshold for AMH was found to be a serum AMH level of ≤5.39 ng/mL. The model used for this group was logit(p) = -2.562 - 0.430 × AMH + 0.127 × BMI + 1.512 × hypertension + 0.956 × diabetes -1.145 × regular menstruation. On the other hand, for non-PCOS women aged 20-39 years, the optimal screening threshold for AMH was determined to be a serum AMH value of ≤2.18 ng/mL. The model used for this group was logit(p) = -3.778 - 0.823 × AMH + 0.176 × BMI + 2.660 × diabetes -1.527 × regular menstruation -1.117 × dysmenorrhea. It is important to note that all of these findings have successfully passed internal verification. For PCOS and non-PCOS women aged 20-39 years, the serum AMH test and related multiple regression models were obtained for the warning of EPL.

Postoperative outcomes of ovarian preserving surgery in premenopausal women with adnexal torsion.

We aimed to determine whether ovarian-preserving surgery for adnexal torsion helps preserve ovarian function without increasing the risk of postoperative complications. We retrospectively evaluated 71 women who were surgically diagnosed with adnexal torsion between January 2015 and December 2019 at Severance Hospital, Yonsei University College of Medicine (ovarian preservation group, 56; oophorectomy, 15). Serum anti-Müllerian hormone (AMH) levels measured within 6 months before surgery were compared to levels measured 6-24 months after surgery. Surgical findings and postoperative complications were compared between the groups. There was a borderline significant difference in the decrease in serum AMH levels between the oophorectomy group and ovarian preservation group before and after surgery. There were no significant differences between the groups in terms of fever, infection, or duration of admission. Discoloration of the twisted ovary was found in 27.3% and 33.3% of the patients in the ovarian preservation and oophorectomy groups, respectively. There was no difference in the decrease in serum AMH levels between patients with and those without discoloration. Ovarian-preserving surgery may not increase postoperative complications in patients with adnexal torsion, even if a twisted mass is suspected to be necrotic. Moreover, the ovarian reserve may not be affected by torsion if the ovary is preserved. Conservative ovarian surgery can be safely performed to preserve the reproductive potential of women with adnexal torsion and cystic masses.

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&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<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

FRI382 High Androgen And Progesterone Metabolite Concentrations In Naturally Matured Follicles Are Concurrent With High Serum Anti-Müllerian Hormone Concentrations

Abstract Disclosure: T. Du Toit: None. M. Von Wolff: None. A.C. Swart: None. M. Groessl: None. C.E. Flueck: None. Infertility in women is routinely evaluated with the assessment of circulating steroid levels. Profiling steroid levels in follicular fluid (FF) would provide a focused evaluation of the ovarian endocrine milieu and is therefore better suited to identify key hormones potentially involved in dysfunctional follicular growth. The anti-Müllerian hormone (AMH) level in serum is a well-established clinical marker to estimate the ovarian reserve in assisted reproductive technology, while the AMH level in FF serves as a new prognostic marker for oocyte developmental potential. However, AMH-linked changes in the follicular steroid milieu have not been fully explored. We conducted an AMH-dependent analysis of the FF endocrine milieu. Hormones were quantified using LC-MS (n=42) and ELISA (n=4) in FF of 83 women undergoing natural cycle in vitro fertilisation. Patients were age-matched and classified into 4 statistically different (p<0.0001) groups according to serum AMH levels: group A (<1.1 pmol/L, n=20); group B (1 - 7.14 pmol/L, n=21); group C (7.14 - 35.5 pmol/L, n=21); and group D (>35.5 pmol/L, n=21). Group D was designated as our polycystic ovary syndrome (PCOS)-like group, as high serum AMH is a marker for PCOS. We characterised androgen and progesterone metabolic pathways in FF. Androstenedione (A4) and testosterone (T) levels differed significantly between the groups (p<0.01) and were highest in group D at 60 nmol/L and 4.7 nmol/L, respectively. The levels of 11-ketoandrostenedione (11KA4) and 11β-hydroxyandrosterone (adrenal-origin) also differed between the groups (p<0.05), with higher 11KA4 levels (±2.7-fold) quantified in group D. In parallel with serum AMH, FF AMH differed between the groups (p<0.0001), together with luteinizing hormone/FSH, A4/dehydroepiandrosterone, estradiol(E2)/T and E2/A4 ratios. In comparison to groups A, B and C combined, the PCOS-like group D showed significantly increased downstream progesterone metabolite levels –11α-hydroxyprogesterone [OHP4], 17α,20α-diOHP4, 16α-OHP4 and 5α-pregnanolone, with lower FSH levels. Our results show that the follicular milieu is significantly different when high AMH levels are measured compared to when AMH levels are low, marked by: (i) higher progesterone metabolite levels in follicles and (ii) higher A4 and T levels, concomitant with unchanged E2 levels suggesting that androgens were not fully converted to estrogens in these follicles. Our study furthermore corroborates other studies reporting an intrafollicular hyperandrogenic state in women with increased circulatory AMH levels. In summary, our study not only provides data based on a broad steroid profile that the follicular androgen endocrine milieu is affected in women with high serum AMH levels, but it also provides a model for the premature progesterone increase in PCOS women which leads to a reduction in the embryo implantation rate. Presentation: Friday, June 16, 2023

Evaluation of serum anti-Müllerian hormone concentrations following treatment with vitamin D in Holstein Friesian heifers.

Anti-Müllerian hormone (AMH) levels in the blood of dairy cattle are associated with the count of antral follicles (AFC), ovarian function. Numerous studies, particularly in human medicine, have shown that vitamin D3 (Vit D3) has a positive effect on AMH levels. To our knowledge, the effects of Vit D3 on serum AMH levels in heifers have not been investigated. The goal of the current study was to evaluate the concentrations of serum AMH in dairy heifers following Vit D3 treatment. The study included 20 healthy non-pregnant Holstein Friesian heifers. These animals came to estrus at least once. All heifers received a single intramuscular dosage of 5 million IU Vit D3 (Cholecalciferol). Blood samples were collected from the coccygeal veins of all animals before and after Vit D3 injection (days 7, 14, and 28) for the measurement of AMH and 25(OH)D concentrations. In our analysis, we observed that after exogenous Vit D3 administration, circular 25(OH)D increased constantly (up to day 28 after Vit D3 injection) in all animals. On day 28, AMH concentrations saw a 10% increase in comparison with those measured the day before the Vit D3 injection. However, a comparison of AMH concentrations measured across days did not reveal statistically significant differences between Day 0, 7, 14, and 28 levels (p = .10). Furthermore, no statistical correlation was observed between the pairs (age-AMH) and (weight-AMH). Considering all times, no correlation was found between 25(OH)D and blood AMH levels. These findings demonstrated that exogenous Vit D3 did not affect serum AMH in Holstein Friesian heifers.

Correlation Between Pre-Chemotherapy AMH Level, Menstrual Status, and Prediction of Ovarian Function Recovery after FAC Chemotherapy AMH in Breast Cancer Patients

Around 52.6% of women aged <50 years in Indonesia are diagnosed with breast cancer. One of the chemotherapy regimens with a toxicity effect on reproductive function, especially ovarian follicles, is 5-fluorouracil-doxorubicin-cyclophosphamide (FAC). Anti-Mullerian Hormone (AMH) is a biomarker that can be used to assess the ovarian function. This study aimed to determine the correlation between pre-chemotherapy AMH serum level, menstrual status, and whether the AMH serum level can predict ovarian function recovery in pre-menopausal women receiving FAC chemotherapy. This was an analytical observational study with a prospective cohort design performed in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, during 2021-2022. Data were analyzed using correlation analysis. Subjects were breast cancer patients aged ≤45 years, still of reproductive age, with no prior history of chemotherapy, and were undergoing the FAC chemotherapy. All 32 patients who met the inclusion criteria were included in this study. There was a significant difference (p 0.0001) between pre- and post-6 cycles of chemotherapy AMH levels. Post-6 cycles of chemotherapy showed lower AMH levels. There was a high correlation (p 0.0034) between pre-chemotherapy AMH level and menstrual status six months after six cycles of chemotherapy. The correlation test between post-chemotherapy AMH level and menstrual status showed a non-significant result. Thus, there is a high statistical correlation between pre-chemotherapy anti-Mullerian hormone levels in pre-menopausal women with breast cancer and the menstrual status after FAC chemotherapy which demonstrates that the AMH level could also be used to predict ovarian function recovery.

Value of Assessing AMH in the Management of Polycystic Ovarian Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in reproductive age affecting 5 “ 10% of women and is the leading cause of ovulatory dysfunction. Anti-mullerian hormone (AMH) is a dimeric glycoprotein releases from the granulosa cells of small preantral and antral follicles and these concentrations have shown to be proportional to the number of developing follicles in the ovaries. In women with PCOS serum levels are elevated 2- to 3- fold in comparison with normo-ovulatory women, consistent with the increased number of small antral follicles in these women. AMH production per granulosa cell is increased on average 75-fold in anovulatory PCOS compared with normal ovaries. AMH is a marker for ovarian reserve of the women. It also can be used for diagnosis of PCOS. The high level of PCOS has negative effect on reproduction. It inhibits the function of FSH and causes follicular arrest and anovulation. In presence of high AMH there is poor response to oral ovulation inducing agent, gonadotropin and laparoscopic ovarian drilling. Quality of embryo, implantation rate and live birth rate are significantly reduced in presence of high AMH. High LH, hyperandrogenism, hyperinsulinemia have association with high AMH. Androgen is responsible for increasing the number of preantral follicles, hence AMH. Adjuvant therapy like metformin can correct hyperandrogenism, reduce the serum level of AMH and improve ovulation, pregnancy and live birth rate. Pre-treatment AMH level 7.77ng/ml is a cutoff level to predict the response to fertility treatment in PCOS. Ovulation, pregnancy and live birth rate are significantly lower when AMH level is >7.77ng/ml. So, to predict response to treatment and to fix the treatment plan value of assessment of AMH is important in case of PCOS. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(1): 47-62

Body composition in association with serum anti-Mullerian hormone (AMH) levels in adult males implies hemodilution effects

Body composition in association with serum anti-Mullerian hormone (AMH) levels in adult males implies hemodilution effects

Body mass index evolution and ovarian function in adolescent girls who received GnRH agonist treatment for central precocious puberty or early and fast puberty.

Gonadotropin-releasing hormone agonist (GnRHa) has been used for central precocious puberty (CPP) or early and fast puberty. It was aimed to assess changes in body mass index (BMI), polycystic ovary syndrome (PCOS) frequency, and anti-Müllerian hormone (AMH) in girls who had been treated with GnRHa. Fifty-eight adolescent girls treated with GnRHa for CPP or early and fast puberty (3.75 mg/28days), between 2011 and 2015, were re-evaluated in 2020-2022 at least 2 years after menstruation. Hormonal analyses were compared with 51 healthy adolescents. In the GnRHa-treated group, a statistically significant increase was observed when the BMI standard deviation score (SDS) at the beginning of the treatment was compared with the BMI SDS at the end of the treatment (p=0.038). A statistically significant decrease was observed when the BMI SDS at the end of the treatment was compared with the BMI SDS in late adolescence (p=0.012). When the BMI SDS at the beginning of the treatment was compared with the BMI SDS in late adolescence, it was observed that there was no statistically significant difference (p=0.196). Of the 58 girls in the GnRHa-treated group, 8 (14 %) had PCOS. Serum AMH levels did not differ between the GnRHa-treated and the control group. GnRHa treatment causes no adverse effect on BMI, at least in late adolescence. Girls treated with GnRHa were not found to be prone to developing PCOS. AMH levels were similar in the GnRHa-treated group as in the control group.

Comparison of serum anti-Müllerian hormone between unilateral and bilateral ovarian endometriomas during follicular, luteal, and random menstrual phases: a retrospective study.

Over the last two decades, serum levels of anti-Müllerian hormone (AMH) have been shown to be reliable markers of ovarian reserve. This study aimed to compare baseline serum AMH levels and well-controlled clinical factors between patients with unilateral and bilateral ovarian endometriomas during the menstrual phase. We conducted a retrospective study. We enrolled 136 patients aged 18 to 36 years who were diagnosed with unilateral or bilateral ovarian endometriomas. Serum AMH levels of all patients and their latest two to three menstrual cycles were measured before surgery for ovarian endometriomas. The latest menstrual cycle length ranged from 26 to 30 days. Patients with irregular menstruation, a recent medication history of hormonal drugs other than oral contraceptive pills, a previous history of ovarian surgery, or any medical history influencing ovarian function were excluded. Of the 136 patients, 76 (55.9%) had unilateral ovarian endometriomas and 60 (44.1%) had bilateral ovarian endometriomas. Serum AMH levels were not significantly different between the two groups in the follicular phase, luteal phase, or at any random time point. Serum AMH levels were not significantly different between unilateral and bilateral ovarian endometriomas in the follicular and luteal phases, or at any random time during the menstrual cycle when various confounding factors were excluded.

The predictive effect of serum AMH and FSH levels alone or in combination on fertility outcome

Objective: To explore the roles of anti-mullerian hormone (AMH) and follicle stimulating hormone (FSH) in predicting clinical pregnancy. Materials and Methods: Forty patients who were decided on IVF/ICSI due to different infertility etiologies were included in the study. The patients were divided into two groups according to their AMH and FSH values as having a good prognosis or a poor prognosis. The clinical pregnancy and miscarriage rates of 33 cycles with good prognosis and 17 cycles with poor prognosis were compared. Results: In the good prognosis group, the FSH value was significantly lower than the poor prognosis group (5.98±1.04 mIU/mL vs. 13.6±3.07 mIU/mL, p<0.01), while the serum AMH level was significantly higher. (3.80±1.32 ng/mL vs 0.54±0.02 ng/mL, p<0.01). The rate of chemical pregnancy in the group with good prognosis was twice as high and significant compared to the group with poor prognosis (12 (36.3%) vs 5 (29.4%), p<0.02). In terms of clinical pregnancy rates, the group with good prognosis showed a higher frequency (33.3% vs. 23.5%, p<0.001), while miscarraige rates were higher in the group with poor prognosis (9.0% vs. 25%, p<0.003). Conclusions: Evaluation of AMH and FSH together is critical in determining clinical pregnancy rates.

Diagnostic utility of serum anti-Mullerian hormone levels in south Indian women with polycystic ovarian syndrome

Introduction and Aim: Polycystic ovarian syndrome (PCOS) is a prevalent endocrinopathy among women of reproductive age group, conventionally diagnosed using multiple clinical and biochemical tests. We aimed to evaluate the diagnostic utility of serum anti-Müllerian hormone (AMH) levels in PCOS. Materials and Methods: The case control study involved 60 women of 18-40 years age, further grouped using Rotterdam criteria as cases with PCOS (n = 30) and controls without PCOS (n = 30). Study variables were compared between the groups using independent t-test. Correlation analyses were performed to predict the relationship of AMH with other PCOS determinants. Simple logistic regression and ROC analyses were used to determine the diagnostic utility of AMH. Results: PCOS cases had increased levels of serum LH, testosterone, AMH, BMI, total antral follicular count (AFC), ovarian volume (OV) (p < 0.05*) than controls. Of all, serum AMH had the strongest association with PCOS (OR > 1, p < 0.05*) and showed considerable positive correlations with LH:FSH ratio, testosterone, AFC (r = 0.7768, p < 0.05*), OV (r = 0.7981, p < 0.05*). ROC analysis of AMH was significant (AUC = 0.966, p < 0.05*) with high sensitivity, specificity for cut points between 5.595 ng/mL and 5.90 ng/mL. Conclusion: Elevated serum AMH levels were strongly associated with PCOS and correlated with its routine clinical determinants. Serum AMH estimation with cut-off between 5.595 ng/mL to 5.90 ng/mL, is proposed as a useful index for PCOS diagnosis.

Can evaluation of seminal plasma and serum anti-Müllerian hormone be useful in the diagnosis of male infertility? (Literature review)

Background. Anti-Müllerian hormone (AMH) is secreted in men by Sertoli cells and plays an important role in the development of the male reproductive organs. High expression of AMH during embryonic development contributes to the regression of the Müllerian (paramesonephric) ducts; in the absence of AMH, the Müllerian ducts develop into the female internal genital organs. In adulthood, the clinical value of measuring AMH in serum and seminal plasma remains controversial. It is assumed that AMH, as a marker of the functional state of Sertoli cells, can be useful in the diagnosis of male infertility.Aim. To determine the clinical value of measuring serum and seminal plasma AMH levels in the diagnosis of male infertility by examining the current evidence base in the world literature.Materials and methods. A search was made for publications devoted to the study of the role of AMH in the diagnosis of male infertility in the international database PubMed, in the scientific electronic library eLIBRARY.RU and in the Google Scholar search engine. There were no restrictions regarding the status and period of publication.Results and conclusion. The results of the analysis indicate the absence of a significant relationship between the parameters of the ejaculate and the serum concentration of AMH, which does not allow using this indicator to assess male fertility. Serum AMH is of no value in the differential diagnosis of obstructive and non-obstructive azoospermia, the prediction of assisted reproductive technologies outcomes, and the prediction of testicular biopsy outcomes in the general non-obstructive azoospermia patient population. It is likely that serum AMH may be useful in predicting testicular biopsy results in patients with Klinefelter’s syndrome and idiopathic non-obstructive azoospermia.The clinical application of measuring the level of AMH in seminal plasma is limited by the high variability of this indicator, probably due to the dependence on the volume of the ejaculate and exposure to semen proteolytic enzymes. This indicator may be useful for the differential diagnosis of obstructive and non-obstructive azoospermia. In obstructive azoospermia, AMH is not detected in seminal plasma, but undetectable AMH concentrations can also be observed in patients with non-obstructive azoospermia, which reduces the differential value of this indicator. A promising direction is the use of AMH concentration in seminal plasma to predict the recovery of sperm motility after cryopreservation.

Evaluation of chemical castration using intra-testicular injection of zinc gluconate into the testis of the male donkey versus surgical castration: antimullerian hormone as an endpoint marker

BackgroundChemical castration of male animals is an alternative to surgical castration for inducing azoospermia, consequent sterility. Intra-testicular injection of zinc gluconate has been used for chemical castration in several animal species. However, its application to equine species, such as donkeys, has yet to be reported. This study aimed to evaluate the use of zinc gluconate for the chemical castration of male donkeys and to compare its effectiveness relative to routine surgical castration. For this purpose, investigations of serum testosterone and anti-Müllerian hormone levels, testicular ultrasonographic echogenicity, and histopathological findings were performed.MethodsFourteen clinically healthy adult male donkeys were randomly and equally divided into two groups. The donkeys in group I (n = 7) underwent surgical castration. The donkeys in group II (n = 7) received intra-testicular zinc gluconate injections. The donkeys were kept under close clinical observation for 60 days. Abnormalities in donkey behavior and gross alterations in the external genitalia were recorded daily. Serum testosterone and anti-Müllerian hormone (AMH) levels were measured 15 days before the start of the treatment and 15, 30, 45, and 60 days after treatment. The testicles of group II donkeys were evaluated ultrasonographically. At the end of the study, the testes were removed and histologically examined.ResultsSerum testosterone levels significantly declined compared to pre-castration levels in surgically castrated donkeys (group I), but donkeys exposed to chemical castration (group II) showed a non-significant reduction in testosterone levels. Donkeys in the surgical group had considerably lower serum AMH levels. In contrast, there was a non-significant (p > 0.05) increase in AMH levels in the chemical group compared with the pre-sterilization level. In addition, ultrasonographic examination revealed that the testicular echo-density had changed, as observed by a few scattered hyperechoic regions throughout the entire testis parenchyma. The histopathological investigation confirmed the presence of necrosis of the spermatogenic epithelium, increased thickness of the basement membrane of the seminiferous tubules, marked interstitial fibrosis, and shrinkage of the seminiferous tubules. Furthermore, syncytial giant cells were present in the lumen of seminiferous tubules and were associated with Sertoli cell vacuolation. Donkeys subjected to chemical castration (group II) had orchitis, as confirmed histopathologically.ConclusionIntra-testicular injection of zinc gluconate resulted in histopathological and ultrasonographic testicular changes in adult male donkeys, which may affect their reproductive potential. However, it did not significantly alter serum testosterone or AMH levels, indicating that it cannot be used as a substitute for surgical castration in male donkeys.

Does the addition of metformin to carboplatin treatment decreases ovarian reserve damage associated with carboplatin usage?

BackgroundWe aimed to determine whether adding metformin to carboplatin treatment would reduce the damage to ovarian reserve associated with carboplatin use.MethodsWe included 35 adult female non-pregnant albino Wistar rats approximately three months old, weighing 220–310 g. The rats were divided into five groups of seven rats according to the treatment they received. Carboplatin and salin was given to Group 2, and carboplatin plus metformin was given to Group 3. Group 4 was administered only metformin. Group 5 was administered only salin. Carboplatin was given to Groups 2 and 3 as a single dose on the 15th day, while metformin was given to Groups 3 and 4 during the 28-day experiment. After oophorectomy, histopathologic analyses of primordial, primary, secondary, and tertiary Graff follicles according to the epithelial cells surrounding the oocyte and total follicular number were conducted per section. Serum Anti-Mullerian Hormone (AMH), tissue catalase, and malonyl dialdehyde levels were measured and compared within each group.ResultsThe baseline and 15th-day serum AMH values of the menstrual cycle were compared among the groups, and no statistically significant differences were observed (p > 0.05). Group 3, which was given both carboplatin and metformin, had statistically significantly higher 28th-day AMH levels than Group 2, which was given only carboplatin and saline (p < 0.001). The number of primordial follicles in Group 3 was found to be statistically significantly higher than in Group 2 (p < 0.001). Tissue catalase enzyme levels in Group 3 were statistically significantly higher than in Group 2 (p < 0.001). Tissue malondialdehyde levels in Group 2 were statistically significantly higher than tissue malondialdehyde levels in Groups 3 and 4 (p < 0.001).ConclusionsMetformin may attenuate carboplatin-induced ovarian damage, possibly through its antioxidative effects.

Endometrioma cerrahisinde kistektomi over rezervini olumsuz etkiler: Kistektomi öncesi ve sonrası serum FSH, AMH ve AFC'nin karşılaştırılması

Objective: Surgical removal of endometriomas, even if performed in experienced hands, leads to a decrease in ovarian reserve in varying degrees depending on age. This study was designed to determine the pre- and post-surgical changes of ovarian reserve markers in patients who underwent endometrioma cystectomy. Methods: Gözde Akademi Hospital gynecology outpatient clinic with the diagnosis of symptomatic ovarian endometrioma was included in the study. Fourteen normal-ovulatory women aged between 21-36 were included in the study. In addition to serum anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol levels, antral follicle count (AFC) was evaluated before and 3 months after cystectomy. Ovarian damage was avoided as much as possible during endometrioma surgery. Results: After endometrioma cystectomy, serum AMH levels were significantly decreased (3.21 ± 1.1 ng/mL vs 1.9 ± 0.6 ng/mL; p= 0.02). There was no significant change in serum FSH (5.97 ± 1.6 mIU/mL vs 7.34±0.55 mIU/mL, p=0.08) and estradiol (37.8 ±9.44 pg/mL vs 32.9 ±10.7 pg/mL, p=0.56) values measured three months after surgery. Similarly, there was no significant change in AFC values before and after surgery (4.12 ± 2.80 vs 4.89 ±3.06, p=0.24). Conclusion: Endometrioma cystectomy leads to a significant decrease in AMH levels, which is the main ovarian reserve marker, but does not affect AFC and FSH values.

Honokiol alleviates radiation-induced premature ovarian failure via enhancing Nrf2.

The ovary is highly sensitive to radiation, and patients receiving radiotherapy are at significant risk of premature ovarian failure (POF). This study aimed to explore the radioprotective effect of honokiol (HKL) on ionizing radiation (IR)-induced POF. Female C57BL/6 mice were administered intraperitoneally with vehicle or HKL once daily for 7 days. On day 7, the mice in the IR and HKL+IR groups were exposed to 3.2Gy whole-body radiation for one hour after the intraperitoneal injection and sacrificed 12 or 72h after radiation exposure. The gonadosomatic index (GSI) was calculated. Blood samples were collected for enzyme-linked immunosorbent assay (ELISA). Ovaries were harvested for histological examination, immunohistochemistry, immunofluorescence, TUNEL, western blot, and qPCR. The fertility assessment was evaluated by calculating live offspring number. The optimum dose of HKL against radiation was 10mg/kg via intraperitoneal injection. POF was induced 72h after irradiation with significantly downregulated proliferating cell nuclear antigen (PCNA). The numbers of primordial and preantral follicles decreased significantly after irradiation (p<.001), whereas the number of atretic follicles increased (p<.001). The serum levels of estradiol (E2 ) and anti-Müllerian hormone (AMH) decreased to 50% of the control group after irradiation (p<.05). Moreover, the GSI after irradiation was 27% lower than in the control group (p<.05). The number of offspring in the IR group dropped by 50% compared with the control group (p<.05). HKL pretreatment protected the animals' fertility, GSI, PCNA, serum levels of E2 and AMH, and the number of primordial and preantral follicles. Significant upregulation of apoptosis-related proteins such as Pho-P53, Bax, Cyto C, C-caspase-3, C-PARP, and pyroptosis-related proteins such as Pho-NF-κB p65, NLRP3, caspase-1, IL-1β, and IL-18 was observed after irradiation, while the expression of Bcl-2 decreased. HKL pretreatment prevented these changes. After irradiation, malondialdehyde (MDA), Nrf2, and HO-1 were upregulated. HKL treatment activated the expression of Nrf2 and HO-1 and promoted the nucleus translocation of Nrf2. Furthermore, HKL did not affect ovarian reserves under physiological conditions. HKL ameliorated IR-induced POF by inhibiting apoptosis and pyroptosis by enhancing Nrf2 expression and translocation.

Higher serum AMH level is associated with better pregnancy outcomes of IVF/ICSI assisted pregnancy in infertile patients under 35 years old.

This study aimed to investigate the effect of anti-Mullerian hormone (AMH) on the pregnancy outcome of infertility assisted by IVF/Micro-Insemination/Embryo Transfer Infertility Assistance (IVF/ICSI-ET). A total of 324 patients under the age of 35 who received IVF/ICSI-ET assistance in our center were included in this analysis. AMH levels of these patients were measured by chemiluminescence method and divided into clinical pregnancy group (175 cases) and non-pregnancy group (149 cases) according to the final pregnancy outcome. The relationship between the two groups' pregnancy outcomes and AMH levels was analyzed. The above association was re-evaluated after excluding patients with polycystic ovary syndrome. There was no significant difference in age, body mass index (BMI), follicle-stimulating hormone (FSH), and 2 pronucleus (PN) between clinical and non-clinical pregnancy groups. Compared with the clinical pregnancy group, the level of AMH in the non-pregnancy group was significantly lower (p < 0.05). A higher AMH level was closely related to better IVF/ICSI-ET assisted pregnancy outcome in vitro. After excluding AMH abnormalities, the AMH level was still significantly associated with pregnancy outcomes of in vitro IVF/ICSI-ET-assisted pregnancy. Our results show a correlation between AMH level and pregnancy outcome of in vitro IVF/ICSI-ET assisted pregnancy. For women under age 35, lower AMH levels may be one of the predictors of adverse pregnancy outcomes. For patients with low AMH level, it is suggested to strengthen monitoring to ensure the safety and smoothness of the pregnancy process.

Ovarian reserve in children with juvenile idiopathic arthritis using biologic disease-modifying anti-rheumatic drugs.

The aim of the study is to assess the effect of juvenile idiopathic arthritis (JIA) and biologic disease-modifying anti-rheumatic drugs (bDMARDs) on ovarian reserve in children. A cross-sectional study was performed from March 2021 to March 2022 and included 81 patients with JIA and 49 healthy children. Serum anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol levels were analyzed using electrochemiluminescence methods. The mean of current age (13.5 ± 3.2 vs. 14.4 ± 2.4years), height standard deviation score (SDS) (- 0.35 ± 1.18 vs. - 0.44 ± 0.94), body mass index SDS (0.12 ± 1.33 vs. 0.25 ± 1.28), and the median weight SDS (- 0.13 (- 2.27-3.23) vs. - 0.52 (- 3.4-3.3)) were similar in JIA patients and controls (p > 0.05). Patients with JIA were divided into two groups according to their treatment regimens: treated with methotrexate (MTX) (biologic naive) (n = 32) and treated with MTX plus bDMARDs (n = 49). No significant differences were detected between the 3 groups regarding menarche age, menstrual cycle length, and flow duration (for all p > 0.05). The median serum concentration of AMH was 2.94 (1.12-7.88) ng/ml in the control group, 3.02 (0.36-8.54) ng/ml in the biologic naïve group, and 3.01 (0.99-8.26) ng/ml in the MTX plus bDMARD group. There were no significant differences between 3 groups according to serum AMH, FSH, LH, and estradiol levels (p > 0.05). Biologic DMARDs are reassuring in terms of ovarian reserve in girls with JIA and demonstrate that AMH is unaffected by treatment. Prospective studies with larger sample sizes are needed to confirm our findings and to evaluate the impact on the future fertility of patients. Key Points • Although biologic disease-modifying anti-rheumatic drugs (bDMARDs) are being game-changing treatment options in juvenile idiopathic arthritis, their effect on fertility and ovarian reserve is one of the most discussed issues. • In addition to treatment used, autoimmune diseases might also have a negative effect on fertility. • In this cross-sectional study, we found that anti-Mullerian hormone level of patients who were on bDMARDs, patients who were on methotrexate, and healthy controls were similar. • Our results suggest that bDMARDs are reassuring in terms of ovarian reserve in girls with JIA and demonstrate that AMH is unaffected by treatment.

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