Association between Metal(loid)Exposure and Risk of Polycystic Ovary Syndrome Mediated by Anti-Müllerian Hormone among Women Undergoing In Vitro Fertilization and Embryo Transfer

Objective To investigate the relationship and potential pathways between metal(loid)exposure and the risk of polycystic ovary syndrome(PCOS)in women of childbearing age.Methods This case-control study included 200 patients with PCOS(cases)and 896 non-PCOS controls with the age of 25-37 years.The concentrations of 29 metal(loid)s in the follicular fluid(FF)and clinical indicators in the serum were measured in all participants.Logistic regression analysis and mediation analysis were conducted to evaluate the associations between metal(loid)exposure and PCOS risk and investigate the possible roles of clinical indicators,respectively.Results Logistic regression analysis revealed an association between high copper levels in FF and increased PCOS risk(highest vs.lowest quartile:adjusted odds ratio=2.94,95%confidence interval:1.83-4.72).A high luteinizing hormone/follicle-stimulating hormone ratio and elevated levels of testosterone and anti-Müllerian hormone(AMH)were strongly associated with increased PCOS risk induced by high copper exposure.The mediation analysis indicated a mediating effect of AMH in the association between copper exposure and PCOS risk.Conclusion Copper may affect PCOS risk through the hypothalamic-pituitary-ovarian axis,mediated by AMH.Copper exposure and internal AMH levels are important indicators for early warning of PCOS development.

Seminal plasma anti-Müllerian hormone level correlates with semen parameters but does not predict success of testicular sperm extraction （TESE）

Aim： To assess seminal plasma anti-Müllerian hormone （AMH） level relationships in fertile and infertile males. Methods： Eighty-four male cases were studied and divided into four groups： fertile normozoospermia （n = 16）, oligoastheno- teratozoospermia （n = 15）, obstructive azoospermia （OA） （n = 13） and non-obstructive azoospermia （NOA） （n = 40）. Conventional semen analysis was done for all cases. Testicular biopsy was done with histopathology and fresh tissue examination for testicular sperm extraction （TESE） in NOA cases. NOA group was subdivided according to TESE results into unsuccessful TESE （n = 19） and successful TESE （n = 21）. Seminal plasma AMH was estimated by enzyme linked immunosorbent assay （ELISA） and serum follicular stimulating hormone （FSH） was estimated in NOA cases only by radioimmunoassay （RIA）. Results： Mean seminal AMH was significantly higher in fertile group than in oligoasthenoteratozoospermia with significance （41.5±10.9 pmol/L vs. 30.5±10.3 pmol/L, P 〈 0.05）. Seminal AMH was not detected in any OA patients. Seminal AMH wascorrelated positively with testicular volume （r = 0.329, P = 0.005）, sperm count （r = 0.483, P = 0.007）, sperm motility percent （r = 0.419, P = 0.021） and negatively with sperm abnormal forms percent （r = -0.413, p = 0.023）. Nonsignificant correlation was evident with age （r = -0.155, P = 0.414） and plasma FSH （ r = -0.014, P = 0.943）. In NOA cases, seminal AMH was detectable in 23/40 cases, 14 of them were successful TESE （57.5%） and was undetectable in 17/40 cases, 10 of them were unsuccessful TESE （58.2%）. Conclusion： Seminal plasma AMH is an absolute testicular marker being absent in all OA cases. However, seminal AMH has a poor predictability for successful testicular sperm retrieval in NOA cases.

Anti-Müllerian hormone and antral follicle count predict ovarian response in women less than 45 years following GnRH antagonist multiple-dose protocol

Objective:To speculate which of the following parameters:antral follicle count(AFC),anti-Müllerian hormone(AMH),follicle-stimulating hormone(FSH)and age can be used as a predictor of ovarian response to gonadotropin-releasing hormone(GnRH)antagonist stimulation multiple-dose protocol in women under 45 years,and to determine the cutoff value of these parameters and their correlations for predicting low and high ovarian response.Methods:This prospective study included 462 women with the mean age of(29.3±6.5)years.All women were subjected to the GnRH antagonist stimulation multiple-dose protocol.On the second day of the menstrual cycle,ultrasonography was conducted to determine AFC in both ovaries.Peripheral blood samples were collected to evaluate the level of estradiol,FSH,luteinizing hormone,prolactin,thyroid-stimulating hormone,and AMH.The women were divided into three groups:low response(AHH<1 ng/mL,n=173),normal response(AMH=1.0-3.5 ng/mL,n=175),and high response(AMH>3.5 ng/mL,n=114).Results:A significant decrease was found in the age and FSH level in the high response group compared to other groups(P<0.001).Conversely,a significant increase was shown in AMH,estradiol on human chorionic gonadotropin(hCG)day,AFC,mature oocytes,fertilized oocytes,and embryos transferred in the high response group compared to the other two groups(P<0.001).The receiver operating characteristic(ROC)curves demonstrated that AFC and AMH had the highest accuracy,followed by basal FSH level and age in the prediction of low ovarian reserves(P<0.001)with cutoff values of≤4.50 and≤0.95 for AFC and AMH,respectively.Moreover,the ROC analysis showed that AFC had the highest accuracy,followed by AMH level and age in the prediction of high ovarian reserves with a cutoff value of≥14.50,≥3.63,and≤27.50 years,respectively(P<0.01).A significant decrease was observed in women's age,estradiol level,and oocyte fertilization rate in pregnant women compared to non-pregnant women(P<0.001).Additionally,significant negative correlations were found between the AFC,the number of mature oocytes,fertilized oocytes,embryos transferred,and the age of pregnant women(P<0.001).Conclusions:AFC and AMH predict low and high ovarian response to GnRH antagonist stimulation multiple-dose protocol in women under 45 years.

Association between anti-Müllerian hormone concentrations and sperm retrieval outcomes in patients with idiopathic nonobstructive azoospermia:a systematic review and meta-analysis

Microdissection testicular sperm extraction(mTESE)is commonly performed to retrieve sperm in the testes for assisted reproductive techniques in patients with idiopathic nonobstructive azoospermia(iNOA).However,the success rate of sperm retrieval varies among individuals.We aim to investigate the association between clinical parameters and sperm retrieval outcomes in patients with iNOA.We searched PubMed,EMBASE,and Web of Science from database inception to August 2,2023.The main measure was whether sperm retrieval was successful in patients with iNOA who underwent mTESE.Pooled estimates of the sperm retrieval rate and weighted mean differences were calculated using random-effects models.The overall sperm retrieval rate was 36.8%(95%confidence interval[CI]:27.5%-46.0%,I 2=95.0%)in nine studies comprising 1892 patients with iNOA.No significant differences were found in age,testicular volume,serum total testosterone concentrations,or inhibin B concentrations between positive and negative sperm retrieval outcomes.Lower anti-Müllerian hormone concentrations in patients with iNOA were associated with a positive outcome of mTESE(weighted mean differences:−2.70;95%CI:−3.94-−1.46,I 2=79.0%).In conclusion,this study shows a significant relationship between anti-Müllerian hormone and sperm retrieval outcomes in patients with iNOA,while age,testicular volume,total testosterone,and inhibin B show no significant association.These findings have important implications for assessing the potential success of sperm retrieval and selecting appropriate treatment strategies in patients with iNOA.

Evaluation of Serum Anti-Müllerian Hormone (AMH) Values for 28,016 Bulgarian Women: Prognostic Statistical Model of Age Specific AMH Declining

The present study aims to establish a relationship between serum AMH levels and age in a large group of women living in Bulgaria, as well as to establish reference age-specific AMH levels in women that would serve as an initial estimate of ovarian age. A total of 28,016 women on the territory of the Republic of Bulgaria were tested for serum AMH levels with a median age of 37.0 years (interquartile range 32.0 to 41.0). For women aged 20 - 29 years, the Bulgarian population has relatively high median levels of AMH, similar to women of Asian origin. For women aged 30 - 34 years, our results are comparable to those of women living in Western Europe. For women aged 35 - 39 years, our results are comparable to those of women living in the territory of India and Kenya. For women aged 40 - 44 years, our results were lower than those for women from the Western European and Chinese populations, close to the Indian and higher than Korean and Kenya populations, respectively. Our results for women of Bulgarian origin are also comparable to US Latina women at age 30, 35 and 40 ages. On the base on constructed a statistical model to predicting the decline in AMH levels at different ages, we found non-linear structure of AMH decline for the low AMH 3.5) the dependence of the decline of AMH on age was confirmed as linear. In conclusion, we evaluated the serum level of AMH in Bulgarian women and established age-specific AMH percentile reference values based on a large representative sample. We have developed a prognostic statistical model that can facilitate the application of AMH in clinical practice and the prediction of reproductive capacity and population health.

Anti-Müllerian Hormone and Its Utility in Cattle Reproduction

Reproductive biotechnologies offer us greater possibilities to improve animal genetics. However, the success of these depends on different factors such as the proper selection of the donor female. For this reason, endocrine markers have been used to evaluate the ovarian reserve, which allow a successful selection of donors. Recent research has shown, among other things, that concentrations greater than 0.130 ng/mL of anti-Mullerian hormone (also known as Muller-inhibiting substance, which is a member of the transforming growth factor beta superfamily of growth and differentiation factors) are related to donors of more than fifteen transferable embryos. Therefore, this review describes studies showing that the measurement of anti-Müllerian hormone concentrations, before superovulation programs, reduces the costs per embryo produced.

Potential Application of Anti-Müllerian Hormone in Polycystic Ovary Syndrome According to Chinese Classification Criteria:A Retrospective Analysis

Objective:Anti-Müllerian hormone(AMH)expression is elevated in patients with polycystic ovary syndrome(PCOS),however,its clinical significance is not clear.Owing to the strong correlation between AMH and polycystic ovarian morphology(PCOM),some studies believe that AMH alone can be used to diagnose PCOS.The aim of this study was to explore whether AMH can be used to diagnose PCOS and to differentiate the various PCOS subtypes.Methods:This was a retrospective study of 503 patients with PCOS.Patients were divided into eight subtypes based on the presence/absence of hyperandrogenemia(HA),insulin resistance(IR),or obesity(OB).The expression characteristics of AMH in each subtype were analyzed.Due to the small number of patients with subtypes 7 and 8,only patients with subtypes 1-6 were included in the analysis.Results:AMH showed a good positive correlation with PCOM(P=0.000)and negative correlations with OB(P=0.000)and IR(P=0.003).The free testosterone index showed no correlation with AMH(P=0.803).The percentages of patients with each subtype(excluding subtypes 7-8)and their respective AMH levels were as follows:Type 1(HA+NIR+OB)4.77% and 9.12 ng/mL;Type 2(HA+IR+NOB)20.68% and 10.34 ng/mL;Type 3(HA+NIR+NOB)23.66% and 9.47 ng/mL;Type 4(HA+IR+OB)30.82% and 8.32 ng/mL;Type 5(NHA+NIR+NOB)11.73% and 10.0 ng/mL;and Type 6(NHA+IR+NOB)6.16% and 9.76 ng/mL.The diagnostic rates of AMH(>8.09 ng/mL)and ultrasound for PCOM were 60.10% and 85.60% ,respectively,suggesting that AMH did not completely predict PCOM.Conclusions:High AMH levels can be used to evaluate the incidence trend of PCOS.However,due to clinical heterogeneity,accurately evaluating the severity of PCOS and identifying the subtype of PCOS in Chinese patients are difficult.Individualized treatment should be administered based on accurate clinical subtypes and other clinical characteristics.

Circulating anti-Müllerian hormone as predictor of ovarian response to gonadotrophins in women with polycystic ovary syndrome

Objective To investigate the impact of high circulating anti-Müllerian hormone（AMH）on the outcome of ovulation induction using human menopausal gonadotropin（hM G）in women with polycystic ovary syndrome（PCOS）.Methods This prospective study included 63 anovulatory women with PCOS who underwent hM G ovarian stimulation. Serum AMH concentrations were compared between responders and non-responders. The receiver-operating characteristic（ROC）curve was used to evaluate the prognostic value of circulating AMH.Results hM G responders had a significantly lower serum AMH concentration compared with non-responders（8.43±2.18 μg/L vs 11.05±2.85 μg/L, P〈0.001）. In multivariate Logistic regression analysis, AMH was an independent predictor of ovulation induction by hM G in PCOS patients. ROC curve analysis showed AMH was a useful predictor of ovulation induction by hM G in PCOS patients, having 91.7% specificity and 66.7% sensitivity when the threshold AMH concentration was 10.12 μg/L.Conclusion Serum AMH can be used as an effective parameter to predict ovarian response to hM G treatment in PCOS patients.

Anti-Müllerian hormone, antral follicle count and folliclestimulating hormone for predicting the number of oocytes retrieved in IVF/ICSI cycles

Objective To evaluate the efficacy of anti-Müllerian hormone（AMH）, antral follicle count（AFC） and follicle-stimulating hormone（FSH） for predicting the number of oocytes retrieved in in-vitro fertilization/intracytoplasmic sperm injection（IVF/ICSI）cycles.Methods In this retrospective study, a total of 122 infertile women were divided into two groups： group A, 〈35 years（n=71）; group B, ≥35 years（n=51）. AMH and FSH were determined on 2-5 d of the early menstrual cycle. AFC was tested on the second day of the menstrual cycle before the start of stimulation.Results Group B had higher FSH levels compared with group A（8.2±3.5 IU/L vs 6.8±2.4 IU/L, P〈0.05）. However, levels of AMH and AFC in group B were lower than those of group A（AMH： 4.2±3.5 μg/L vs 2.7±2.7 μg/L; AFC： 9.0±3.9 vs 5.4±3.3, P〈0.05）. The number of oocyte retrieved in the two groups was not significantly different（11.5±6.8 vs 9.6±6.9, P〉0.05）. The level of AMH was more strongly correlated with the number of oocytes retrieved than that of AFC or FSH level. The strengths of the correlation degrees were AMH level, AFC, and FSH level in turn（r=0.600, 0.511,-0.369）.Conclusion AMH would be a useful predictor for ovarian response.

Comparison of body mass index, anti-müllerian hormone and insulin resistance parameters among different phenotypes of polycystic ovary syndrome

Background:Diagnosis of polycystic ovary syndrome(PCOS)depends on 2003 Rotterdam Criteria.According to these criteria there are four possible combinations resulting in various phenotypes.We aimed(i)to confirm that the levels of body mass index(BMI),anti-müllerian hormone(AMH)levels and insulin resistance(IR)are higher in PCOS patients and higher in phenotype-A among PCOS patients,and(ii)to determine cut-off values for the diagnosis of PCOS and phenotype-A.Materials and methods:This study was conducted in an IVF Center,between November 2019 and January 2021.Data of infertile women participating in the study was evaluated retrospectively.Parameters such as menstruation pattern,clinical hyperandrogenism,age,BMI,follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol,thyroid stimulating hormone(TSH),prolactin,AMH,dehydroepiandrosterone sulphate(DHEA-S),fasting blood glucose,fasting insulin levels,antral follicle counts(AFC)and ovarian volumes were recorded for each patient.Women were grouped as PCOS and non-PCOS,and PCOS group was further divided into 4 subgroups according to their phenotypes.Data of infertile patients with PCOS patients were compared with infertile non-PCOS patients and PCOS phenotypes were compared among each other.Results:Data of 244 infertile patients was included in the study.BMI,AMH,AFC,and HOMA-IR were statistically higher in PCOS patients,compared to non-PCOS patients.We found the AMH level of>3.105 ng/ml to be having 90.8%sensitivity and 90%specificity to diagnose a patient as PCOS.Among different phenotypes,also BMI,AMH,and insulin resistance index(HOMA-IR)levels were significantly higher in infertile PCOS phenotype-A when compared to other three phenotypes(p:0.003,p:0.000,and p:0.000,respectively).The AMH cut-off value to estimate phenotype-A was found as 6.095 ng/ml with 69.2%sensitivity and 86.7%specificity.We did not found threshold levels of BMI and HOMA-IR with high sensitivity to identify phenotype-A.Conclusion:Properly diagnosing PCOS and determining the phenotype are crucial due to the long-term health conditions.Therefore,we suggest that serum AMH level could be included in PCOS diagnosis criteria,and the value of 3.105 ng/ml would have a 90.8%sensitivity and 90%specificity.Also,to identify phenotype-A,AMH level could be used.Therefore,we speculate that AMH may serve to identify PCOS and PCOS phenotype-A in places where ultrasound imaging is not straightforward to perform or not easily accessible.

Impact of Systemic Lupus Erythematosus on Ovarian Reserve in Premenopausal Women before Receiving Cyclophosphamide Therapy: Evaluation Using Anti-Müllerian Hormone

Introduction: Anti-Müllerian hormone (AMH) is shown to be a possible indicator of ovarian function. Severe systemic lupus erythematosus (SLE) patients exposed to high-dose cyclophosphamide (CTX) have a much higher risk of developing infertility and premature ovarian failure. Therefore, we performed a prospective case-control study to evaluate the impact of SLE on women’s ovarian reserve using AMH before CTX therapy. Methods: SLE patients before receiving CTX therapy were enrolled in our hospital. Age-matched healthy women were served as controls. Serum AMH level was measured using an enzyme-linked immunosorbent assay. Basal hormone levels were measured including follicle-stimulating hormone, luteinizing hormone, and estradiol on the third day of their menstrual periods. All participants underwent transvaginal ultrasonographic examination for the determination of total antral follicle count on the third day. Results: AMH value in SLE patients was significantly lower compared to healthy control with normal ovarian reserve. No significant difference in AMH levels was found between SLE and healthy control with low ovarian reserve. Conclusions: SLE patients not receiving CTX therapy even with normal menstruation, still had an impaired ovarian reserve. Therefore, early monitoring of AMH levels could better reflect the ovarian function and reproductive outcomes of SLE patients and relative protective strategy needed to reserve fertility.

Association of Genetic Polymorphisms of Anti-Müllerian Hormone (AMH) and Its Type II Receptor with Ovarian Hyperstimulation Syndrome

Objective To explore the association of genetic polymorphisms in the genes encoding the anti-Miillerian hormone （AMH） and its type H receptor （AMHRII） with ovarian hyperstimulation syndrome （OHSS）. Methods Using polymerase chain reaction （PCR） and DNA sequencing techniques, the exons of AMH and AMHRII were analyzed in 27 OHSS patients （OHSS group） and 22 non-OHSS patients （control group） who were applied controlled ovarian hyper- stimulation （COH）. Single nucleotide polymorphisms （SNPs） were also analyzed. Results SNPs G〉 T at position 146 of AMH exon 1 and G〉 A at position 134 of AMH exon 2 showed significant differences between the OHSS group and control group （P〈0.05）. SNP G〉 T at position 303 of AMH exon 1 showed no significant difference between the OHSS group and control group （P〉0.05）. No SNP was detected from the AMHR H exons 1 to 11 in either groups. Conclusion Genetic polymorphisms in the AMH gene may be a cause of ovarian hypersensitivity to exogenous hormone stimulation and the development of OHSS.

Effect of modified laparoscopic salpingectomy on ovarian reserve:Changes in the serum antimüllerian hormone levels

Objective:To retrospectively estimate the impact of modified laparoscopic salpingectomy on the ovarian reserve in infertile women.Methods:There were 74 infertile women undergone modified laparoscopic salpingectomy from June 2016 to January 2017,and their levels of serum antimüllerian hormone,basal follicle-stimulating hormone and estradiol were reviewed retrospectively.Results:No significant change was detected in serum antimüllerian hormone at 3 months after surgery compared to preoperative level(p=0.857).Similar changes were observed for the basal follicle-stimulating hormone(p=0.102)and estradiol(p=0.233)level.Conclusions:Our results revealed that modified laparoscopic salpingectomy might be a valuable treatment for hydrosalpinx before in vitro fertilization.

Effects of Post-Weaning Consumption of Soy Isoflavones on Prepubertal and Postpubertal Serum Levels of Some Reproductive Hormones of Male Wistar Rats

Chemically, soy contains a group of phytoestrogens called isoflavones, pre-dominantly genistein and daidzein. The aim of the present study was to determine the effects of post weaning consumption of dietary soy isoflavones on prepubertal and postpubertal serum levels of some reproductive hormones of male Wistar rats. The study involved investigating the effects of different doses of isoflavones in the diet. Male rats were weaned on either soy isoflavone free diet or on isoflavone containing diets, formulated by adding increasing amounts of Novasoy, a commercially available isoflavone supplement to the isoflavone free diet to give varying concentrations of isoflavones. Three isoflavone containing diets were used and these had 74.5, 235.6 and 1046.6 mg total isoflavones/kg pelleted diet. These diets represented the isoflavone concentration lower, equal to and more than that found in soy-based infant formulas respectively. The results obtained showed that;administration of low doses soy isoflavones (74.5 mg/kg) produced significant (p < 0.05) increase in serum Antimullerian Hormone levels both in prepubertal and post pubertal rats, when compared to the control groups. Administration of moderate doses of isoflavones (235.6 mg/kg) produced significant (p < 0.05) increase in serum levels of Antimullerian Hormone and Inhibin in both prepubertal and post pubertal rats when compared to the control groups. Administration of high doses of isoflavones (1046.6 mg/kg) produced significant (p < 0.05) increase in serum levels of Inhibin in both prepubertal and post pubertal rats when compared to the control groups. From this study, it was concluded that post-weaning consumption soy isoflavones produced significant changes in serum Inhibin and Antimullerian Hormone both in prepubertal and post pubertal male Wistar rats and the changes were dose dependent.

多囊卵巢综合征合并卵巢储备功能低下病人的内分泌特征

目的了解中国多囊卵巢综合征(polycystic ovary syndrome,PCOS)合并卵巢储备功能低下(diminished ovarian reserve,DOR)病人的发生率及内分泌特征。方法选取2015年1月至2017年1月就诊的多囊卵巢综合征病人338例及同期就诊的单纯DOR病人68例,记录所有研究对象的年龄、月经情况,测量其身高、体质量、腰围、臀围,测定基础血清卵泡刺激素(follicle stimulation hormone,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2)、睾酮(testosterone,T)、抗苗勒管激素(antiMüllerian hormone,AMH)及基础窦卵泡数(baseline antral follicle count,b AFC)。对PCOS合并DOR病人、单纯PCOS及单纯DOR病人的各指标进行方差分析。结果 1)PCOS合并DOR的病人发生率为16.9%。2)在PCOS合并DOR病人中,基础FSH>10IU/L且<40IU/L、FSH/LH>3、基础E2>80pg/m L、b AFC≤4的发生率分别为38.6%、35.1%、35.1%及36.8%。3)PCOS合并DOR病人基础FSH及睾酮浓度与单纯PCOS及单纯DOR病人之间的差异均具有统计学意义(P<0.05),PCOS合并DOR病人基础E2、FSH/LH、AMH与单纯PCOS之间的差异有统计学意义(P<0.05),而与单纯DOR之间的差异无统计学意义(P>0.05)。4)在单纯PCOS组,AMH与睾酮呈正相关(P<0.01)。在PCOS合并DOR组,AMH与FSH呈负相关,与LH呈正相关(P<0.01)。在单纯DOR组,AMH与年龄、FSH、LH、FSH/LH均呈负相关(P<0.01)。结论 PCOS合并DOR病人的内分泌特征既不同于单纯PCOS组,也不同于单纯DOR病人。

抗苗勒管激素与抑制素B对多囊卵巢综合征的临床预测价值

目的通过分析多囊卵巢综合征(polycystic ovary syndrome,PCOS)病人与对照组的抑制素B(inhibin B,INHB)、抗苗勒管激素(anti-Müllerian hormone,AMH)及各项内分泌指标,探讨INHB、AMH对PCOS的临床预测价值及比较两组内分泌指标的特点。方法选取2016年9月至2017年5月间在首都医科大学附属北京妇产医院内分泌科就诊的PCOS病人567例为研究组,取同期就诊的年龄、原发不孕与继发不孕病人或正常体检者53例作为对照组。测量所有参与者的身高、体质量,空腹抽血查INHB、AMH、卵泡刺激素(follicle-stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2)、睾酮(testosterone,T),分析PCOS组与对照组的血清INHB、AMH质量浓度及内分泌指标特点。结果 PCOS组的血清AMH质量浓度、LH、T、体质量指数(body mass index,BMI)均明显高于对照组,E2、FSH/LH低于对照组,且组间差异均有统计学意义(P<0.05)。PCOS组的INHB质量浓度高于对照组,FSH低于对照组,组间差异均无统计学意义(P>0.05)。AMH预测多囊卵巢综合征的最佳分界值(cut-off)值为4.84μg/L,敏感度为84.48%,特异度为69.81%。INHB预测多囊卵巢综合征的cut-off值为70.8 ng/L,敏感度为53.97%,特异度为67.92%,AMH与INHB联合预测(并联试验)多囊卵巢综合征的敏感度为90.29%,特异度为54.92%。结论 AMH预测PCOS的cut-off值为4.84μg/L,INHB预测PCOS的cut-off值为70.8 ng/L,且AMH与INHB的联合检测(并列试验)敏感度高于AMH单项检测,这对临床PCOS的预测有很重要的指导意义。

AMH在卵巢囊肿术后对卵巢储备影响的评价作用

目的：探讨 AMH 在腹腔镜卵巢囊肿剔除术中卵巢创面采用电凝或缝合止血方法对卵巢储备功能影响的评价作用。方法：选取2008年5月至2013年7月因单侧卵巢囊肿行腹腔镜下卵巢囊肿剔除术的38例患者,随机将患者分为缝合组（20例）、电凝组（18例）,术中创面止血分别采用缝合法和电凝法。同时选取23例正常育龄妇女为对照组。于术前1个月及术后第1、3、6个月检测基础性激素水平（AMH、FSH、LH、E2）,月经周期第3-5天行阴道彩色多普勒超声检查,检测卵巢间质动脉血流阻力指数（RI）及窦卵泡数（AFC）。结果：3组患者的术前一般情况和卵巢储备功能比较,差异均无统计学意义（P〉0.05）。与正常对照组比较,缝合组、电凝组囊肿侧卵巢术后1月的 AFC 明显减少,术后1、3、6月 AMH 水平明显下降,术后1月 E2水平增高,差异均有统计学意义（P 均〈0.05）；缝合组、电凝组术后1、3、6月卵巢间质动脉 RI、LH、FSH 水平与正常对照组比较,差异均无统计学意义（P〈0.05）。结论：卵巢囊肿术后,AMH 较其他评价卵巢储备的指标明显下降,在其他指标恢复术前水平后仍提示卵巢储备受损。提示 AMH 可用于临床评价卵巢储备。

抗缪勒管激素检测在非梗阻性无精子症诊断中的临床应用

目的通过测定非梗阻性无精子症患者精浆抗缪勒管激素（AMH）,了解其对非梗阻性无精子症患者睾丸精子生成状况的预测作用,探讨其是否可以作为睾丸精子生成的精浆标志物。方法使用酶联免疫法、固相化学发光免疫法测定正常生育组（n=20）、梗阻性无精子症组（OA组,n=12）、非梗阻性无精子症组（NOA组,n=24）3组年轻男性精浆中的AMH浓度和血清促卵泡激素（FSH）和睾酮（T）浓度,经阴囊B超测量睾丸体积（TV）,并用睾丸组织病理活检或睾丸精子获取术（TESE）寻找此3组男性的精子生成证据。运用ROC曲线来确定各实验诊断指标对NOA患者TESE术成功与否的预测诊断价值,并运用ROC曲线决定图来确定各指标的最佳诊断阈值。结果 AMH在正常生育组人员精浆中的浓度范围为未检出（〈3.20 pmol/L）至556.00 pmol/L（几何平均值为118.73 pmol/L）,高于血清水平（范围从〈3.20-84.82 pmol/L,几何平均值为28.72 pmol/L）。OA组患者精浆AMH浓度均未检出,这就确认了其睾丸来源。NOA组患者精液AMH浓度比正常生育组显著降低（范围：〈3.20-68.60 pmol/L,几何平均值为17.70 pmol/L）（P〈0.01）,但与血清FSH水平无关。NOA组患者精浆AMH浓度和睾丸活检的结果比较显示,13例检测不出精浆AMH的患者有11例与精子缺乏有关;而检出精浆AMH（浓度为7.60-68.60 pmol/L）的11例患者中有8例与存在持续性睾丸生精功能有关。精浆AMH、血清FSH、睾丸体积和联合参数用于区分NOA患者TESE术成功与否的最佳诊断阈值分别为≥8.60 pmol/L、≤11.3 IU/L、≥12.5 mL和≥18.6。结论精液AMH在非梗阻性无精子症患者中可作为一种非侵入性持久性精子发生过少的标志物,这可在卵胞浆内单精子显微注射术（ICSI）前预示睾丸精子恢复成功与否的可能性。

伴胰岛素抵抗多囊卵巢综合征患者二甲双胍治疗后血清抗苗勒管激素水平的观察

分析28例伴胰岛素抵抗（IR）的多囊卵巢综合征（PCOS）行口服二甲双胍治疗患者的临床资料.治疗前血清抗苗勒管激素（AMH）水平为（8.5±3.2） μg/L,血清睾酮及黄体生成素（LH）水平正常,二甲双胍剂量为500 mg/次、2次/d,连续3个月.治疗后AMH水平为（8.4±3.2） μg/L,治疗前后比较差异无统计学意义（P=0.148）;治疗后BMI、血糖、空腹胰岛素、稳态模型IR指数（HOMA-IR）水平[（27.6±4.1） kg/m2、（5.32±0.47） mmol/L、（93.3±17.8） pmol/L及3.17±0.71],均较治疗前降低[（29.3±4.4） kg/m2、（5.55±0.71） mmol/L、（147.7±44.1） pmol/L及5.27±1.85],差异均有统计学意义（均P〈0.05）.提示二甲双胍治疗3个月能改善IR,降低BMI,但AMH水平变化不明显.

促性腺激素释放激素类似物缓解环磷酰胺导致卵巢损伤的机制研究

目的:通过动物实验和细胞实验初步探索促性腺激素释放激素类似物在环磷酰胺暴露下保护卵巢功能的机制。方法:构建乳腺癌荷瘤小鼠36只,随机分成Control组,CTX组和CG(CTX+GnRHa)组,药物干预后麻醉下剥离肿瘤和子宫卵巢并称重,计数卵巢原始卵泡和生长卵泡数目,提卵巢蛋白进行Western blot检测抗缪勒氏管激素(Anti-Müllerian hormone,AMH)蛋白表达量,提取卵巢RNA进行qRT-PCR实验检测mRNA水平,心尖取血检测血清AMH水平。卵巢颗粒细胞加药处理36小时后,收细胞蛋白进行Western blot检测AMH蛋白表达量,提细胞RNA进行qRT-PCR检测mRNA水平,ELISA法检测细胞培养基上清中AMH水平。结果:成瘤后第21天,CTX组和CG组小鼠肿瘤质量无统计学差异(P>0.05)且均小于Control组(P<0.05);CTX组子宫和卵巢的总重量均显著低于Control组和CG组(P<0.01),卵巢内原始卵泡数量均低于Control组和CG组(P<0.001),生长卵泡数量无统计学差异(P>0.05)。动物实验,Western blot结果提示,CTX组卵巢AMH蛋白含量显著高于Control组或CG组(P<0.05);由ELISA结果提示,CTX组血清AMH蛋白浓度显著低于CG组(P<0.01)。细胞实验,由Western blot可见,CTX组AMH蛋白含量显著高于Control组和CG组(P<0.05);由ELISA实验可见,CG 750组和CG1000组培养基上清的AMH蛋白浓度均高于对应CTX剂量组(P<0.01)。无论在动物实验还是细胞实验中,各组AMH的mRNA表达水平均无统计学差异(P>0.05)。结论:在CTX化疗的同时运用GnRHa,可以在不干扰化疗疗效的前提下,通过减少CTX所致细胞内AMH潴留程度,增加细胞外和血清中的AMH浓度从而发挥保护卵巢储备的功能。