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.

A New Protocol for Controlled Ovarian Stimulation Monitoring by Self-Determination of Estrone-3-Glucuronide and Single Ultrasound (COSSESU)

Background: Answering the question of what is the optimal protocol for monitoring controlled ovarian stimulation (COS) still remains a challenge. The rapid introduction of new diagnostic methods and various components of telemedicine makes it possible to reduce the number of patient visits during ovarian stimulation, which will reduce the loss of time, costs, and risk for the patient from COVID-like situations. Methods: The different COS monitoring protocols are examined, thus proposing a new approach consisting of two successive phases. Results: In the first phase, E3G in urine samples is being examined, which is performed by the patient themselves with a small portable analyzer. Based on the results, the specialist prescribes the doses for stimulation. The second phase involves one single determination of the size and number of follicles at the end of stimulation, using TVUS, as well as the dynamics of serum levels of P4 and E2. This proves to be in many cases sufficient. Conclusions: It is of our opinion that on the basis of new diagnostic tests such as E3G in urine and telemedicine, patients are able to independently and actively participate in the treatment process. This new approach to COS monitoring can be successfully implemented in different protocols for ovarian stimulation.