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.

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.

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.

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.

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.

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.

AMH联合卵巢超声影像学参数对早发性卵巢功能不全的预测价值

目的 探讨育龄期女性不同年龄的性激素、抗苗勒氏管激素(anti-Müllerian hormone, AMH)水平和卵巢超声影像学参数的变化,分析其对早发性卵巢功能不全(premature ovarian insufficiency, POI)的预测价值并建立预测模型。方法 选择2018年2月至2022年6月就诊于西安交通大学第一附属医院的1 968名育龄期女性为研究对象,检测其性激素、AMH、窦卵泡计数(antral follicle count, AFC)、卵巢总体积、卵巢皮质体积、卵巢髓质体积、卵巢总面积、卵巢皮质面积、卵巢髓质面积,分析不同年龄各项指标的变化及其对POI的预测价值,采用AMH联合卵巢超声影像学参数建立预测POI的模型。结果 1 968名研究对象中POI患病率为3.10%,30~39岁年龄组POI的患病率显著高于20~29岁年龄组(P<0.05)。30~34岁组血清AMH水平显著低于20~24岁组和25~29岁组(P<0.05),35~39岁组血清卵泡刺激素(follicle stimulating hormone, FSH)、黄体生成素(luteinizing hormone, LH)水平显著高于30~34岁组(P<0.05),而血清雌二醇(estradiol, E2)和AMH水平、AFC、卵巢体积、卵巢皮质体积、卵巢面积、卵巢皮质面积均显著低于30~34岁组(P<0.05)。POI组患者的血清FSH、LH水平显著高于同龄女性卵巢功能正常者(P<0.05),而血清E2、AMH水平显著低于同龄女性卵巢功能正常者(P<0.05)。POI组患者的AFC、卵巢体积、卵巢皮质体积、卵巢髓质体积、卵巢面积、卵巢皮质面积和卵巢髓质面积均显著低于同龄女性卵巢功能正常者(P<0.05)。对POI的预测价值分析结果显示,激素水平中AMH的预测价值最高(AUC=0.957),其次为E2(AUC=0.840)。超声影像学参数中AFC的预测价值最高(AUC=0.867),其次为卵巢皮质体积(AUC=0.835)。AMH联合卵巢超声影像学参数建立的模型对POI具有较好的预测价值,其灵敏度为94.86%,特异度为91.23%,AUC为0.960,截断值为12分。结论 育龄期女性中30~39岁年龄组POI的患病率较高,AMH联合卵巢超声影像学参数建立的模型对POI具有一定的预测价值,特别对隐匿期女性获得临床关注。

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。

PCOS不孕患者血清Hcy、AMH水平及与临床指标的相关性和诊断价值

目的:分析多囊卵巢综合征(PCOS)不孕患者血清同型半胱氨酸(Hcy)、抗缪勒管激素(AMH)水平及临床指标的相关性。方法:将2022年11月-2023年11月本院收治的102例PCOS不孕患者作为PCOS组,体检健康女性124例作为对照组。采用酶循环法检测血清Hcy、磁微粒发光法检测血清AMH水平;采用Pearson相关分析探讨PCOS不孕患者血清Hcy、AMH水平与临床指标关系,采用受试者工作特性(ROC)曲线评估血清Hcy、AMH对PCOS不孕的诊断价值。结果:观察组血清Hcy(19.26±2.87μmol/L)、AMH(9.27±1.86ng/ml)水平均高于对照组(11.83±2.14μmol/L、5.13±1.14ng/ml),C反应蛋白(3.74±0.51mg/L)、胰岛素抵抗指数(4.15±0.82)、黄体生成素(16.44±2.75U/L)水平均高于对照组(1.16±0.23mg/L、2.04±0.37、5.47±1.36U/L),孕酮(P)(0.76±0.23ng/ml)、雌二醇(E_(2))(71.04±8.26pg/ml)水平均低于对照组(1.64±0.52ng/ml、81.32±9.58pg/ml)(均P<0.05)。Pearson相关分析显示,血清Hcy、AMH水平与CRP、HOMA-IR、LH水平均呈正相关,与P、E_(2)水平均呈负相关(均P<0.05)。血清Hcy、AMH诊断PCOS不孕的曲线下面积(AUC)(95%CI)分别为0.761(0.750~0.812)、0.867(0.816~0.918),两项指标联合诊断的AUC(95%CI)为0.904(0.853~0.955)。结论:PCOS不孕患者血清Hcy、AMH水平异常升高且与其炎症反应、糖代谢紊乱、性激素水平异常相关,且两项指标诊断PCOS不孕效能较好。

血清AMH、Hcy水平诊断PCOS价值及与不孕治疗结局关系

目的:分析血清抗缪勒氏管激素(AMH)和同型半胱氨酸(Hcy)水平诊断多囊卵巢综合征(PCOS)价值及与不孕治疗结局关系。方法:选择北京市垂杨柳医院和内蒙古自治区人民医院2021年9月-2022年3月收治的81例PCOS和卵巢功能减退(DOR)不孕患者临床资料,其中PCOS 42例为PCOS组,DOR 39例为DOR组,选择健康体检女性40例为对照组;比较3组血清AMH和Hcy水平,采用logistics回归模型分析2指标联合应用诊断PCOS模型,采用Spearman相关性检验分析AMH和Hcy水平与PCOS患者不孕治疗1年后结局关系。结果:PCOS组、DOR组、对照组血清AMH和Hcy水平存在差异,其中PCOS组AMH和Hcy水平最高(P<0.05);采用logistics回归模型构建的PCOS诊断模型为Log(P)=0.675×AMH+0.701×Hcy+0.644(P<0.05);AMH和Hcy联合应用诊断PCOS的曲线下面积(0.970)高于AMH(0.850)、Hcy(0.895)单独应用(P<0.05);PCOS组随访1年,妊娠患者血清AMH(12.03±1.21 ng/ml)和Hcy(11.79±1.31μmol/L)水平均低于未妊娠患者(15.12±2.31 ng/ml、14.11±1.89μmol/L),且二者水平均与PCOS患者不孕妊娠结局呈正相关(均P<0.05)。结论:血清AMH和Hcy水平联合联合检测有效诊断PCOS,且两指标与PCOS患者治疗不孕结局呈正相关。

超声检查SA/TA及卵巢间质血流动力学指标联合AMH在多囊卵巢综合征诊疗中的应用分析

目的:研究超声检查卵巢间质面积/卵巢总面积比(SA/TA)及卵巢间质血流动力学指标联合抗苗勒管激素(AMH)在多囊卵巢综合征(PCOS)诊疗中的应用。方法:选取本院2020年8月至2022年1月临床诊断的PCOS患者50例作为PCOS组,单纯多囊性卵巢(PCO)患者50例作为PCO组,以及正常女性50例作为对照组。对所有受试者均开展超声检查,对比三组SA/TA及卵巢间质血流动力学指标水平,血清AMH及生化指标水平,以Pearson相关性分析明确各项指标相关性。通过受试者工作特征曲线(ROC)分析明确SA/TA及卵巢间质血流动力学指标水平与实验室生化指标的相关性。结果:PCOS组及PCO组SA/TA、PSV、EDV水平均高于对照组,PCOS组上述指标水平均高于PCO组;PCOS组及PCO组PI、RI均低于对照组,且PCOS组PI、RI均低于PCO组(均P<0.05)。PCOS组、PCO组FPG、TG、FINS以及血清AMH水平均高于对照组,且PCOS组高于PCO组(均P<0.05)。经Pearson相关性分析发现:SA/TA、PSV、EDV水平与FPG、TG、FINS、血清AMH水平均呈正相关,而PI、RI与FPG、TG、FINS、血清AMH水平均呈负相关(均P<0.05)。经ROC曲线分析发现,SA/TA及卵巢间质血流动力学指标与血清AMH水平联合诊断PCOS的效能优于上述指标单独检测(均P<0.05)。结论:超声检查SA/TA及卵巢间质血流动力学指标联合AMH在PCOS诊疗中的应用效果较好。

血清CTRP9、AMH对多囊卵巢综合征患者IVF-ET助孕结局的预测价值

目的探讨行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)助孕的多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者血清中补体C1q/肿瘤坏死因子相关蛋白9(complement C1q/tumour necrosis factor-related protein 9,CTRP9)、抗苗勒管激素(anti-mullerian hormone,AMH)对治疗结果的预测价值。方法选取2022年3月—2023年7月于重庆医科大学附属第一医院生殖中心行IVF-ET的85例PCOS患者。根据妊娠结局分为临床妊娠组43例与临床未妊娠组42例。记录2组患者的一般资料,测定血清CTRP9和AMH水平,分析其与妊娠结局的关系。结果临床未妊娠组血清CTRP9为(290.19±58.97)ng/mL,AMH为3.39(2.09,5.42)ng/mL,均低于临床妊娠组的(413.63±89.56)ng/mL、7.42(5.45,9.90)ng/mL(P<0.05)。血清CTRP9、AMH水平、优胚数是PCOS患者IVF-ET妊娠成功的保护因素(P<0.05)。血清CTRP9预测行IVF-ET的PCOS患者妊娠成功的敏感度与特异度为74.40%和90.50%,曲线下面积(area under the curve,AUC)值为0.836;血清AMH预测敏感度与特异度为83.70%和73.80%,AUC值为0.859;血清CTRP9和AMH联合预测的敏感度和特异度分别为88.40%和92.90%,AUC值为0.924,高于单独使用CTRP9或AMH预测的价值。结论血清CTRP9、AMH与PCOS患者IVF-ET治疗结局密切相关,且与单一指标检测比较,两者联合检测可提高预测价值。

MRI联合血清AMH、AFP水平在剖宫产术后早期子宫瘢痕妊娠诊断中的临床价值分析

目的 探讨核磁共振(MRI)联合血清抗苗勒管激素(AMH)、甲胎蛋白(AFP)对剖宫产术后早期子宫瘢痕妊娠(CSP)的诊断价值。方法 选取2020年2月-2022年3月期间本院收治的疑似CSP患者133例为研究对象。收集其基本资料(年龄、距上次剖宫产时间、停经天数、剖宫产史等),所有CSP患者均接受MRI检查。酶联免疫吸附法(ELISA)测定血清AMH、 AFP水平;受试者工作特征(ROC)曲线分析血清AMH、AFP水平对CSP的诊断效能;采用Kappa检验分析MRI单独及联合血清AMH、AFP诊断CSP与金标准病理结果的一致性;采用四线格分析并比较MRI、血清AMH、AFP单独及联合对CSP的诊断效能。结果本研究经MRI确诊81例CSP孕妇,52例非CSP孕妇。以手术病理诊断结果作为参考,MRI诊断CSP的灵敏度为78.72%,特异度为82.05%。CSP组血清AMH水平显著低于非CS P组,AF P水平显著高于非CSP组(P<0.05);血清AMH、AFP诊断CSP的AUC分别为0.785、0.824,特异度分别为84.62%、87.18%,灵敏度分别为76.60%、78.72%。MRI、血清AM H、血清AFP单独诊断CS P的Kappa值为0.554、0.547、0.592,三者联合诊断CSP的Kappa值最高,为0.746(P<0.05)。MRI联合血清AMH、AFP诊断CSP的灵敏度及阴性预测值明显高于MRI、血清AMH、AFP单独诊断,准确度明显高于MRI、血清AMH单独诊断(P<0.05)。结论 CSP患者血清AMH低表达,血清AFP高表达,MRI联合血清AMH、AFP对早期CSP进行综合诊断弥补了单一MRI诊断的不足,具有较高临床应用价值。

血清、腹腔液AMH水平对子宫内膜异位症合并不孕症患者术后妊娠结局的影响

目的探讨血清、腹腔液抗苗勒管激素(AMH)水平对子宫内膜异位症(EAI)合并不孕症患者术后妊娠结局的临床预测价值。方法选取122例行宫腹腔镜联合诊治术的患者,患者通过手术病理确诊为不孕症,按照前瞻性研究方法将患者分为试验组(子宫内膜异位症合并不孕症患者,EAI组)和对照组(非子宫内膜异位症合并不孕症患者,Non-EAI组),每组61例。所有患者均在月经干净后第3~7天进行手术。比较两组血清、腹腔液AMH水平和术后妊娠率。结果EAI组的血清、腹腔液AMH水平均显著低于Non-EAI组,差异有统计学意义(P<0.05)。EAI组的术后妊娠率提高,与Non-EAI组对比,差异无统计学意义(P>0.05)。结论血清、腹腔液AMH水平在预测子宫内膜异位症合并不孕症患者手术治疗后的妊娠结局方面具有重要的临床价值。

探讨对卵巢储备功能采取AMH及AFC计数预测的价值

目的 探讨对卵巢储备功能采取AMH和AFC计数进行预测的价值。方法 回顾性分析本院2022年1月—2023年6月妇科门诊接诊的90例患者作为研究对象,按照卵巢储备功能的差异分为对照组(卵巢功能正常)和观察组(卵巢功能减退),每组45例,对两组患者的抗缪勒管激素(AMH)、窦卵泡数(AFC)、雌二醇(E2)、促卵泡生成素(FSH)及FSH与促黄体生成素(LH)的比值(FSH/LH)进行对比,并以Logistic二元回归分析对具有统计学差异的指标与卵巢储备功能的相关性进行分析。结果 两组在AMH和AFC指标方面的差异存在统计学意义(P<0.05),对两项指标与卵巢储备功能的相关性进行分析,发现AMH、AFC是影响患者卵巢储备功能的关键指标。ROC分析结果提示AMH、AFC联合进行卵巢储备功能预测时,敏感度为88.90%,特异度为88.89%。结论 AMH和AFC计数在卵巢储备功能早期评估及预测方面具有良好的价值。

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.

子宫动脉搏动/阻力指数联合血清AMH预测IVF-ET助孕结果

目的:探讨子宫动脉搏动指数(UtA-PI)、子宫动脉阻力指数(UtA-RI)联合抗苗勒管激素(AMH)对体外受精-胚胎移植(IVF-ET)助孕结果的预测价值。方法:选择2020年2月-2022月2月本院确诊并行IVF-ET助孕的165例患者临床资料,根据IVF-ET助孕结果分为临床妊娠组(n=95例)与未妊娠组(n=70例)。分析比较各组UtA-PI、UtA-RI与血清AMH水平及临床一般资料;绘制受试者工作特征曲线(ROC)分析UtA-PI、UtA-RI、AMH水平及对IVF-ET助孕结果的预测价值,采用多因素logistic回归分析IVF-ET助孕结果的影响因素。结果:未妊娠组UtA-PI、UtA-RI均高于临床妊娠组,血清AMH水平低于临床妊娠组(均P<0.05)。ROC曲线分析,预测IVF-ET助孕结果血清AMH的曲线下面积为0.855,截断值5.21ng/ml,敏感度91.4%、特异度68.4%;UtA-PI的曲线下面积为0.795,截断值1.66,敏感度91.4%、特异度55.8%;UtA-RI的曲线下面积为0.832,截断值0.94,敏感度91.4%、特异度62.1%;3者联合的曲线下面积为0.922,敏感度、85.7%特异度86.3%。多因素分析显示,血清AMH、UtA-PI、UtA-RI及移植胚胎数目均为影响IVF-ET助孕结果的因素(P<0.05)。结论:UtA-PI升高、UtA-RI升高及AMH降低与IVF-ET是助孕失败的风险因素,3者对IVF-ET助孕结果有较好预测效果,且联合检测预测价值最佳。

不同AMH水平的PCOS患者卵巢反应性及与体外受精-胚胎移植结局的关系

目的探究不同抗苗勒管激素(AMH)水平的多囊卵巢综合征(PCOS)患者卵巢反应性与体外受精-胚胎移植结局的关系。方法选取88例PCOS患者,均接受体外受精-胚胎移植,均在取卵促排前进行AMH检测,结合AMH检测结果分为高AMH组(34例)与低中AMH组(54例)。两组患者均进行常规生化检查、卵巢反应性评估、体外受精-胚胎移植结局等相关指标统计,并比较妊娠结局。结果高AMH组和低中AMH组在窦卵泡计数、睾酮、基础垂体生成素、促性腺激素(Gn)用量、优胚率比较,差异有统计学意义(P<0.05),两组患者的基础雌二醇、基础卵泡刺激素、Gn天数、扳机日雌二醇、获卵数、优质卵泡数、受精率、临床妊娠率比较,差异无统计学意义(P>0.05)。结论高AMH水平会影响PCOS患者的卵巢反应性,并对体外受精-胚胎移植结局造成一定影响。