Serum anti-Müllerian hormone: a novel marker of ovarian responsiveness in IVF cycles
Feng-po Tsai, Chao-wen Chen, Hsun-ming Chang,Chao-chang Lin, Hsiao-ching Chen,Yueh-chiao Chang,Chun-chun Chen,Mone-li Peng
Poyuan Women Clinic IVF centre
Introduction
Anti-Müllerian hormone (AMH) expression starts in the columnar granulosa cells of primary follicles immediately after differentiation from the flattened pregranulosa cells of primordial follicles. Expression is highest in granulosa cells of preantral and small antral follicles. AMH is no longer expressed during the FSH-dependant final stage of follicle development. Therefore, AMH reflects the number of follicles that have made the transition from the primordial pool into the growing pool, and that is not controlled by gonadotropins. In contrast to FSH, inhibin B and E2, AMH level remain relatively constant during entire menstrual cycle. This characteristic benefits both patients and clinicians.
Material and method
We review 50 IVF patients from December 1, 2007 till July 31, 2008 retrospectively.
The ovarian response was determined by the E2 level on the day of HCG , the number of oocyt yield (mature and immature) and the number of embryos. .
Result
AMH levels showed a positive correlation with number of oocyte yield, immature oocytes, E2 level on the day of HCG injection, and the number of embryo. It also showed a negative correlation with basal serum FSH level. We divided 50 patients into 3 groups based on AMH level : group 1 (AMH <2ng/ml), group2(AMH≧2ng/ml and <4ng/ml)and group 3( AMH≧4ng/ml). A statistics significance was noted between the 3 groups on oocyte yield ( 3.84, 7.56 and 11.1 respectively), E2 level (951.38, 1420.38 and 1558.74 respectively), the number of immature oocyte (0.23, 1.11 and 2.16) and the embryo number (3.0, 5.28 and 7.0).
Fig1: AMH levels showed a positive correlation with number of oocyte yield
Fig2: AMH levels showed a negative correlation with basal serum FSH level.
Discussion(1)
In this study, we demonstrate that high AMH is associated with higher number of oocyte yield and subsequently embryos available for transfer. This result is consistent with other studies that suggest AMH as a predictor of ovarian response to gonadotropins in cycles of ART (van Rooij et al.,2002,Fanchin et al.,2003,Hazout et al.,2004, Muttukrishna et al., 2004,2005, Penarrubia et al.,2005)
AMH has been shown to not fluctuate across the menstrual cycles (Cook et al.,2000, La Marca et al.,2004,2006), consistent with its role reflecting the continuous, non-cyclic growth of small follicles in the ovary. This characteristic of AMH makes it become a convenient test for patients and clinicians
Discussion(2)
It is important for a clinician to be able to predict both extremes of response who are at risk of ovarian hyperstimulation syndrome and poor responders who are at risk of cycles cancellation. A reliable indicator of ovarian response to stimulation during IVF treatment can be used to modify therapeutic approaches individually.
Due to the limited size of our study, we failed to demonstrate the possible cut-off level of AMH to predict the occurrence of OHSS.
Conclusion
AMH level seems to be a reliable marker to forecast the ovarian response and may help individualization of therapy in IVF treatment.
Serum anti-Mullerian hormone: a novel marker of ovarian responsiveness in IVF cycles
Chao-wen Chen, Feng-po Tsai, Chao-chang Lin
Poyuan Women Clinic IVF centre
Background: Anti-Mullerian hormone (AMH) expression starts in the columnar granulosa cells of primary follicles immediately after differentiation from the flattened pregranulosa cells of primordial follicles. Expression is highest in granulosa cells of preantral and small antral follicles. AMH is no longer expressed during the FSH-dependant final stage of follicle development. Therefore, AMH reflects the number of follicles that have made the transition from the primordial pool into the growing pool, and that is not controlled by gonadotropins. In contrast to FSH, inhibin B and E2, AMH level remain relatively constant during entire menstrual cycle. This characteristic benefits both patients and clinicians.
Study design: We review 50 IVF patients from December 1, 2007 till July 31, 2008 retrospectively. The ovarian response was determined by the E2 level on the day of HCG , the number of oocyt yield (mature and immature) and the number of embryos.
Result: AMH levels showed a positive correlation with number of oocyte yield, immature oocytes, E2 level on the day of HCG injection, and the number of embryo. It also showed a negative correlation with basal serum FSH level. We divided 50 patients into 3 groups based on AMH level : group 1 (AMH <2ng/ml), group2(AMH≧2ng/ml and <4ng/ml)and group 3( AMH≧4ng/ml). A statistics significance was noted between the 3 groups on oocyte yield ( 3.84, 7.56 and 11.1 respectively), E2 level (951.38, 1420.38 and 1558.74 respectively), the number of immature oocyte (0.23, 1.11 and 2.16) and the embryo number (3.0, 5.28 and 7.0).
Conclusion: AMH level seems to be a reliable marker to forecast the ovarian response and may help individualization of therapy in IVF treatment.
http://www.libertytimes.com.tw/2010/new/sep/14/today-health2.htm 抽血檢測AMH ，可測知卵巢功能，生育力高或低。 （記者吳為恭攝） 記者吳為恭／彰化報導 45歲的作 家吳淡如成功懷孕生子消息曝光後，讓高齡熟女燃起「生」機，彰化市博元婦產科醫院表示 ，其實，熟女不必碰運氣或猜測還能不能生子，只要抽血進行抗穆式管荷爾蒙（AMH）檢測， 即可測知卵巢功能、生育力高或低，擬定自己的生子計畫。 抗穆式管荷爾蒙，是不成熟卵" />
http://www.libertytimes.com.tw/2010/new/sep/14/today-health2.htm 抽血檢測AMH ，可測知卵巢功能，生育力高或低。 （記者吳為恭攝） 記者吳為恭／彰化報導 45歲的作 家吳淡如成功懷孕生子消息曝光後，讓高齡熟女燃起「生」機，彰化市博元婦產科醫院表示 ，其實，熟女不必碰運氣或猜測還能不能生子，只要抽血進行抗穆式管荷爾蒙（AMH）檢測， 即可測知卵巢功能、生育力高或低，擬定自己的生子計畫。 抗穆式管荷爾蒙，是不成熟卵" /> 熟女生育力 AMH一測便知 
http://udn.com/NEWS/HEALTH/HE A2/5961787.shtml 2010.11.09 02:29 am 台中縣趙姓婦人結婚8年不孕，檢查發現子宮裡竟有「蜘蛛網 」，進一步檢查確認架網凶手正是披衣菌；她和丈夫一起服用抗生素滅菌，再由外科手術清 除子宮裡的「障礙」，順利懷孕生子。 31歲趙姓婦人為求子嗣，四處求醫，曾藉由人工生殖 技術懷孕卻流產，調好身體後繼續求子，醫師使用子宮鏡深入查看，竟看到婦人的子宮內有 網狀物，很" /> 子宮內披衣菌 8年不孕 【聯合報╱記者簡慧珍／彰化縣報導】 2010.11.09 10:14 am 台中縣趙姓婦人結婚8年不孕，檢查發現子宮裡竟有「蜘蛛網」，進一步檢查確認架網凶手正是披衣菌；她和丈夫一起服用抗生素滅菌，再由外科手術清除子宮裡的「障礙」，順利懷孕生子。 31歲趙姓婦人為求子嗣，四處求醫，曾藉由人工生殖技術懷孕卻流產，調好身體後繼續求子，醫師使用子宮鏡深入查看，竟看到婦人的子宮內有網狀物，很像蜘蛛網，懷疑是披衣菌留下的網狀沾黏，抽血檢查果然是披衣菌惹禍。 趙姓婦人聽到檢查結果，第一個反應是：「我丈夫在外拈花惹草？」丈夫發誓說：「我沒有！」 彰化市博元婦產科醫師蔡鋒博說，披衣菌盛行率因地而異，台灣某都市醫學調查有33%受檢婦女感染披衣菌；全球文獻資料顯示，千分之5到8的婦女感染披衣菌。醫界證實，大多數披衣菌患者是經由性行為感染，因為90%病人毫無症狀，等到不孕才知「事情大條」。 蔡鋒博表示，世界衛生組織調查，全球傳播速度最快的性病是披衣菌，年增9200萬人，其餘依序是淋病和梅毒；不孕症夫婦中，有11.5%是披衣菌帶原者；男性被感染後可能發生尿道增生分泌物、睪丸腫脹等不適症狀，女性可能有陰道分泌物增加、下腹疼痛、輸卵管發炎等症狀，令人擔憂的是75%到90%的婦女沒症狀。 【2010/11/09 聯合報】@ 
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