Use Of Anti-Mullerian Hormone Research Articles

P-619 AMH/AFC ratio as a predictive factor for ovarian responsiveness to gonadotropins during ovarian stimulation

Abstract Study question Does AMH/AFC ratio correlate to the number of follicles on the day of trigger and to the number of oocytes retrieved after ovarian stimulation? Summary answer The AMH/AFC ratio correlates significantly to the number of pre-ovulatory follicles and the number of oocytes collected after ovarian stimulation (OS). What is known already Although AFC is a robust marker of oocyte yield after OS, its combination with Anti-Mullerian hormone (AMH) seems to improve the predictability. Besides, Follicular Output Rate [FORT: (number of pre-ovulatory follicles on day of trigger/AFC at baseline) x 100] and Follicle-to-Oocyte Index [FOI: (number of retrieved oocytes/AFC) × 100] evaluate the ovarian responsiveness to gonadotropins during OS, representing its sensitivity to exogenous FSH. Both parameters take antral follicle count (AFC) only into consideration. AMH and AFC as a ratio might optimize the accuracy of FORT and FOI metrics, helping to predict which patients are at higher risk of suboptimal results. Study design, size, duration This retrospective study analyzed 2,163 ovarian stimulation cycles for IVF/ICSI, performed between May 2015 and October 2023 in a tertiary referral IVF centre. For all the cycles, measurement of AMH using Elecsys (Roche®) no longer than 6 months before starting OS, AFC at baseline, number of pre-ovulatory follicles on the day of trigger, and the treatment outcomes were available. Participants/materials, setting, methods Couples with primary/secondary infertility who underwent OS with antagonist protocol, starting on day 2/3 for IVF/ICSI were included, independent of their age or ovarian reserve parameters. Exclusion criteria were patients with body mass index (BMI) >40 kg/m2, non-vaginal ultrasound measurement for AFC and/or follicles during OS, cycles with previous estradiol priming or oral contraceptives. Ethical approval was obtained from the Research Ethics Committee. Main results and the role of chance 2,163 ovarian stimulation cycles were included in the analysis. The mean age, BMI, AMH, AFC, FOI and FORT of the included women were: 35.6±6.1 years, 27.5±4.7 kg/m2, 2.4±2.1 ng/mL, 12±7 follicles, 1.02±0.66 and 1.38±0.79. The correlation of AMH/AFC ratio (coefficient: 0.62, 95% CI: 0.59 to 0.65, p<0.001) to FOI was stronger than the correlation of AMH (coefficient: 0.31, 95% CI: 0.27 to 0.34, p<0.001) or AFC alone (coefficient: -0.09, 95% CI: -0.14 to -0.05, p<0.001). The correlation of AMH/AFC ratio (coefficient: 0.62, 95% CI: 0.59 to 0.64, p<0.001) to FORT was also stronger than the correlation of AMH (coefficient: 0.21, 95% CI: 0.16 to 0.25, p<0.001) or AFC alone (coefficient: -0.23, 95% CI: -0.27 to -0.19, p<0.001). AMH/AFC ratio was better at predicting stimulation efficiency parameters, FOI and FORT, compared to joint use of AMH and AFC (p>0.001 for both). However, regression analysis showed stand-alone use of the AMH/AFC ratio did not provide a better prediction for collected oocyte count compared to joint use of AMH and AFC. In fact, prediction errors were significantly larger for the AMH/AFC ratio (median: -0.4, range: -11 to 11) compared to the model using AMH and AFC separately (median: -0.2, range: -6 to 7). Limitations, reasons for caution Although clinical assessment was performed in the same centre following the same methodology, inter-observer variability for AFC is a limitation. Additionally, AMH levels used in the study were not obtained in the same cycles, which may adversely affect the performance of the ratio. Wider implications of the findings While AMH/AFC ratio was better at predicting stimulation efficiency compared to FOI and FORT parameters, it was not significantly better at predicting absolute oocyte yield. This may imply AMH/AFC ratio can represent the ovarian sensitivity to exogenous FSH. Trial registration number Not applicable

O.17.5 - Community awareness and use of anti-Mullerian hormone (AMH) testing in Australia: Presenter(s): Tessa Copp, The University of Sydney, Australia

O.17.5 - Community awareness and use of anti-Mullerian hormone (AMH) testing in Australia: Presenter(s): Tessa Copp, The University of Sydney, Australia

Anti-Mullerian Hormone (AMH) and adenomyosis: Mini-review of literature of the last 5 years.

IntroductionAdenomyosis is a form of endometriosis characterized by the presence of endometrial tissue in the myometrium. The correlation between anti-Mullerian hormone (AMH) expression and adenomyosis is unclear. Few studies investigated this possible correlation with promising results. The aim of this mini-review is to illustrate the potential prognostic and therapeutic role of AMH in adenomyosis.Materials and methodsA study protocol was completed conforming to the Preferred Reporting Items for Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. We performed an electronic databases search from each database’s inception from August 2017 to August 2022 for full-text articles and published abstracts. For database searches, the following main keywords were the following text words: “adenomyosis” or “uterine endometriosis” [Mesh] AND “AMH” or “anti-mullerian hormone”.ResultsFrom the literature search, 8 abstracts of studies were retrieved and independently screened for inclusion by three authors. It was found that the most common therapeutic strategies (such as adenomyomectomy and high-intensity focused ultrasound (HIFU) do not alter AMH levels. Moreover, a higher expression of the AMH receptor II was observed in adenomyotic tissue, hence a possible therapeutic use of AMH was hypothesized.ConclusionThe available evidence shows an unclear relationship between adenomyosis and AMH. Probably, women with adenomyosis have lower levels of AMH and the surgical treatment (adenomyomectomy, HIFU) does not alter this characteristic, therefore in all of them, ovarian function is not influenced.

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

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

Utility of anti-Mullerian hormone in clinical decision making in BRCA mutation carriers

Objectives: BRCA1/2 mutations increase cancer risk and may also confer risk for reduced fertility potential, posing a dilemma for BRCA mutation carriers desiring future fertility. On December 19, 2016, the FDA approved the use of Anti-Mullerian Hormone (AMH) assay for use in the assessment of ovarian reserve. AMH serum concentration accurately reflects the size of the pool of antral follicles, representing the quantity of the remaining primordial follicles and is not dependent on timing in the menstrual cycle. The purpose of this study is to determine the frequency of AMH testing to monitor ovarian reserve and utility in clinical decision making among patients with BRCA1/2 mutations. Methods: BRCA1/2 mutation carriers were retrospectively identified from electronic medical records using ICD-10 codes, and BRCA1/2 mutation carriers between the ages of 18 and 50 seen between January 1, 2017 and August 1, 2020 were included in the study. CPT codes were used to identify patients with prior AMH testing; for patients who received testing, AMH levels and clinical data were abstracted from medical records. AMH levels were categorized as low or normal based on reported age-dependent reference ranges1. Referral to REI and cryopreservation were outcomes of interest and were compared between patients with low vs. normal AMH levels using Fisher's exact test. Results: Of 1,186 BRCA1/2 mutation carriers of reproductive age seen at NYU Langone Health, 73 (6.2%) received AMH laboratory testing. Of the 73 patients who had AMH testing, 39 (53.4%) had BRCA1 mutation and 36 (49.3%) had BRCA2 mutations; two patients (2.7%) carried mutations on both genes. AMH tests were ordered by the following providers: 64 (87.7%), gynecologic oncologists; 7 (9.6%), general gynecologist; and 2 (2.7%), reproductive endocrinologists (REI). Of the 73 women, 53 (72.6%) were interested in future fertility and 11 (15.1%) were unsure. The median age at the time of AMH testing was 30 years (Interquartile range [IQR] 27-34 years), and the median AMH level was 3.6 ng/mL (IQR 1.9-6.0 ng/mL). Twenty-nine patients (39.7%) had low AMH levels and of patients with low AMH levels, 14 (48.3%) received REI referrals and 9 (31.0%) patients were seen by REI. Significantly more patients with low AMH underwent cryopreservation compared to patients with normal AMH (17.2% vs 2.3%, p=0.03). One patient decided to undergo risk reducing surgery following a very low AMH value of Conclusions: Only 6% of BRCA1/2 mutation carriers of reproductive age at our institution received AMH testing. Incorporation of AMH monitoring into the screening and preventative care of BRCA1/2 mutation carriers desiring future fertility may help guide patient decision making regarding oocyte cryopreservation and timing of risk reducing surgery; further prospective evaluation in needed to better assess the role of AMH in these patients.

Impact of Obesity on Anti-Mullerian Hormone (AMH) Levels in Women of Reproductive Age.

Obesity negatively impacts reproductive health, including ovarian function. Obesity has been posited to alter Anti-Müllerian hormone (AMH) production. Understanding biological factors that could impact AMH levels is necessary given the increasing use of AMH for predicting reproductive health outcomes in response to controlled ovarian stimulation, diagnosing ovulatory disorders, onset of menopause, and natural conception. In this narrative review, we evaluated the impact of obesity on AMH levels in healthy, regularly cycling reproductive-age women (18–48 years). Thirteen studies (n = 1214 women; (811, non-obese (body mass index; BMI < 30 kg/m2); 403, obese (BMI > 30 kg/m2))) were included, of which five reported decreased AMH levels with obesity, whereas eight showed comparable AMH levels between groups. Inclusion of women with higher obesity classes (Class 3 versus Class 1) may have been a factor in studies reporting lower AMH levels. Together, studies reporting AMH levels in otherwise healthy women remain limited by small sample sizes, cross-sectional designs, and lack of representation across the entire adiposity spectrum. Ultimately, the degree to which obesity may negatively impact AMH levels, and possibly ovarian reserve, in otherwise healthy women with regular menstrual cycles should be deemed uncertain at this time. This conclusion is prudent considering that the biological basis for an impact of obesity on AMH production is unknown.

Use of Anti-Mullerian Hormone (AMH) for Testing of Ovarian Reserve: A Survey of Fifteen (15) Fertility Centres in Ghana

Anti-Mullerian Hormone (AMH) is a dimeric glycoprotein with a molecular weight of 140 kD, encoded by a gene on the short arm of chromosome and a member of the transforming growth factor-beta (TGF-β) superfamily. The expression of AMH is markedly different in males and females, both in concentration and temporality. In males, Sertoli cells maintain a high concentration of AMH in utero which peaks shortly after birth and then drops precipitously at puberty. In females, granulosa cells produce very low levels of AMH in utero followed by a transient spike in the neonatal period. Concentrations of the hormone then rise steadily through adolescence to a peak in the mid-twenties and subsequently decline until becoming undetectable in menopause. The study aimed to understand how Clinicians and Clinical Embryologists used anti-mullerian hormone (AMH) test to assess ovarian reserve, direct patient selection and treatment regimens and guide in vitro fertilization (IVF) cycle management in all registered fertility hospitals in a West African country, Ghana. A web-based survey (questionnaire) using google forms was performed to solicit responses from all IVF hospitals that are registered with the Fertility Society of Ghana (FERSOG). This questionnaire consisted of fifteen (15) broader questions, ten (10) of which assessed the clinics’ use of AMH. Responses were screened for quality to verify that only one (1) survey was completed by each IVF centre. The study was conducted during May and June 2020 at the In Vitro Fertilization (IVF) Department of the Airport Women’s Hospital (AWH) in Accra, Ghana. Results are reported as the proportion of IVF cycles represented by a particular answer choice. Survey responses were completed from 15 IVF centres, representing 2504 IVF cycles performed annually. A good majority (73.3%) [1835 IVF cycles] of the respondent IVF hospitals reported to use AMH as a first line test and 93.3% reported it as the best test for evaluating ovarian reserve. Another 66.7% reported that AMH results were extremely relevant to clinical practice. However, in contrast, for predicting live birth rate, 60% reported age as the best predictor in their practice. Overall, our results indicate that AMH is considered a first line test for assessing ovarian reserve and is relevant to the clinical practice of majority of Assisted Reproductive Technologies (ART) providers in Ghana.

The Clinical Value and Interpretation of Anti-Müllerian Hormone in Women With Cancer.

Cancer treatments can be damaging to the ovary, with implications for future fertility and reproductive lifespan. There is therefore a need for a biomarker than can usefully provide an assessment of the ovary and its potential for long-term function after cancer treatment, and ideally also be of value pre-treatment, for the prediction of post-treatment function. In this review we assess the value of anti-Müllerian hormone (AMH) in this context. Measurement of AMH at the time of cancer diagnosis has been shown to be predictive of whether or not there will remain some ovarian function post-treatment in women with breast cancer, in conjunction with age. AMH may however be reduced at the time of diagnosis in some conditions, including lymphoma, but probably not in women with breast cancer unless they are carriers of BRCA1 mutations. Following chemotherapy, AMH is often much reduced compared to pretreatment levels, with recovery dependent on the chemotherapy regimen administered, the woman’s age, and her pretreatment AMH. Recent data show there may be a long duration of relative stability of AMH levels over 10 to 15 years prior to decline rather than a rapid decline for many young women after cancer. Post-treatment AMH may have utility in determining that ovarian function will not recover, contributing to assessment of the need for ovarian suppression in women with hormone-sensitive breast cancer. AMH measurement provides an index of treatment gonadotoxicity, allowing comparison of different treatment regimens, although extrapolation to effects on fertility requires caution, and there are very limited data regarding the use of AMH to estimate time to menopause in the post-cancer setting.

A NOVEL DIAGNOSTIC APPROACH FOR POLYCYSTIC OVARY SYNDROME DIAGNOSIS USING GONADOTROPIN RELEASING HORMONE RECEPTOR AUTOANTIBODY ACTIVITY AND ANTIMULLERIAN HORMONE

Despite being the most common endocrinological disorder of reproductive aged women, polycystic ovary syndrome (PCOS) remains a complex disease of unknown etiology. Patients spend an average of two years of clinical evaluation with at least three health professionals before diagnosis. As PCOS remains a diagnosis of exclusion, there is room for improvement in diagnostic classification. Although the use of Antimullerian hormone (AMH) as a diagnostic test has shown promise, it has limitations. Our laboratory has identifiedvariation in levels of activating autoantibody (AAb) to the second extracellular loop of the gonadotropin-releasing hormone receptor (GnRHR) associated with PCOS in infertile patients.

Correlation of anti-Mullerian hormone with humanchorionic gonadotropin test in the evaluation of testicular function of children with 46 XY male hypogonadism: Use of anti-Mullerian hormone as abiomarker.

It is challenging to evaluate reproductive potential during childhood. These challenges necessitate the use of invasive dynamic tests. Although the anti-Mullerian hormone (AMH) is a reliable biomarker in evaluating testicular function, especially in the pre-pubertal period, there are uncertainties concerning its use in a clinical setting. This study is focused on comparing the AMH and human chorionic gonadotropin (hCG) test in boys with hypogonadism. A total of 160 boys aged between 0 and 18 years who presented with complaints associated with hypogonadism were prospectively enrolled in the study. All children were assigned to the following five groups: gonadal disorders (n = 34), androgen synthesis and end organ effect disorder (n = 48), isolated genital malformation disorders (n = 57), hypogonadotropic hypogonadism (n = 15) and constitutional delayed puberty (n = 6). All children underwent a short 3-day hCG test (1500 U/m2 /day). The concordance and correlation were evaluated between the hCG test and AMH. All groups exhibited a strong correlation (r160 = 0.689) and strong concordance (Kappa coefficient160 = 0.7) between the AMH and hCG test. Values of AMH higher than 32.7 pmol/L and hCG responses higher than 86 pmol/L were significant as indicative markers of functional testicular tissue presence. This study has shown that there is a strong correlation between the AMH and short-term hCG test and that values of AMH higher than 32.7 pmol/L and stimulated testosterone higher than 86 pmol/L can be used as indicators of functionally sufficient testicular tissue. These results indicate that AMH value can be used as a reliable and useful biomarker in the evaluation of the testicular function in 46 XY hypogonadism.

SAT-258 Anti-Mullerian Hormone (AMH) Levels Reflect Ovarian Follicle Count by MRI but Not Ovarian Size in Young Patients with Polycystic Ovary Syndrome

Background: PCOS affects 5-15% of females of reproductive age and frequently manifests in adolescence. One of its diagnostic criteria is presence of polycystic ovary morphology (PCOM); however, this criterion is based on adult data obtained by transvaginal ultrasound thus may not be relevant to younger patients. AMH represents an alternative marker for PCOM as it is produced by preantral ovarian granulosa cells, which are increased in this condition. This study uses MRI, a noninvasive and accurate method, to determine FC and OV in young patients with PCOS and controls. Aims: 1. To determine if AMH is different in PCOS compared to controls; 2. To examine the relationship between AMH and FC and OV by MRI in PCOS and controls; 3. To determine the relationship between AMH and androgens and insulin resistance in PCOS and controls. Methods: Healthy nonobese adolescents and young adults with PCOS (n=12) and controls (n=12), (mean age 19.7 ± 3.2 years, BMI 23.1 ± 3.2 kg/m2) participated. Labs after an overnight fast included AMH, LH, FSH, estradiol, total and free testosterone, androstenedione, DHEAS, and a 2h OGTT with glucose and insulin levels. HOMA-IR and insulin area under the curve (iAUC) were calculated. Whole body dual-energy x-ray absorptiometry (DXA) scan for percentage body fat (%BF) and ovarian MRI for OV and FC were obtained. Results: Compared to controls, PCOS had higher AMH (10.7 ± 5.8 vs 5.0 ± 2.5 ng/mL. Reference range: 1.05-12.86 ng/mL), total and free testosterone, androstenedione and DHEAS (P<0.003 for all). HOMA-IR, iAUC , BMI and %BF were similar between the groups. AMH correlated with total testosterone (r=0.66, p<0.03) and to FC (r=0.88, p=0.0002), but not with free testosterone, androstenedione, DHEA-S, LH, HOMA-IR, iAUC or OV by MRI. Conclusions: In this small study of young and nonobese patients, AMH was higher in PCOS than controls and highly correlated with FC using ovarian MRI and to testosterone levels. These findings support the use of AMH as a minimally invasively additional marker to assist in the diagnosis of PCOS.

Tamizaje de reserva ovárica con hormona antimülleriana

En la actualidad, las pruebas de reserva ovárica (RO) son usadas principalmente en la evaluación de pacientes subfértiles. En este artículo, se discute el uso del dosaje de hormona antimülleriana (HAM), asociado en algunos casos con el recuento de folículos antrales (RFA) y el dosaje de FSH, en la población general de mujeres jóvenes, postulando un algoritmo de tamizaje para identificar riesgo de reserva ovárica disminuida. Usando su plena autonomía y luego de una consejería, la mujer decidiría hacer o no las pruebas, según sus prioridades en la vida. Si dichos exámenes resultaran alterados, la mujer podría modificar sus planes en lo que se refiere a la maternidad.

Anti-Mullerian hormone (AMH) concentration in follicular fluid and mRNA expression of AMH receptor type II and LH receptor in granulosa cells as predictive markers of good buffalo (Bubalus bubalis) donors

High individual variability in follicular recruitment and hence in the number of embryos produced is a major factor limiting the application of reproductive technologies in buffalo. Therefore, the identification of reliable markers to select embryo donors is critical to enroll buffaloes in embryo production programs. Better understanding of factors involved in follicular growth is also necessary to improve the response to superovulation in this species. The aim of this work was thus to determine the anti-Mullerian hormone (AMH) concentration in follicular fluid (FF) recovered from different size follicles and evaluate the mRNA expression profiles of development-related (AMHR2, CYP19A1, FSHR, and LHR) and apoptosis-related genes (TP53INP1 and CASP3) in the corresponding granulosa cells (GCs) in buffalo. Another objective was to evaluate whether the AMH concentration in FF and gene expression of GCs is associated with the antral follicular count. Ovaries were collected at the slaughterhouse, and all follicles were counted and classified as small (3–5 mm), medium (5–8 mm), and large (>8 mm). Follicular fluid was recovered for AMH determination, and the mRNA expression of AMHR2, FSHR, LHR, CYP19A1, TP53INP1, and CASP3 was analyzed in GCs. The AMH concentration in FF decreased (P < 0.01) at increasing follicular diameter. The mRNA expression of AMHR2 and FSHR was higher (P < 0.05) in small follicles, whereas that of LHR and CYP19A1 was higher (P < 0.05) in large follicles. The intrafollicular AMH concentration was positively correlated with the antral follicular count (r = 0.31; P < 0.05). Interestingly, good donors (≥12 follicles) had a higher (P < 0.05) concentration of AMH and AMHR2 levels in small follicles and higher (P < 0.05) LHR levels in large follicles than bad donors (<12 follicles). These results suggest a potential use of AMH to select buffalo donors to enroll in embryo production programs, laying the basis for further investigations.

Use of anti-mullerian hormone for testing ovarian reserve: a survey of 796 infertility clinics worldwide.

The aim of this study is to assess how anti-mullerian hormone (AMH) is used worldwide to test ovarian reserve and guide in vitro fertilization (IVF) cycle management. An internet-based survey was sent electronically to registered IVF providers within the IVF-Worldwide.com network. This survey consisted of nine questions which assessed the clinics' use of AMH. The questionnaire was completed online through the IVF-Worldwide.com website, and quality assurance tools were used to verify that only one survey was completed per clinical IVF center. Results are reported as the proportion of IVF cycles represented by a particular answer choice. Survey responses were completed from 796 globally distributed IVF clinics, representing 593,200 IVF cycles worldwide. Sixty percent of the respondent-IVF cycles reported to use AMH as a first line test, and 54 % reported it as the best test for evaluating ovarian reserve. Eighty-nine percent reported that AMH results were extremely relevant or relevant to clinical practice. However in contrast, for predicting live birth rate, 81 % reported age as the best predictor. AMH is currently considered a first line test for evaluating ovarian reserve and is considered relevant to clinical practice by the majority of IVF providers.

The correlations of anti-mullerian hormone, follicle-stimulating hormone and antral follicle count in different age groups of infertile women.

The objective of our study was to identify the correlations between the tests currently used in ovarian reserve assessment: anti-Mullerian hormone (AMH), follicle stimulating hormone (FSH) and antral follicle count (AFC) and to distinguish the most reliable markers for ovarian reserve in order to select an adequate strategy for the initial stages of infertility treatment. In this prospective study, 112 infertile women were assessed. Subjects were divided into three age groups: group I <35 years (n=39), group II 35-40 years (n=31), and group III 41-46 years (n=42). AMH, FSH and AFC were determined on days 2-3 of the patients' menstrual cycles. There was a significantly elevated negative correlation between age and AMH level (rs=-0.67, p<0.0001) and AFC (rs=-0.55, p<0.0001). We observed a significantly positive correlation between age and FSH (rs=0.38, p<0.0001). AMH negatively correlated with FSH (rs=-0.48, p<0.0001) and positively with AFC (r=-0.71, p=0.0001). There was a moderate negative relation between FSH and AFC (r=-0.41, p=0.0001) and moderate positive relation between age and FSH (rs=0.38, p<0.0001). The correlation analysis performed in separate groups showed that AMH and AFC showed a statistically significant positive correlation for group I (r=0.57, p<0.0001), group II (r=0.69, p<0.0001) and group III (r=0.47, p<0.002). A statistically significant correlation between FSH and AMH was detected only in groups I (r=-0.41, p<0.02) and II (r=-0.55, p<0.0001). A statistically significant correlation existed between FSH and AFC only in group III (r=-0.42, p<0.006), as well as between age and AFC only in group I (r=-0.35, p<0.03). Currently, AMH should be considered as the more reliable of the ovarian reserve assessments tests compared to FSH. There is a strong positive correlation between serum AMH level and AFC. The use of AMH combined with AFC may improve ovarian reserve evaluation.

Anti-mullerian hormone is expressed by endometriosis tissues and induces cell cycle arrest and apoptosis in endometriosis cells.

BackgroundThe anti-mullerian hormone (AMH) is a member of the transforming growth factor β (TGF-β) superfamily, which is responsible of the regression of the mullerian duct. AMH is expressed in the normal endometrium, where, acting in a paracrine fashion, negatively regulates cellular viability. Our objective was to evaluate the in vitro effects of the treatment with AMH of endometriosic cells.MethodsAMH expression in human endometriosis glands was evaluated by immunohistochemistry. RT-PCR has been used to quantify the expression levels of AMH and AMH RII isoforms, as well as of cytochrome P450 in both endometriosis epithelial and stromal cells Effects of AMH and AMH-cleaved treatment in endometriosis cells were evaluated by flow-cytometry analysis. Finally, it has been evaluated the effect of plasmin-digested AMH on cytochrome P450 activity.ResultsAMH and AMH RII isoforms, as well as cytochrome P450, were expressed in both endometriosis epithelial and stromal cells. Treatment of endometriosis stromal and epithelial cell growth with AMH was able to induce a decrease in the percentage of cells in S phase and increase percentage of cells in G1 and G2 phase; coherently, decreased cell viability and increased percentage of cells death fraction was observed. The plasmin-digested AMH was able to suppress most of the cytochrome P450 activity, causing an increase of pre-G1 phase and of apoptosis induction treating with plasmin-digested AMH in both cell lines, most marked in the epithelial cells.ConclusionsThe data produced suggest a possible use of AMH as therapeutic agents in endometriosis.

Anti-Mullerian hormone normogram in an Irish subfertile population

There has been much interest in the use of anti-Mullerian hormone (AMH) as a biomarker in the assessment of ovarian reserve, and debate on its use as a predictor of assisted reproductive technology (ART) outcomes. Normal levels have not been well defined, and age-based reference ranges may have a role in counselling patients. To determine AMH levels in females attending with subfertility, identify age-specific centiles and the age-related decline, to create population normograms to be used in patient counselling prior to ART. Retrospective study in a tertiary academic Assisted Conception Centre analysing AMH levels in female patients attending for investigation of subfertility between January 2009 and December 2011 (n = 3,058). Few patients have AMH levels within external laboratory pre-defined "normal fertility potential" ranges. Only 8.1 % had "optimal fertility" and 18.6 % "satisfactory", with 54.6 % "low" fertility and 15.9 % in the "very low/undetectable" group. By age 32, over 50 % of women have AMH levels categorised as "low fertility" (AMH ≤19.5 pmol/L), increasing to 75 % by age 39. Based on a regression model a decrease in mean AMH of 1.72 pmol/L/year was measured. We recommend that each ART centre defines their "own" normograms for accurate advice for and treatment of their patients. External laboratory-defined "normal" and "abnormal" AMH levels should be filtered and adapted to the reality of each population. These findings need to be considered when counselling patients and planning treatments as age-specific population normograms can provide a tailored approach.

The combined use of antimullerian hormone and age to predict the ovarian response to controlled ovarian hyperstimulation in poor responders: A novel approach

CONTEXT:Reduced ovarian response to stimulation represents one of the most intractable problems in infertility treatment. As failed cycle can cause considerable amount of emotional and economical loss, there are various attempts made to predict ovarian response.AIMS:To evaluate different factors influencing outcome of assisted reproduction in women with predicted reduced response (antimullerian hormone between 1 and 5 pmol/L) and to develop a model using of AMH and age to predict the number of oocytes in poor responders.SETTINGS AND DESIGN:Retrospective study in a teaching hospital.MATERIALS AND METHODS:We analyzed 85 cycles (57 women) with predicted reduced response with serum AMH value between 1 and 5 pmol/L. Standard ovarian stimulation protocol was used. Primary outcome measures were clinical pregnancy rates and oocytes retrieved.STATISTICAL ANALYSIS USED:Data were analyzed using Microsoft excel and MetlabR software.RESULTS:Clinical pregnancy rate/ET was 20.33%, in this group. AMH and age was analyzed using linear regression model which produced an equation to give predicted oocyte count if AMH and age are known. (Oocytes = age × (-ß) + Serum AMH × α) (Constant ß=0.0102 and α = 1.0407).CONCLUSIONS:Combined use of serum AMH and age to predict ovarian response within reduced responder group should be further evaluated. For first time, we suggested combining both factors to predict ovarian response using a simple equation which allow developing tailored strategy.

Role of Anti-Müllerian Hormone in Diagnosing Granulosa Cell Tumor: A Case Report

Introduction Anti-Mullerian hormone (AMH) is becoming commonly used in a range of clinical situations in reproductive medicine clinics. Much of the work on AMH is concentrated on its role as an ovarian reserve marker. The emerging value of AMH in the diagnosis and follow-up of patients with granulosa cell tumor (GCT) of the ovary and its vital role in predicting fertility preservation strategies in female patients needing chemotherapy for malignancies has expanded the use of AMH in clinical practice.

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.