Kadın İnfertilitesinde AMH’nin Değerlendirilmesi ve Yorumlanması

Year 2022, Volume: 24 Issue: Special Issue, 82 - 85, 30.10.2022

Berna Dilbaz , Şule Atalay Mert

https://doi.org/10.18678/dtfd.1186131

Cited By: 1

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

References

• Josso N, Rey RA, Picard JY. Anti-müllerian hormone: a valuable addition to the toolbox of the pediatric endocrinologist. Int J Endocrinol. 2013;2013:674105.
• La Marca A, Spada E, Grisendi V, Argento C, Papaleo E, Milani S, et al. Normal serum anti-Müllerian hormone levels in the general female population and the relationship with reproductive history. Eur J Obstet Gynecol Reprod Biol. 2012;163(2):180-4.
• Barbakadze L, Kristesashvili J, Khonelidze N, Tsagareishvili G. The correlations of anti-mullerian hormone, follicle-stimulating hormone and antral follicle count in different age groups of infertile women. Int J Fertil Steril. 2015;8(4):393-8.
• de Vet A, Laven JS, de Jong FH, Themmen AP, Fauser BC. Antimüllerian hormone serum levels: a putative marker for ovarian aging. Fertil Steril. 2002;77(2):357-62.
• Weenen C, Laven JSE, von Bergh AR, Cranfield M, Groome NP, Visser JA, et al. Anti‐Müllerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment. Mol Hum Reprod. 2004;10(2):77-83.
• Grynberg M, Pierre A, Rey R, Leclerc A, Arouche N, Hesters L, et al. Differential regulation of ovarian anti-müllerian hormone (AMH) by estradiol through α- and β-estrogen receptors. J Clin Endocrinol Metab. 2012;97(9):E1649-57.
• Jeppesen JV, Anderson RA, Kelsey TW, Christiansen SL, Kristensen SG, Jayaprakasan K, et al. Which follicles make the most anti-Müllerian hormone in humans? Evidence for an abrupt decline in AMH production at the time of follicle selection. Mol Hum Reprod. 2013;19(8):519-27.
• Eilsø Nielsen M, Rasmussen IA, Fukuda M, Westergaard LG, Yding Andersen C. Concentrations of anti-Müllerian hormone in fluid from small human antral follicles show a negative correlation with CYP19 mRNA expression in the corresponding granulosa cells. Mol Hum Reprod. 2010;16(9):637-43.
• Mamsen LS, Bøtkjær JA, Kristensen SG, Pors SE, Jeppesen JV, Kumar A, et al. High variability of molecular isoforms of AMH in follicular fluid and granulosa cells from human small antral follicles. Front Endocrinol (Lausanne). 2021;12:617523.
• Lie Fong S, Visser JA, Welt CK, de Rijke YB, Eijkemans MJC, Broekmans FJ, et al. Serum anti-müllerian hormone levels in healthy females: a nomogram ranging from infancy to adulthood. J Clin Endocrinol Metab. 2012;97(12):4650-5.
• Moolhuijsen LME, Visser JA. Anti-Müllerian hormone and ovarian reserve: update on assessing ovarian function. J Clin Endocrinol Metab. 2020;105(11):3361-73.
• Sherman BM, West JH, Korenman SG. The menopausal transition: analysis of LH, FSH, estradiol, and progesterone concentrations during menstrual cycles of older women. J Clin Endocrinol Metab. 1976;42(4):629-36.
• Tsepelidis S, Devreker F, Demeestere I, Flahaut A, Gervy Ch, Englert Y. Stable serum levels of anti-Müllerian hormone during the menstrual cycle: a prospective study in normo-ovulatory women. Hum Reprod. 2007;22(7):1837-40.
• Overbeek A, Broekmans FJ, Hehenkamp WJ, Wijdeveld ME, van Disseldorp J, van Dulmen-den Broeder E, et al. Intra-cycle fluctuations of anti-Müllerian hormone in normal women with a regular cycle: a re-analysis. Reprod Biomed Online. 2012;24(6):664-9.
• Moslehi N, Shab-Bidar S, Ramezani Tehrani F, Mirmiran P, Azizi F. Is ovarian reserve associated with body mass index and obesity in reproductive aged women? A meta-analysis. Menopause. 2018;25(9):1046-55.
• Oh SR, Choe SY, Cho YJ. Clinical application of serum anti-Müllerian hormone in women. Clin Exp Reprod Med. 2019;46(2):50-9.
• Dennis NA, Houghton LA, Jones GT, van Rij AM, Morgan K, McLennan IS. The level of serum anti-Müllerian hormone correlates with vitamin D status in men and women but not in boys. J Clin Endocrinol Metab. 2012;97(7):2450-5.
• van den Berg MH, van Dulmen-den Broeder E, Overbeek A, Twisk JW, Schats R, van Leeuwen FE, et al. Comparison of ovarian function markers in users of hormonal contraceptives during the hormone-free interval and subsequent natural early follicular phases. Hum Reprod. 2010;25(6):1520-7.
• Pigny P, Merlen E, Robert Y, Cortet-Rudelli C, Decanter C, Jonard S, et al. Elevated serum level of anti-mullerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest. J Clin Endocrinol Metab. 2003;88(12):5957-62.
• Tal R, Seifer DB, Khanimov M, Malter HE, Grazi RV, Leader B. Characterization of women with elevated antimüllerian hormone levels (AMH): correlation of AMH with polycystic ovarian syndrome phenotypes and assisted reproductive technology outcomes. Am J Obstet Gynecol. 2014;211(1):59.e1-8.
• Pellatt L, Hanna L, Brincat M, Galea R, Brain H, Whitehead S, et al. Granulosa cell production of anti-Müllerian hormone is increased in polycystic ovaries. J Clin Endocrinol Metab. 2007;92(1):240-5.
• Wongwananuruk T, Panichyawat N, Indhavivadhana S, Rattanachaiyanont M, Angsuwathana S, Techatraisak K, et al. Accuracy of anti-Müllerian hormone and total follicles count to diagnose polycystic ovary syndrome in reproductive women. Taiwan J Obstet Gynecol. 2018;57(4):499-506.
• Song DK, Oh JY, Lee H, Sung YA. Differentiation between polycystic ovary syndrome and polycystic ovarian morphology by means of an anti-Müllerian hormone cutoff value. Korean J Intern Med. 2017;32(4):690-8.
• Coskun B, Dilbaz B, Karadag B, Coskun B, Tohma YA, Dur R, et al. The role of anti-Mullerian hormone in predicting the response to clomiphene citrate in unexplained infertility. Taiwan J Obstet Gynecol. 2018;57(5):713-7.
• Xi W, Yang Y, Mao H, Zhao X, Liu M, Fu S. Circulating anti-mullerian hormone as predictor of ovarian response to clomiphene citrate in women with polycystic ovary syndrome. J Ovarian Res. 2016;9:3.
• Hamdine O, Eijkemans MJ, Lentjes EW, Torrance HL, Macklon NS, Fauser BC, et al. Ovarian response prediction in GnRH antagonist treatment for IVF using anti-Müllerian hormone. Hum Reprod. 2015;30(1):170-8.
• Tian T, Chen L, Yang R, Long X, Li Q, Hao Y, et al. Prediction of fertilization disorders in the in vitro fertilization/intracytoplasmic sperm injection: a retrospective study of 106,728 treatment cycles. Front Endocrinol (Lausanne). 2022;13:870708.
• Ovarian Stimulation TEGGO, Bosch E, Broer S, Griesinger G, Grynberg M, Humaidan P, et al. ESHRE guideline: ovarian stimulation for IVF/ICSI†. Hum Reprod Open. 2020;2020(2):hoaa009.
• Toner JP, Seifer DB. Why we may abandon basal follicle-stimulating hormone testing: a sea change in determining ovarian reserve using antimüllerian hormone. Fertil Steril. 2013;99(7):1825-30.
• Zhao D, Fan J, Wang P, Jiang X, Yao J, Li X. Age-specific definition of low anti-Mullerian hormone and associated pregnancy outcome in women undergoing IVF treatment. BMC Pregnancy Childbirth. 2021;5;21(1):186.