Kadın İnfertilitesinde AMH’nin Değerlendirilmesi ve Yorumlanması

Abstract

Anti-Müllerien hormon (AMH), çapı 8 mm’nin altında olan pre-antral ve antral over foliküllerinin granüloza hücreleri tarafından salgılanan bir glikoproteindir. AMH, hem primordial folliküllerin primer folliküllere gelişimini hem de antral folliküllerin siklik recruitment aşamasında folikül uyarıcı hormona (follicle stimulating hormone, FSH) duyarlılığını inhibe ederek bir “folikül bekçisi” olarak görev yapar. AMH, folikül havuzundaki azalmanın erken bir belirteci olarak kabul edilmektedir. AMH düzeylerinin tüm menstrüel siklus boyunca sabit değerlerde olduğu kabul edilmekle birlikte, yüksek duyarlılıklı otomatize kitlerle yapılan çalışmalarda, hem aynı siklus içinde hem de farklı sikluslar arasında değişkenlik gösterdiği saptanmıştır. Yaşlanmanın yanı sıra, vücut kitle indeksi, obezite, oral kontraseptif kullanımı, geçirilmiş over cerrahisi, kemoterapi, BRCA mutasyonları ve etnik köken de AMH değerleri üzerinde etkiye sahiptir. Polikistik over sendromu (PKOS), artmış AMH düzeyi ile ilişkilidir ve bu nedenle tanı kriteri olarak kullanılması önerilmektedir. Bununla birlikte, AMH için PKOS tanısında kullanılacak evrensel olarak kabul edilmiş bir eşik değer belirlenmemiştir. AMH değerleri, yardımcı üreme tekniklerinde ideal bir tedavi protokolünün belirlenmesi için de kullanılmaktadır. AMH ölçümleri zayıf veya aşırı over cevabının öngörülmesi için kullanılabilir. AMH düzeylerinin gebelik sonuçlarının öngörülmesindeki yeri tartışmalıdır.

Keywords

• Anti-Müllerian hormon
• kadın
• infertilite

Evaluation and Interpretation of AMH in Female Infertility

Abstract

Anti-Müllerian hormone (AMH) is a glycoprotein that secreted by the granulosa cells of the pre-antral and antral ovarian follicles that have a diameter <8 mm. By inhibiting both initial recruitments of primordial follicles into primary follicles and also the sensitivity of antral follicles to follicle stimulating hormone (FSH) in cyclic recruitment AMH acts as a “follicular gatekeeper”. AMH is recognized as an early marker of the decline in the follicular pool. Although AMH levels are accepted to be stable all through the menstrual cycle, inter- and intracycle variability are detected in the studies with the highly sensitive automated assays. Besides aging, body mass index, obesity, oral contraceptive use, previous ovarian surgery, chemotherapy, BRCA mutations, and ethnicity play a role on the AMH levels. Polycystic ovary syndrome (PCOS) is related with increased AMH level and thus proposed to be used as a diagnostic criterion. However, there is no universally accepted threshold value for AMH that can be used in the diagnosis of PCOS. AMH levels have also been used for designing an ideal treatment protocol in assisted reproduction. AMH measurements can be utilized for the prediction of poor or hyper ovarian response. The value of AMH levels in the prediction of pregnancy outcome remains controversial.

Keywords

• Anti-Müllerian hormone
• female
• infertility

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