Clinical Value of Serum Anti-Mullerian Hormone and Inhibin B in Prediction of Ovarian Response in Patients with Polycystic Ovary Syndrome

The present study aimed to investigate the clinical value of serum anti-mullerian hormone（AMH） and inhibin B（INHB） in predicting the ovarian response of patients with polycystic ovary syndrome（PCOS）. A total of 120 PCOS patients were enrolled and divided into three groups in terms of the ovarian response： a low-response group（n=36）, a normal-response group（n=44）, and a high-response group（n=40）. The serum AMH and INHB levels were measured by enzyme-linked immunosorbent assay（ELISA）. The follicle stimulating hormone（FSH）, luteinizing hormone（LH）, and estradiol（E2） levels were determined by chemiluminescence microparticle immunoassay. The correlation of the serum AMH and INHB levels with other indicators was analyzed. A receiver operating characteristic（ROC） curve was established to analyze the prediction of ovarian response by AMH and INHB. The results showed that there were significant differences in age, body mass index（BMI）, FSH, total gonadotropin-releasing hormone（Gn RH）, LH, E2, and antral follicle counts（AFCs） between the groups（P〈0.05）. The serum AMH and INHB levels were increased significantly with the ovarian response of PCOS patients increasing（P〈0.05）. The serum AMH and INHB levels were negatively correlated with the age, BMI, FSH level, Gn, and E2 levels（P〈0.05）. They were positively correlated with the LH levels and AFCs（P〈0.05）. ROC curve analysis of serum AMH and INHB in prediction of a low ovarian response showed that the area under the ROC curve（AUC） value of the serum AMH level was 0.817, with a cut-off value of 1.29 ng/m L. The sensitivity and specificity were 71.2% and 79.6%, respectively. The AUC value of serum INHB was 0.674, with a cut-off value of 38.65 ng/m L, and the sensitivity and specificity were 50.7% and 74.5%, respectively. ROC curve analysis showed when the serum AMH and INHB levels were used to predict a high ovarian response, the AUC value of the serum AMH level was 0.742, with a cut-off value of 2.84 ng/m L, and the sensitivity and specificity were 72.7% and 65.9%, respectively; the AUC value of the serum INHB level was 0.551 with a cut-off of 45.76 ng/m L, and the sensitivity and specificity were 76.3% and 40.2%, respectively. It was suggested the serum AMH and INHB levels have high clinical value in predicting the ovarian response of PCOS patients.

Anti-Mullerian Hormone and Follicle Counts as Predictors of Superovulatory Response and Embryo Production in Beef Cattle

This study evaluated Anti-Mullerian hormone (AMH) and/or follicle counts as predictors of subsequent superovulatory response and embryo production in 79 beef cows. Before superovulation, 3 to 5 mm follicles presented on the ovaries of donor cows were counted, and blood was collected for measure of serum AMH. Across cows, serum AMH ranged from 0.013 to 0.898 ng/mL, with a mean of 0.293 ng/mL. The distribution of both AMH concentrations and follicle counts were divided into quartiles (AMH Q1 through Q4, with Q1 the lowest and Q4 the highest) for analysis. Donor cows in AMH Q4 had a greater (P < 0.001) number of 3 to 5 mm follicles at the start of superovulation than did donors in either Q1 or Q2. At embryo collection, cows in AMH Q3 and 4 had more (P < 0.001) palpable corpora lutea (CL) than cows in AMH Q1. The mean number of embryos recovered from donor cows in AMH Q4 was greater (P < 0.001) than those recovered from cows in either AMH Q1 or 2, but similar to that of AMH Q3. Analysis indicated that AMH was positively correlated (P < 0.001) with mean follicles (r = 0.458), CL (r = 0.452) and embryos recovered (r = 0.430). Donor cows with higher follicle counts (F Q3 and 4) at the start of superovulation had more (P < 0.001) palpable CL at embryo collection than donor cows in F Q1 or 2. More (P < 0.001) embryos were recovered from cows with the highest follicle counts (F Q4) as compared with cows having lower (F Q1 and 2) follicle counts. Results confirm that relative AMH concentration was positively correlated with number of small antral follicles in the ovaries of cows;both AMH measure and antral follicle counts might be used to predict subsequent superovulatory response in beef cows.

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.

Expression of anti-Mullerian hormone receptor on the appendix testis in connection with urological disorders

The female internal sex organs develop from the paramesonephric （Mullerian） duct. In male embryos, the regression of the Mullerian duct is caused by the anti-Mullerian hormone （AMH）, which plays an important role in the process of testicular descent. The physiological remnant of the Mullerian duct in males is the appendix testis （AT）. In our previous study, we presented evidence for the decreased incidence of AT in cryptorchidism with intraoperative surgery. In this report, the expression of the anti-Mullerian hormone receptor type 2 （AMHR2）, the specific receptor of AMH, on the AT was investigated in connection with different urological disorders, such as hernia inguinalis, torsion of AT, cysta epididymis, varicocele, hydrocele testis and various forms of undescended testis. The correlation between the age of the patients and the expression of the AMHR2 was also examined. Reverse transcriptase-polymerase chain reaction （RT-PCR） and immunohistochemistry were used to detect the receptor＇s mRNA and protein levels, respectively. We demonstrate that AMHR2 is expressed in the ATs. Additionally, the presence of this receptor was proven at the mRNA and protein levels. The expression pattern of the receptor correlated with neither the examined urological disorders nor the age of the patients; therefore, the function of the AT remains obscure.

Relationship of Anti-Mullerian Hormone to Reproductive Traits in Katahdin Ewes Bred in Late Spring or Fall

Anti-Mullerian hormone (AMH) is an endocrine marker for fertility in many species. This study investigated possible correlations between serum AMH concentrations, mean number of lambs born (out-of-season in spring or fall), and estimated breeding values (EBVs) for number of lambs born (NLB), number of lambs weaned (NLW), maternal weaning weight (MWWT), weaning weight (WWT), and maternal index (determined by Sheep Genetics Australia). Blood was collected at breeding from Katahdin ewes between 0.7 and 7 years of age in 2015 (n = 163) for the analysis of serum concentrations of AMH. Anti-Mullerian hormone concentration was either expressed quantitatively or divided into quartiles (AMH Q1 through Q4, with Q1 the lowest and Q4 the highest, pg/ml). Data were analyzed by PROC CORR, GLM or chi-squared using SAS. Mean serum AMH was 182 ± 11 pg/ml and ranged from 0 to 1112 pg/ml. There was no correlation between serum AMH and EBVs for NLB, NLW, MWWT, WWT and the maternal index. Serum AMH concentration was similar in ewes in different age categories (P = 0.157). There was a correlation between EBV for NLB (0.29;P = 0.0002) and NLW (0.19;P = 0.013) with average number of lambs born. Ewes in the lowest AMH quartile (Q1) had a lower mean number of offspring born from spring breeding compared with ewes in other AMH quartiles (Q2, Q3, and Q4;P < 0.05). Further study is needed to determine the effectiveness of using serum AMH for selecting ewes for out-of-season (spring) breeding.

Anti-Mullerian Hormone: Establishing the Ovarian Reserve Range with Age in Rivers State Women, Niger Delta Region of Nigeria

Background: The measurement of circulating anti-Mullerian hormone (AMH) in the plasma of adult women has been used as a tool in the assessment of ovarian reserve. This is based on its ability to reflect the number of growing follicles in the ovaries and knowing the level of AMH in a woman’s blood is generally a good indicator of her ovarian reserve and this can be achieved by making reference to a decision values. Objective: The purpose of this study was to measure the level of this hormone in normal, apparently healthy subjects in Rivers State, Nigeria with respect to age. The percentage of women, at their reproductive age with infertility problems in the state is in the increase and the essence was to establish a reference range for the hormone because of its clinical application in women fertility. Materials/method: A total of one thousand and sixty two apparently healthy women divided into four age groups were recruited for this study;this comprised of 300 each in age group of 20 - 30, 31 - 40, 41 - 50 respectively and 162 in 51 - 60 years age group from May 2014 to June 2017. They were randomly selected after filling a questionnaire form that has the information of age, tribe, last date of menses and whether on medication for any infertility problems. Excluded from the study were subjects identified with different endocrine dysfunction and/or on drugs for different types of anovulatory dysfunction. The Enzyme linked Immunoassay method was used in the measurement of the AMH. Results: The result from the measurement of plasma AMH levels showed a Mean ± SD value of 3.193 ± 0.943, 1.644 ± 0.691, 0.516 ± 0.276 and 0.135 ± 0.081 ng/ml respectively for the 1st, 2nd, 3rd and 4th age groups respectively. The mean value for the AMH decreases with increasing age and was statistically significant at the different age group levels (P &minus;2.250 - 4.136;0.953 - 2.350;0.240 - 0.792 and 0.054 - 0.216 respectively for the age groups. This study summarizes the findings concerning AMH and its role as a marker for the quantitative aspect of ovarian reserve, ovarian aging, as well as ovarian dysfunction in this region of the country.

Clinical efficacy of anti-Mullerian hormone inspection in supporting diagnosis for climacteric disorders

The diagnosis of climacteric disorders in gynecology is performed on the basis of symptoms rather than hormonal levels. Generally, the follicle-stimulating hormone (FSH) level increases when the 17β-estradiol (E2) level decreases in menopause. However, the problem of these hormones should be determined by strict timing of sampling, and there are individual specificities of decreases of hormone levels. We considered that anti-Mullerian hormone (AMH) can be measured at any time of the menstrual cycle and that it shows ovary functional decline earlier than FSH/E2, and we examined whether AMH would possibly become a good index for climacteric disorders. The subjects were 163 healthy females and 21 patients with climacteric disorders between 20 and 59 years old. We examined AMH, FSH and E2 at the same time. It is understood that in healthy females, AMH decreases with age and a decline in ovary function occurs at a relatively early age. Patients visiting clinics for climacteric disorders often have normal-range serum FSH/E2 levels, and it is clear that these values could not serve as indices of menopause at these inspections. Upon measurement of AMH in patients with climacteric disorders, most showed less than normal range (< 14 pmol/L), suggesting a decline in ovarian function. In addition, AMH was low in females with climacteric disorders compared with those without them. In conclusion, AMH was suggested as an objective index for climacteric disorders and possibly as a new diagnostic marker.

Regulation of anti-Mullerian hormone(AMH)in males and the associations of serum AMH with the disorders of male fertility

Anti-Mullerian hormone(AMH)is a functional marker of fetal Sertoli cells.The germ cell number in adults depends on the number of Sertoli cells produced duri ng peri natal development.Rece ntly,AMH has received increasi ng attenti on in research of disorders related to male fertility.This paper reviews and summarizes the articles on the regulation of AMH in males and the serum levels of AMH in male fertility-related disorders.We have determined that follicle-stimulating hormone(FSH)promotes AMH transcription in the absenee of androgen signaling.Testosterone inhibits the transcriptional activation of AMH.The undetectable levels of serum AMH and testosterone levels indicate a lack of functional testicular tissue,for example,that in patients with anorchia or severe Klinefelter syndrome suffering from impaired spermatogenesis.The normal serum testosterone level and undetectable AMH are highly suggestive of persistent Mullerian duct syndrome(PMDS),combined with clinical manifestations.The levels of both AMH and testosterone are always subnormal in patients with mixed disorders of sex development(DSD).Mixed DSD is an early-onset complete type of disorder with fetal hypogonadism resulting from the dysfunction of both Leydig and Sertoli cells.Serum AMH levels are varying in patients with male fertility-related disorders,in cludi ng pubertal delay,severe con genital hypog on adotropic hypogonadism,nonobstructive azoospermia,Klinefelter syndrome,varicocele,McCune-Albright syndrome,and male senescence.

Effect of electroacupuncture on anti-Mullerian hormone expression in rats with polycystic ovarian syndrome

Objective: To observe whether the effect of electroacupuncture (EA) on improving sex hormone disorders and follicle development is by decreasing the expression of anti-Mullerian hormone (AMH) in rats with experimental polycystic ovarian syndrome (PCOS). Methods: Forty rats were randomly divided into four groups, a normal group (NG), a model group (MG), an EA at acupoints group (EAAG), and an EA at non-acupoints group (EANAG), with 10 rats in each group. The rats in the EAAG and EANAG were intervened by EA treatment for consecutive 14 d. Zhongji (CV 3) and Guanyuan (CV 4) were selected as the acupoints in the EAAG, and the tip of the tail and 1 cm up from the tail tip were selected as the non-acupoints in the EANAG. After treatment, the histomorphological changes of the ovary, the levels of aromatase P450 (P450arom)/ testosterone and estradiol in the ovarian tissues, and the expressions of follicle stimulating hormone (FSH) and AMH were observed. Results: After treatment, compared with the MG and EANAG, the expression of AMH decreased (P<0.05), the levels of P450arom and estradiol in creased sign ifica ntly, and the level of testostero ne decreased sign ifica ntly (all P<0.01) in the EAAG. Additionally, several normal follicles were present and the number of cystically dilated follicles decreased in the EAAG. Compared with the MG and EANAG, the EAAG obviously had more follicular granulosa cells. Con elusion: EA can dow n-regulate the abn ormally in creased expressi on of AMH to improve sex hormone disorders and follicle development in PCOS rats.

Association of anti-mullerian hormone and free androgen index level on response to clomiphene citrate in PCOS infertile women

Background:Polycystic ovary syndrome(PCOS)is the leading cause of anovulatory infertility.Clomiphene citrate,insulin-sensitizing drugs,aromatase inhibitors,gonadotropins,or laparoscopic ovarian drilling are various methods used for ovulation induction in women with PCOS.PCOS women with high levels of anti-mullerian hormone(AMH)and free androgen index(FAI)do not respond well to ovulation induction.This prospective observational study explores the relationship between FAI and AMH levels on ovarian response to clomiphene citrate in infertile women with PCOS.Methods:This prospective observational study included 40 infertile with PCOS who underwent ovulation induction with clomiphene citrate with dose ranging from 50 to 150 mg.Participants were classified into four phenotypes by NIH(National Institute of Health)consensus panel criteria.The clinical and endocrine parameters of participants who were sensitive to clomiphene were compared to those who were resistant.Results:The most common phenotype was A,with all three features of PCOS:hyperandrogenism,ovulatory dysfunction,and polycystic ovarian morphology.There was no significant difference in clinical and endocrine parameters among the different phenotypes of PCOS except AMH and FAI values.The mean FAI was 9.39
1.11 and AMH 7.26
0.48(ng/ml)in clomiphene resistant and 5.31
1.93 and 3.69
1.84(ng/ml)respectively in clomiphene-sensitive women.Women with FAI>7.5 and AMH>7 ng/ml might be resistant to clomiphene.Conclusion:FAI and AMH values were significantly higher in women resistant to clomiphene induction.AMH and FAI may help women with PCOS to tailor their ovulation induction protocol.

Clinical Applications of Serum Anti-Mullerian Hormone€Measurements in Both Males and Females:An Update

Infertility is one of the most common non-communicable diseases,affecting both men and women equally.Ovarian reserve,the number of primordial follicles in the ovaries is believed to be the most important determinants for female fertility.Anti-Mullerian hormone(AMH)secreted from granulosa cells of growing follicles is recognized as the most important biomarker for ovarian reserve.Ovarian reserve models have been developed using AMH and other hormonal indicators,thus childbearing plans and reproductive choices could be arranged by women.In assisted reproductive technology cycles,measurement of AMH helps to predict ovarian response and guide recombinant follicle-stimulating hormone dosing in women.Serum AMH level is increasingly being recognized as a potential surrogate marker for polycystic ovarian morphology,one of the criteria for diagnosis of polycystic ovarian syndrome.AMH is also secreted by Sertoli cells of testes in men,and AMH measurements in the prediction of surgical sperm recovery rate in men have also been investigated.AMH levels are significantly higher in boys than in girls before puberty.Therefore,serum levels of AMH in combination with testosterone is used for the differential diagnosis of disorders of sex development,anorchia,non-obstructive azoospermia,and persistent Mullerian duct syndrome.Recently,serum AMH measurements have also been used in fertility preservation programs in oncofertility,screening for granulosa cell tumors,and prediction of menopause applications.In this review,we will focus on clinical application of AMH in fertility assessments for healthy men and women,as well as for cancer patients.

卵巢储备功能低下患者血清AMH、Betatrophin水平与卵巢反应性、IVF-ET妊娠结局关系

目的:探讨卵巢储备功能低下(DOR)患者血清抗苗勒管激素(AMH)、促代谢因子(Betatrophin)水平与卵巢反应性及体外受精-胚胎移植(IVF-ET)妊娠结局的关系。方法:收集2019年12月-2022年12月在本院行IVF-ET的DOR患者137例临床资料,根据卵巢反应性将患者分为低反应组(n=112)、正常反应组(n=16)、高反应组(n=9);根据妊娠结局将患者分为妊娠成功组(n=44)和妊娠失败组(n=93)。酶联免疫吸附法检测血清AMH、Betatrophin水平,受试者工作特性(ROC)曲线评估2项指标预测IVF-ET妊娠结局价值;多因素logistic回归分析影响妊娠的因素。结果:低反应组、正常组、高反应组血清AMH水平(0.49±0.13 ng/ml、0.98±0.21 ng/ml、1.05±0.26 ng/ml)依次升高,血清Betatrophin水平(156.95±16.33 pg/ml、112.17±13.42 pg/ml、92.64±11.03 pg/ml)依次降低;妊娠成功组血清AMH水平(1.07±0.36 ng/ml)高于妊娠失败组(0.34±0.19 ng/ml),Betatrophin水平(136.29±14.42 pg/ml)低于妊娠失败组(216.16±21.05 pg/ml)(均P<0.05)。血清AMH、Betatrophin预测DOR患者IVF-ET妊娠结局的曲线下面积(AUC)(95%CI)别为0.857、0.771,两项指标联合预测的AUC为0.904。多因素logistic回归分析显示,卵泡刺激素/促黄体生成素比值≥2、卵巢低反应、AMH≤0.71 ng/ml、Betatrophin≥176.23 pg/ml是DOR患者IVF-ET妊娠失败的独立危险因素(P<0.05)。结论:血清AMH、Betatrophin水平与DOR患者卵巢反应性、IVF-ET妊娠结局有关,二者有望作为预测DOR患者IVF-ET妊娠结局的生物标记物。

血清AMH和子宫附件B超参数在女童快进展型中枢性性早熟的早期预警价值

目的分析血清抗苗勒管激素(anti-Müllerian hormone,AMH)和子宫附件B超参数在女童快进展型中枢性性早熟的早期预警价值。方法非随机选取2022年6月—2024年6月汕头大学医学院附属粤北人民医院收治的60例中枢性性早熟(central precocious puberty,CPP)女童为研究对象,根据是否出现快速进展的指标分为慢进展型中枢性性早熟(SP-CPP)组和快进展型中枢性性早熟(RP-CPP)组,各30例,选择同期30名健康体检女童为对照组。所有女童均进行血清AMH和子宫附件B超检测,统计并分析3组女童的临床指标以及早期预警价值。结果SP-CPP组与RP-CPP组的血清AMH(3.79±1.24)ng/mL、(2.63±0.31)ng/mL低于对照组的(5.30±1.50)ng/mL,差异有统计学意义(F=41.540,P<0.05)。RP-CPP组的血清AMH相较于SP-CPP组更低,差异有统计学意义(P<0.05)。SP-CPP组与RP-CPP组的横径数据比较,差异无统计学意义(P>0.05)。SP-CPP组的纵径、前后径、子宫体积均低于RP-CPP组,差异有统计学意义(P均<0.05)。SP-CPP组与RPCPP组的卵巢超声参数相较对照组更高,且RP-CPP组高于SP-CPP组,差异有统计学意义(P均<0.05)。子宫体积早期预警女童快进展型CPP的AUC为0.789。结论AMH和子宫附件B超参数对女童快进展型中枢性性早熟具有一定的早期预警价值,且子宫体积的预警价值最高。

成都地区健康女性血清AMH参考区间的建立及与多种临床指标的相关性研究

目的:建立成都地区18~60岁健康女性血清抗苗勒管激素(AMH)的参考区间,并探讨年龄、血糖、血脂、尿酸(UA)、甲状腺激素等临床指标与AMH的相关性。方法:选取2020年8月至2023年7月在四川省人民医院健康管理中心进行健康体检的18~60岁女性作为研究对象,采集空腹静脉血,使用AMH定量检测试剂盒(ELISA)(广州市康润生物科技有限公司)测定AMH水平。经离群值判断,最终纳入1690例研究对象,按照年龄分为9组(18~22岁、23~25岁、26~30岁、31~35岁、36~40岁、41~45岁、46~50岁、51~55岁、56~60岁),建立成都地区健康女性血清AMH参考区间。使用多元线性回归分析年龄、血糖、血脂、UA、甲状腺激素等临床指标与AMH的相关性。结果:采用双侧限值(P_(2.5),P_(97.5))建立本地区健康女性AMH的参考区间,分别为18~22岁(2.74~9.37)ng/mL、23~25岁(1.28~14.55)ng/mL、26~30岁(0.98~16.50)ng/mL、31~35岁(0.38~12.13)ng/mL、36~40岁(0.10~7.70)ng/mL、41~45岁(0.06~4.35)ng/mL、46~50岁(0.06~1.19)ng/mL、51~55岁(0.06~0.35)ng/mL、56~60岁(0.06~0.08)ng/mL。以年龄为X轴,血清AMH水平为Y轴做散点图,可见血清AMH水平随年龄增加而降低。多元线性回归相关性分析显示,多种临床指标中,AMH与年龄呈负相关。结论:本研究建立了成都地区健康女性年龄特异性AMH的参考区间,为中国健康女性年龄特异性AMH的统一参考区间提供依据,进一步为AMH评估卵巢储备功能提供依据。

The Effect of Uterine Artery Occlusion with Tourniquet on Ovarian Reserve during Open Myomectomy at a University Teaching Hospital in Southern Nigeria

Background: The most common surgical treatment for symptomatic uterine fibroids, particularly in women with fertility concerns, is open myomectomy. Given the high vascularity of the uterus, haemorrhage during the procedure is a serious risk that is often mitigated with a uterine tourniquet. Aim and Objectives: To evaluate the effect of uterine artery occlusion with a tourniquet during open myomectomy on ovarian reserve using serial anti-Mullerian hormone (AMH) measurements. Materials and Methods: This was a prospective longitudinal study with a quasi-experimental design and a convenient sampling technique. The study enrolled 47 women who had abdominal myomectomy between September 1, 2021, and March 31, 2022, at the University of Port Harcourt Teaching Hospital. Blood samples were collected before anaesthesia was administered in theatre, on day two, and three months after open abdominal myomectomy for anti-Mullerian hormone assay. The data was collected using a semi-structured proforma, entered into an Excel spreadsheet, and analyzed using SPSS version 25.0 with a 95% confidence interval. Statistical significance level was set at 0.05. Results: The pre-surgery AMH mean value was 1.67 ± 1.44 ng/ml, while the values after using a uterine tourniquet at myomectomy on the second day and three months later were 1.22 ± 1.24 ng/ml and 1.59 ± 1.43 ng/ml, respectively. There was no statistically significant change in AMH levels, and there was no statistically significant relationship between blood loss and tourniquet time and AMH after open abdominal myomectomy. Conclusion: The use of a uterine tourniquet and blood loss during open myomectomy has no effect on ovarian reserve.

基于卵巢颗粒细胞功能探讨调周法治疗卵巢储备功能减退的临床研究

目的:基于卵巢颗粒细胞功能探讨中医药调周法对卵巢储备功能减退(diminished ovarian reserve,DOR)患者体内抗穆勒氏管激素(anti-mullerian hormone,AMH)水平的影响及临床疗效。方法:对60例DOR肾虚证患者给予中医药调周法治疗,观察治疗前后患者血清性激素各项水平[AMH、雌二醇(estradiol,E_(2))、黄体生成素(luteinizing hormone,LH)、卵泡刺激素(follicle stimulating hormone,FSH)]和临床疗效。结果:治疗前后E_(2)、LH、FSH水平比较差异无统计学意义(P>0.05);治疗后AMH水平较治疗前升高(P<0.05),中医证候积分较治疗前减少(P<0.05),总有效率为86.7%(52/60);治疗期间均无明显不良反应。结论:中药调周法通过提高AMH、FSH水平来提升DOR肾虚证患者卵巢储备功能,调整月经周期,增加月经量,改善临床症状。

加味二仙汤联合来曲唑对PCOS患者促排卵及血清性激素水平的影响

目的:探究加味二仙汤联合来曲唑治疗多囊卵巢综合征(PCOS)对患者促排卵及血清抗缪勒管激素(AMH)等性激素水平的影响。方法:选取本院2020年3月-2023年8月确诊的PCOS患者86例,随机数字表法分为西药组(n=43)和中西药组(n=43)。两组均服用来曲唑治疗,中西药组加服加味二仙汤治疗,统计两组治疗前后促排卵情况(成熟卵泡个数、宫颈粘液评分、排卵期子宫内膜厚度),性激素[雌激素(E_(2))、促卵泡激素(FSH)、睾酮(T)、黄体生成素(LH)]水平,AMH水平以及不良反应。结果:治疗后,中西药组成熟卵泡个数(5.3±0.6个)、宫颈粘液评分(11.9±1.4分)、排卵期子宫内膜厚度(9.2±1.1mm)、妊娠率(74.4%)均高于西药组(3.8±0.5个、9.2±1.1分、6.5±0.9mm、46.5%),两组血清E_(2)、T、LH、AMH水平均降低,FSH两组均升高,且中西药组变化幅度大于西药组(均P<0.05);两组不良反应发生率(16.3%、9.3%)无差异(P>0.05)。结论:加味二仙汤联合来曲唑治疗PCOS,可显著改善患者排卵情况及性激素水平,降低AMH水平,提高治疗妊娠率。

联合抗缪勒管激素、硫酸脱氢表雄酮与性激素诊断多囊卵巢综合征的探讨

目的探讨抗缪勒管激素(AMH)、硫酸脱氢表雄酮(DHEA-S)与性激素联合检测对多囊卵巢综合征(PCOS)的诊断价值。方法选取PCOS患者、年龄匹配的健康女性各80例作为PCOS组和对照组。探讨两组血清AMH、DHEA-S、卵泡刺激素(FSH)、黄体生成素(LH)、LH/FSH、泌乳素(PRL)、雌二醇(E_(2))、孕酮(P)、睾酮(T)、性激素结合球蛋白(SHBG)、游离雄激素指数(FAI)水平的差异,以及各指标单独与联合检测对PCOS的诊断价值。结果(1)PCOS组与对照组血清AMH、DHEA-S、LH、LH/FSH、T、FAI、E_(2)水平均有显著差异(P<0.05)。(2)AMH和DHEA-S均为育龄女性发生PCOS的独立危险因素(P<0.001、P=0.022)。(3)PCOS组AMH分别与LH、LH/FSH和T水平呈正相关(r=0.356、0.288、0.292,P=0.001、0.01、0.009);DHEA-S水平分别与P、T和FAI呈正相关(r=0.255、0.522、0.404,P=0.022、<0.001、<0.001),与SHBG呈负相关(r=-0.224,P=0.046)。(4)AMH=6.065ng/mL时AUC(0.881)最大,诊断PCOS的灵敏度为75.0%、特异性92.3%;联合AMH和DHEA-S时AUC为0.933,灵敏度85.0%、特异性91.2%;5项指标联合(AMH+DHEA-S+LH/FSH+LH+E_(2))时AUC为0.95,灵敏度86.5%,特异性97.2%。7项指标联合AUC(0.95)虽无改变,但灵敏度88.8%,特异性93.7%。结论血清AMH、DHEA-S水平可作为育龄女性发生PCOS的独立危险因素;AMH与DHEA-S联合检测,或AMH、DHEA-S、性激素联合检测可在一定程度上提升PCOS患者的诊断效能。

早发性卵巢功能不全患者外周血Tfh占比、功能相关细胞因子表达变化及其与性激素水平的相关性

目的观察早发性卵巢功能不全(POI)患者外周血滤泡辅助性T细胞(Tfh)占比、功能相关细胞因子表达变化,并分析其与性激素水平的相关性。方法POI患者29例(观察组),同期健康体检者31例(对照组),采用流式细胞术检测全血Tfh占比,免疫印迹实验检测外周血单个核细胞(PBMC)CXCR5、BCL-6蛋白,酶联免疫吸附法检测血清IL-6、IL-21,电化学发光法检测血清促卵泡刺激素(FSH)、促黄体生成素(LH)、泌乳素、孕酮、睾酮、雌二醇(E_(2))、抗缪勒管激素(AMH)水平,Spearman相关分析法分析Tfh、CXCR5蛋白、BCL-6蛋白、IL-6、IL-21与性激素的相关性。结果与对照组比较,观察组全血Tfh占比增加,血清IL-6、IL-21水平升高,PBMC CXCR5、BCL-6蛋白表达升高,血清FSH、LH水平升高,血清E_(2)、AMH水平降低,P均<0.05。全血Tfh占比与血清FSH、LH水平呈正相关(r分别为0.75、0.63,P均<0.05),与血清E_(2)、AMH水平呈负相关(r分别为-0.35、-0.82,P均<0.05);血清IL-6水平与血清FSH、LH水平呈正相关(r分别为0.75、0.62,P均<0.05),与血清E_(2)、AMH水平呈负相关(r分别为-0.47、-0.77,P均<0.05);血清IL-12水平与血清FSH、LH水平呈正相关(r分别为0.68、0.56,P均<0.05),与血清E_(2)、AMH水平呈负相关(r分别为-0.25、-0.73,P均<0.05);PBMC BCL-6蛋白表达与血清FSH、LH水平呈正相关(r分别为0.73、0.60,P均<0.05),与血清E_(2)、AMH水平呈负相关(r分别为-0.27、-0.76,P均<0.05);PBMC CXCR5蛋白表达与血清FSH、LH水平呈正相关(r分别为0.72、0.58,P均<0.05),与血清E_(2)、AMH水平呈负相关(r分别为-0.27、-0.70,P均<0.05)。结论POI患者全血Tfh占比增加,PBMC CXCR5、BCL-6蛋白表达升高,血清IL-6、IL-21、FSH、LH水平升高及E_(2)、AMH水平降低,Tfh及其相关因子与性激素呈正相关或负相关,Tfh及其相关因子可能参与了POI发生过程。

血清E2/P、AMH及25(OH)D3水平在冻融胚胎移植妊娠中的临床意义

目的分析血清雌二醇(E2)/孕酮(P)值、抗苗勒管激素(AMH)、血清25羟维生素D3[25(OH)D3]水平在冻融胚胎移植技术(FET)妊娠中的临床意义。方法选取2020年1月至2023年6月邯郸市中心医院收治的214例不孕患者作为研究对象,根据妊娠结局分为妊娠组和未妊娠组。比较两组相关资料;采用多因素Logistic回归分析影响FET妊娠结局的危险因素;采用ROC曲线评估E2/P、AMH及25(OH)D3对FET妊娠结局的预测价值。结果214例接受FET的患者中,共确诊临床妊娠104例(妊娠组),未妊娠者110例(未妊娠组),临床妊娠率为48.59%,两组年龄、移植胚胎数、子宫内膜厚度、E2/P、AMH、25(OH)D3水平比较,差异有统计学意义(P<0.05);经多元Logistic回归分析可知,E2/P、AMH、25(OH)D3值偏低、子宫内膜厚度小、高龄均是影响FET妊娠结局的危险因素(P<0.05);ROC曲线显示,E2/P、AMH与25(OH)D3三者联合预测的AUC值高于各指标单独检测者(P<0.05)。结论血清E2/P、AMH及25(OH)D3水平与不孕患者FET妊娠结局有一定关系,三者联合检测能够更全面地评估患者的妊娠潜力和风险,为临床制定个性化的治疗方案提供参考依据。