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.

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.

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.

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.

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.

营养干预对肥胖型多囊卵巢综合征病人AMH水平及受孕率的影响

目的探讨营养干预对肥胖型多囊卵巢综合征病人抗苗勒管激素(AMH)水平及受孕率影响。方法以2015年8月—2017年8月在我院妇科门诊就诊并接受治疗的110例肥胖型多囊卵巢综合征所致不孕病人为研究对象,按随机数字表法将病人分为3组,对照组30例,二甲双胍组和营养干预组各40例。对照组病人单纯给予达英-35治疗,二甲双胍组病人给予达英-35联合二甲双胍治疗,营养干预组病人给予达英-35联合营养干预治疗。检测并比较各组病人治疗前后血清AMH、促卵泡生成素(FSH)、促黄体生成素(LH)、雌二醇(E_2)、睾酮(T)水平以及空腹胰岛素(FINS)、空腹血糖(FBG)、胰岛素抵抗指数(HOMR-IR)、体质量指数(BMI)等指标变化。所有病人均给予促排卵治疗,统计各组病人的排卵率和受孕率。结果治疗后,3组病人血清AMH、LH、T、FINS和HOMR-IR均较治疗前下降,差异具有统计学意义(t=3.021～21.519,P<0.05);3组病人治疗前后血清AMH、LH、T、FBG、FINS、BMI和HOMR-IR差值比较差异均具有统计学意义(F=4.692～10.605,P<0.05)。营养干预组排卵成功率(90.00%)和受孕成功率(57.50%)最高,与对照组病人的63.33%和26.67%比较差异有显著意义(χ~2=7.240、6.605,P<0.05)。结论营养干预能够调节肥胖型多囊卵巢综合征病人激素分泌和糖代谢水平,减轻病人体质量,降低胰岛素抵抗,改善卵巢功能,提高病人排卵和受孕成功率,值得妇科临床推广使用。

Investigating structural impact of a valine to isoleucine substitution on anti-Müllerian hormone in silico and genetic association of the variant and AMH expression with egg production in chickens

Anti-Mullerian hormone(AMH)acts in maintaining orderly cyclic recruitment of early follicles,suggesting that it is a promising can didate for in flue ncing an imal reproductive efficiency.This study aimed to elucidate the effect of a missense mutati on of Val566lle on the structure of AMH protein and the genetic association of Val566lle and AMH expression with egg production in chickens.Structural perturbations of Val566lle were predicted by homology modeling.The association of the variant with the number of eggs was tested using a quantitative trait transmission disequilibrium test model.AMH expression in granulosa cells in Lueyang black-boned chickens was compared with that in Nick chickens.The Vai566 of AMH is a non?conservative amino acid among mammals and birds,but its hydrophobicity is completely conservative.The substitution of Vai566 for lie566 pote ntially disrupted hydroge n bonds and solve nt accessibility of 22 residues and created a short a-helix in the C terminus of AMH.Despite having striking structure-disrupting potential,the variant was not statistically associated with the number of eggs(P>0.05)in the Lueyang black-boned chickens.We did not detect differential expression of AMH betwee n Lueya ng black-b oned chicke ns and Nick chickens(P>0.05).These results con firmed the structural impact of Val566lle,but suggested that Val566lle and AMH expression might not be the major genetic determinants for egg production in Lueyang black-boned chickens.

Persistent mullerian duct syndrome presenting as retractile testis with hypospadias: A rare entity

A rare entity of persistent mullerian duct syndrome usually presents with a common symptom of undescended testis(UDT) or hernia. Male pseudo-hermaphroditism with persistent internal mullerian duct structures can present with a 46, XY karyotype with normal external genitalia and. It arises due to deficiency of antimullerian substance, resulting from reduced production/responsiveness to mullerian duct, leading to persistence of mullerian duct along with normal development of Wolffian duct structures. Presence of mullerian structure prevents testicular descent increasing the risk of testicular vanishing syndrome. The authors here report a case of 16 years old phenotypical male who came with retractile right sided testis and left side UDT in the urology outpatient department. Explorative laparotomy was performed and an ill-defined mass was excised and sent for histopathological examination. Histopathology revealed presence of mullerian structures. The serum testosterone level was normal, buccal smear cytology and karyotyping revealed a 46, XY genotype of the patient.

Three Dimensional <i>In Vitro</i>Culture of Murine Secondary Follicles in a Defined Synthetic Matrix

Ovarian follicle growth in three dimensional (3D) matrices in vitro has limitations: a) matrices don’t expand as follicles grow, b) requirements for enzyme-mediated retrieval, and c) animal-derived components prevent clinical application. Therefore, we evaluated N-Isopropylacrylamide (SFX-1), a novel synthetic 3D culture matrix, for follicle culture. Groups of three murine secondary follicles were encapsulated in 50 μL of DMEM/F12-1%ITS-10%FCS (DMEM/F12) or SFX-1 (3:2 v/v DMEM/F12) or Matrigel (1:1 DMEM/F12) and cultured for 48 h. Matrigel contains growth factors but SFX-1 has no animal-derived factors. Each culture condition was examined in 6 wells containing 18 follicles, in four replicate experiments (n = 4). Photomicrographs were used to determine follicle diameters and morphological integrity. Follicles were Live-Dead (LD) stained or disaggregated to generate cells for viability assessment using Trypan Blue (TB). Estradiol, progesterone and anti-mullerian hormone (AMH) in conditioned media were measured using Enzyme-linked Immunoassay. All culture conditions supported similar increases in follicle diameter. DMEM/F12 did not maintain morphological integrity which prevented follicle retrieval after 48 h;25% were retrieved from DMEM/F12, but 44% and 41% follicles were retrieved from SFX-1 and Matrigel respectively. Follicles retrieved from Matrigel could not be disaggregated, which prevented TB viability assessment. LD estimations of viable cells/follicle were lower than TB, but culture conditions had no effect on viability;SFX-1 64% ± 8% and DMEM/F12 69% ± 9%. SFX-1 and Matrigel supported similar levels of progesterone synthesis, only Matrigel supported estrogen synthesis, but none of the culture conditions supported AMH production. SFX-1 was not cytotoxic and was comparable to Matrigel. Further development of SFX-1 for use with human follicles is supported.

Mutated elements of a complex promoter (Amh) can help to demonstrate the role of certain elements in controlling differential gene expression

Amh is a single copy gene which is expressed in different ways during mammalian development. Several potential promoter elements have been identified using physiological experimentation and on the basis of interspecific sequence comparison. The role of putative promoter elements in controlling gene expression has been investigated by many workers over the last two decades and here by individually mutating each element. Expression was measured in vitro in cells of Sertoli descent by flowcytometry using EGFP as a reporter gene. Three lines of murine cells were used;pre- and post-pubertal Sertoli and granulosa cells. Differences between the three lines of cells, support the view that differentiation in this in vitro model system is likely to be at the level of available transcription factors at given points in development.

Impact of Age on Hormonal Profiles of Sub-Fertile Women Attending Fertility Clinic in Umuahia, Abia State, South Eastern Nigeria

Aim: This study evaluated the impact of age on the hormonal profiles of women diagnosed with infertility in a Fertility Clinic in Abia State, South-East, Nigeria. Methodology: Subjects comprised of 200 females: 150 subjects and 50 controls, aged Result: The means ± SEM of serum anti-Mullerian hormones were 1602.44 ± 54.42 pg/ml (control), 848.06 ± 23.04 pg/ml (group 1), 26.74 ± 1.28 pg/ml (group 2), 10.37 ± 1.26 pg/ml (group 3) values for follicle stimulating hormone in the control subjects was 4.90 ± 0.22 mIU/ml, 12.59 ± 0.79 mIU/ml (group 1), 30.59 ± 1.31 mIU/ml (group 2), and 41.59 ± 1.59 miU/ml (group 3). Similarly, the mean ± SEM of luteinizing hormone of control, group 1, group 2 and group 3 were 5.01 ± 0.22 mIU/ml, 15.02 ± 1.13 mIU/ml, 42.71 ± 1.82 mIU/ml and 58.22 ± 2.62 mIU/ml respectively while for estadiol the values were 63.16 ± 1.95 pg/ml, 94.10 ± 5.56 pg/ml, 58.84 ± 4.01 pg/ml and 36.7 ± 1.59 pg/ml for control, group 1, group 2 and group 3 respectively. The mean ± SEM of FSH/LH ratio for the control and experimental subjects were 0.98 ± 0.01, 0.89 ± 0.02, 0.74 ± 0.03 and 0.75 ± 0.02 for control, group 1, group 2 and group 3 respectively. The comparison of the means showed significant difference (p Conclusion: The evaluation of levels of the hormonal parameters across the age ranges of the population studied shows that women within the control and experimental group 1 (<20 years and 20 - 29 years) have a better chance of achieving pregnancy naturally.

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.

Development of a predictive model for increasing sperm retrieval sucpess by microdissection testicular sperm extraction in patients with nonobstructive azoospermia

Microdissection testicular sperm extraction(micro-TESE)is widely used to treat nonobstructive azoospermia.However,a good prediction model is required to anticipate a successful sperm retrieval rate before performing micro-TESE.This retrospective study analyzed the clinical records of 200 nonobstructive azoospermia patients between January 2021 and December 2021.The backward method was used to perform binary logistic regression analysis and identify factors that predicted a successful micro-TESE sperm retrieval.The prediction model was constructed using acquired regression coefficients,and its predictive performance was assessed using the receiver operating characteristic curve.In all,67 patients(sperm retrieval rate:33.5%)underwent successful micro-TESE.Follicle-stimulating hormone,anti-Miillerian hormone,and inhibin B levels varied significantly between patients who underwent successful and unsuccessful micro-TESE.Binary logistic regression analysis yielded the following six predictors:anti-Mullerian hormone(odds ratio[OR]=0.902,95%confidence interval[Cl]:0.821-0.990),inhibin B(OR=1.012,95%Cl:1.001-1.024),Klinefelter’s syndrome(OR=0.022,95%Cl:0.002-0.243),Y chromosome microdeletion(OR=0.050,95%Cl:0.005-0.504),cryptorchidism with orchiopexy(OR=0.085,95%Cl:0.008-0.929),and idiopathic nonobstructive azoospermia(OR=0.031,95%Cl:0.003-0.277).The prediction model had an area under the curve of 0.720(95%Cl:0.645-0.794),sensitivity of 65.7%,specificity of 72.2%,Youden index of 0.379,and cut-off value of 0.305 overall,indicating good predictive value and accuracy.This model can assist clinicians and nonobstructive azoospermia patients in decision-making and avoiding negative micro-TESE results.

Hydrogen-rich Water Exerting a Protective Effect on Ovarian Reserve Function in a Mouse Model of Immune Premature Ovarian Failure Induced by Zona Pellucida 3

Background：Premature ovarian failure （POF） is a disease that affects female fertility but has few effective treatments.Ovarian reserve function plays an important role in female fertility.Recent studies have reported that hydrogen can protect male fertility.Therefore,we explored the potential protective effect of hydrogen-rich water on ovarian reserve function through a mouse immune POF model.Methods：To set up immune POF model,fifty female BALB/c mice were randomly divided into four groups：Control （mice consumed normal water,n =10）,hydrogen （mice consumed hydrogen-rich water,n =10）,model （mice were immunized with zona pellucida glycoprotein 3 [ZP3] and consumed normal water,n =15）,and model-hydrogen （mice were immunized with ZP3 and consumed hydrogen-rich water,n =15） groups.After 5 weeks,mice were sacrificed.Serum anti-M＆#252;llerian hormone （AMH） levels,granulosa cell （GC） apoptotic index （AI）,B-cell leukemia/lymphoma 2 （Bcl-2）,and BCL2-associated X protein （Bax） expression were examined.Analyses were performed using SPSS 17.0 （SPSS Inc.,Chicago,IL,USA） software.Results：Immune POF model,model group exhibited markedly reduced serum AMH levels compared with those of the control group （5.41 ± 0.91 ng/ml vs.16.23 ± 1.97 ng/ml,P =0.033） and the hydrogen group （19.65 ± 7.82 ng/ml,P =0.006）.The model-hydrogen group displayed significantly higher AMH concentrations compared with that of the model group （15.03 ± 2.75 ng/ml vs.5.41 ± 0.91 ng/ml,P =0.021）.The GC AI was significantly higher in the model group （21.30 ± 1.74%） than those in the control （7.06 ± 0.27%）,hydrogen （5.17 ± 0.41%）,and model-hydrogen groups （11.24 ± 0.58%） （all P 〈 0.001）.The GC AI was significantly higher in the model-hydrogen group compared with that of the hydrogen group （1 1.24 ± 0.58% vs.5.1 7 ± 0.41%,P =0.021）.Compared with those of the model group,ovarian tissue Bcl-2 levels increased （2.18 ± 0.30 vs.3.01 ± 0.33,P =0.045） and the Bax/Bcl-2 ratio decreased in the model-hydrogen group.Conclusions：Hydrogen-rich water may improve serum AMH levels and reduce ovarian GC apoptosis in a mouse immune POF model induced by ZP3.