The role of ovarian reserve markers in prediction of clinical pregnancy.

To evaluate the role of ovarian reserve markers in the prediction of clinical pregnancy and embryo transfer accomplishment among poor responder IVF applicants. 304 female poor responder IVF applicants were included in this prospective cohort study conducted at the IVF-unit. Antral follicle count, FSH, LH, E2, AMH and IVF outcomes were compared in pregnant and non-pregnant groups as well as in ET vs. non-ET groups. The number of retrieved oocytes was significantly correlated positively with AMH and AFC, and negatively with FSH and age. Quartiles of FSH and AFC were similar to the rate of pregnancy. Quartiles of AMH (<25%/25-75% and <25%/>75%) were statistically significant. Mean serum levels for AMH were significantly lower in the non-ET group. Our findings seem to indicate that day 3 AMH values can predict ET accomplishment with a sensitivity of 96% and a specificity of 35%. Quartiles of AMH <25% (< 0.21 ng/mL) can predict the IVF results among poor responder IVF applicants. Impact statement Various cut-off values have been determined for day 3 serum AMH values. These values help to determine the groups that are expected to give normal, high or low response to stimulation and decide the treatment options. In contrast to other groups of patients, poor responders cannot reach the embryo transfer stage for several reasons. These are; absence of a mature oocyte after oocyte pick-up, fertilisation failure without male factor or poor embryo quality. In the present study; a cut-off value of 0.33 ng/mL for the prediction of ET accomplishment in poor responder patients was determined with a sensitivity of 96%. Additionally, clinical pregnancy could not be achieved under the value of 0.21 ng/mL day 3 AMH values. It is important to clarify the embryo transfer success of poor responder patients prior to expected treatment success. Pre-treatment counselling for these patients would lessen the disappointment that may develop after treatment. The cost-effectiveness of treatments below these AMH values can be determined by further studies.

Relation of antimullerian hormone with the clinical signs of hyperandrogenism and polycystic ovary morphology.

The relation of antimullerian hormone (AMH) levels with the clinical and biochemical markers of polycystic ovary syndrome (PCOS) could be different. A total of 463 PCOS patients were evaluated in this cross-sectional study. Groups were constructed according to polycystic ovarian morphology (PCOM) and menstrual cycle-length. The relation of serum AMH with androgenic hormones, menstrual cycle-length and clinical signs of PCOS were investigated. A powerful positive relation was found between the PCOM and AMH levels (odds ratio = 2.49). There was a negative correlation between age and AMH level (p < 0.001, r[correlation coefficent] = -0.155). Positive correlations were found between luteinizing hormone (LH) and AMH (p < 0.001, r = 0.25) and also between cycle length and AMH (p < 0.01, r = 0.27). We found a negative week correlation between AMH and follicle-stimulating hormone (FSH) (p = 0.01, r = -0.19). After controlling main androgenic hormones, AMH was found to be correlated with the Ferriman-Gallway score (p = 0.03, r = 0.18). There was a positive relationship between hirsutism and AMH (odds ratio = 1.43), but no correlation between AMH and other parameters of clinical hyperandrogenism like hair-loss, acne and seborrhea were identified. The strongest relation was presented between the AMH levels and PCOM. Also, cycle-length correlated well with the AMH levels. The relationship between hirsutism and AMH is found to be independent from androgenic hormones.

Evaluation of ovarian reserve in Hashimoto's thyroiditis.

Human ovary is commonly the target of an autoimmune attack in cases of organ- or non-organ-specific autoimmune disorders. Hashimoto's thyroiditis (HT) is likely to be associated with ovarian dysfunction and diminished ovarian reserve. In this study, we aimed to evaluate the possible negative association between this significantly prevalent autoimmune disease and the ovarian reserve. Thirty-two premenopausal women with primary hypothyroidism, who under replacement therapy with thyroxine were recruited. Forty-nine healthy female subjects who had normal anti-thyroid antibody levels and were comparable with the HT group in terms of age and BMI values, comprised the control group. There was no statistically significant difference between the study and the control patients in terms of antral follicle count. Serum anti-Müllerian hormone (AMH) levels were significantly higher in woman with HT compared to the control group. The results of this study found no impairment in ovarian reserve parameters of patients with HT. Interestingly, the results revealed a significant increase in serum AMH levels of the patients with HT compared to controls. Hashimoto's thyroiditis may share a common etiologic linkage with polycystic ovary syndrome; therefore, leading to elevated serum AMH levels, which we are currently unable to define elaborately.

Diagnosis of Polycystic Ovary Syndrome: AMH in combination with clinical symptoms.

PURPOSE: We assessed the utility of using anti-Müllerian hormone (AMH) and clinical features of polycystic ovary syndrome (PCOS), polycystic ovarian morphology (PCOM), oligo/amenorrhea (OA), and hyperandrogenism (HA) for diagnosing PCOS, and compared their diagnostic accuracy with those of classical diagnostic systems. METHODS: A total of 606 females were admitted to a university hospital with menstrual irregularities or symptoms of hyperandrogenism were enrolled in this cross-sectional study. Fasting blood samples were collected. Pelvic and/or abdominal ultrasonography and clinical examination were performed. Patients were evaluated for the presence of PCOS according to conventional diagnostic criteria. The diagnostic performance of using serum AMH levels alone and in various combinations with the clinical features of PCOM, OA, and HA were investigated. RESULTS: For the diagnosis of PCOS, the combination of OA and/or HA with AMH showed 83% sensitivity and 100% specificity according to the Rotterdam criteria; 83% sensitivity and 89% specificity according to the National Institutes of Health (NIH) criteria; and 82% sensitivity and 93.5% specificity according to the Androgen Excess Society (AES) criteria. CONCLUSIONS: The serum AMH level is a useful diagnostic marker for PCOS and is correlated with conventional diagnostic criteria. The combination of AMH level with OA and/or HA markedly increased the clinical scope for PCOS diagnosis and can be introduced as a possible objective criterion for the diagnosis of this disease.

Anti-müllerian hormone levels as a predictor of the pregnancy rate in women of advanced reproductive age.

PURPOSE: To investigate whether serum anti-müllerian hormone (AMH), follicle stimulating hormone (FSH), or antral follicle count (AFC) are predictive for clinical pregnancy in women who underwent IVF cycles at the age of 35 and older METHODS: A total of 240 consecutive women who underwent IVF cycles at the age of 35 and older were enrolled in this crsoss- sectional study. Pregnant and nonpregnant women were compared. RESULTS: The median AMH level of pregnant women was higher than non-pregnant women [3.20 (0.63-9.60) vs 1.15 (0.01-14.90) ng/ml, p < 0.001]. On logistic regression analysis, AMH was an independent predictor of clinical pregnancy rate (CPR) (OR 1.353; 95 % CI 1.141-1.605; P < 0.001). After controlling for the other independent variables (the number of retrieved oocytes, AFC and age), the significant association between AMH and clinical pregnancy rate remained strong (OR 1.677; 95 % CI 1.216-2.311; p = 0.002) on multivariate logistic regression analysis. CONCLUSIONS: AMH is an effective measure of quantitative ovarian reserve and it can predict ovarian response to controlled stimulation for advanced age women. The CPR tends to increase as AMH increases.

Elevated serum levels of anti-Müllerian hormone can be introduced as a new diagnostic marker for polycystic ovary syndrome.

OBJECTIVE: To determine the possible role of anti-Müllerian hormone (AMH) in the diagnosis of polycystic ovary syndrome (PCOS) with a larger population of women and to evaluate its role as a new diagnostic marker. DESIGN: Cross-sectional study. SETTING: University hospital. POPULATION: A total of 570 women, with PCOS (n = 419) and without PCOS (n = 151). METHODS: Serum basal hormone; AMH, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and thyroid-stimulating hormone (TSH) levels were measured. Mean hormone levels were compared and the predictive value of serum AMH level was evaluated with the use of the receiver operating characteristic (ROC) curve analysis. RESULTS: No statistically significant differences were found between PCOS women and control groups in terms of age, body mass index and TSH levels. Differences between mean serum, FSH, LH and estradiol levels and LH/FSH ratio were found to be statistically significant (p < 0.001). Mean serum AMH level was higher in PCOS women than in controls (7.34 vs. 2.24 ng/mL, p < 0.001). The area under the ROC curve assay yielded a satisfactory result of 0.916 (95% confidence interval 0.897-0.935, p < 0.0001). The best compromise between 89.8% specificity and 80% sensitivity was obtained with a cut-off value of 3.94 ng/mL for PCOS diagnosis. CONCLUSIONS: Serum AMH measurement is very valuable in the diagnosis of PCOS women. The serum AMH level in women with hyperandrogenism or oligo-anovulation could indicate the diagnosis of PCOS when reliable ultrasonography data are not available or when typical clinical and laboratory findings are not available. The serum AMH level is a new and useful diagnostic tool in PCOS diagnosis.

Anti-Müllerian hormone and polycystic ovary syndrome: assessment of the clinical pregnancy rates in in vitro fertilization patients.

OBJECTIVE: The purpose of this study is to investigate the role of serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH) and antral follicle count (AFC) for the prediction of clinical pregnancy rates (CPR) in women with polycystic ovary syndrome (PCOS) undergoing IVF treatment. DESIGN: Prospective cohort study. SETTING: University hospital. PATIENTS: One hundred and fifty consecutive women with PCOS. INTERVENTIONS: All women underwent controlled ovarian stimulation with long agonist protocol followed by IVF procedure. Outcomes of pregnant and non-pregnant groups were compared. MAIN OUTCOME MEASURE: CPR; AMH, FSH and AFC means and percentiles. RESULTS: Fifty-one (34%) clinical pregnancies were observed in 150 women. Mean AMH was 6.7 ± 2.8 and 7.1 ± 4.3 ng/mL in pregnant and non-pregnant women, respectively (p = 0.594). The CPR were 27.8%, 35.0% and 37.8% in <25%, 25%-75% and >75% AMH percentiles, respectively (p = 0.656). There were also no significant difference in mean FSH and AFC between pregnant and non-pregnant women (p = 0.484 and p = 0.165, respectively). CONCLUSION: AMH, FSH and AFC are not predictive for CPR in women with PCOS undergoing IVF treatment. Mean AMH values were not significantly different between pregnant and non-pregnant women. Although CRP increased in parallel with the raise in AMH percentiles, this remained insignificant.

The effect of repeated administration of methotrexate (MTX) on rat ovary: measurement of serum antimullerian hormone (AMH) levels.

OBJECTIVE: To evaluate the possible effect of methotrexate (MTX) on rat ovaries by measuring serum antimullerian hormone (AMH), the novel marker of the ovarian reserve. METHODS: Pretreatment serum AMH levels were measured in 15 Wistar albino rats. MTX was given in 1 mg/kg dose in days 1, 3, 5, and 7. Serum AMH levels were measured twenty-four hours after each MTX administration. Pre- and post-treatment serum AMH levels were compared. RESULTS: Pretreatment median serum AMH was 102.4 ng/mL (25%: 41.9; 75%: 179.8). The median serum AMH levels were 70.6 ng/mL (25%: 54.08; 75%: 125.5); 136.1 ng/mL (25%: 57.3; 75%: 223.09); 121.2 ng/mL (25%: 52.5; 75%: 151.5); and 104.7 ng/mL (25%: 65.8; 75%: 265.5) after the first, second, third, and fourth methotrexate administrations, respectively. The ratio of the final (eighth day) median serum AMH level to the pretreatment median AMH level was 1.27 (25%: 0.84 and 75%: 2.57). Wilcoxon related samples test showed that final AMH was significantly higher as compared to the second day AMH measurement (p = 0.041). CONCLUSION: MTX administration did not cause a statistically significant change between pretreatment and final serum AMH levels in rats. There was no decrease in AMH levels indicating a decrease in ovarian reserve.

Evaluation of subgroups of the human sperm hypoosmotic swelling test in normozoospermic male cases with recurrent fertilization failure: a prospective case-controlled study.

PURPOSE: To compare subgroups of the human sperm hypoosmotic swelling test subgroups in both recurrent fertilization negative infertile cases with normal semen analysis and fertilization positive controls. METHODS: This was a prospective case-controlled study performed with normospermic 33 previously fertile male (secondary infertility) and 41 infertile men who had undergone two or three unsuccessful in vitro fertilization attempts. HOS test was investigated in 4 subgroups including HOS 1, HOS 2, HOS 3, and HOS 4 according to the degree of sperm tail swelling and compared between the two groups. RESULTS: Four subgroups were compared and statistical significance was demonstrated in HOS 1, HOS 3 and HOS 4 tests (p < 0.001) in fertile and infertile men. Highest HOS 1 and lowest HOS 4 grades were determined in Group A. However, no statistical significance was determined between two groups in HOS 2 test which was minimal swelling in sperm tails. CONCLUSIONS: HOS 1, HOS 3 and HOS 4 subgroups of HOS test are reliable and useful methods providing important information regarding the sperm function. A high HOS test 1 grade plus a low HOS test 4 grade should suggest a fertility problem, despite a normal semen analysis. HOS test subgroups provide additional information in normospermic cases with unexplained infertility.

Serum anti-müllerian hormone, follicle stimulating hormone and antral follicle count measurement cannot predict pregnancy rates in IVF/ICSI cycles.

PURPOSE: To investigate whether serum anti-müllerian hormone (AMH), follicle stimulating hormone (FSH), or antral follicle count (AFC) are predictive for clinical pregnancy in in vitro fertilization (IVF) patients. METHODS: Serum AMH, inhibin B, FSH, luteinizing hormone (LH), estradiol (E2), prolactin, and thyroid stimulating hormone (TSH) levels and AFC of 189 women under 40 years of age were investigated. Pregnant and non-pregnant women were compared. RESULTS: Forty-seven (24.8 %) clinical pregnancies were observed in 189 women. There was no significant difference in terms of mean age, duration of infertility, body mass index, AMH, LH, FSH, E2, TSH, Inhibin B, AFC and total oocyte number between women who did and who did not become pregnant. Additionally, there was no significant difference in clinical pregnancy rates between the quartiles of AMH, FSH and AFC. (P values were 0.668, 0.071, and 0.252, respectively.) CONCLUSION: Serum AMH and FSH, and AFC cannot predict clinical pregnancy in IVF patients under 40; the pregnancy rate tends to increase as AMH increases, although this remains non-significant.

Is there any correlation between amh and obesity in premenopausal women?

PURPOSE: To evaluate the correlation between the levels of anti-mullerian hormone and body mass index between obese and non-obese premenopausal women. METHODS: Serum anti-mullerian hormone levels of women younger than 45 years admitted to our reproductive endocrinology clinic for investigation of infertility were examined in this cross-sectional study. Body mass indices were lower than 30 kg/m(2) in 222 patients and equal to or higher than 30 kg/m(2) in 37 patients. Levels of antimullerian hormone were analyzed in each group. Blood samples obtained from study subjects were assayed for levels of anti-mullerian hormone, follicle-stimulating hormone, luteinizing hormone, estradiol, prolactin and thyroid stimulating hormone. RESULTS: There was no significant difference in terms of mean age between the two groups. There was no statistically significant difference between these two groups in terms of FSH, LH, estradiol and prolactin levels. Anti-mullerian hormone levels were 3.46 ± 2.79 ng/ml and 3.79 ± 2.93 ng/ml in non-obese and obese participants, respectively. No statistically significant correlation was found between Anti Müllerian Hormone (AMH) levels and BMI levels in either group (P > 0.05). CONCLUSIONS: Body mass index does not have an effect on serum AMH levels in women of reproductive age. Obesity has no association with levels of serum follicle stimulating hormone, luteinizing hormone, estradiol, prolactin and thyroid stimulating hormone. Obesity is unlikely to affect ovarian reserve in the premenopausal age group.

Anti-Müllerian hormone, an ovarian reserve marker in hypogonadotropic hypogonadism.

OBJECTIVE: To determine the usefulness of Anti-Müllerian Hormone (AMH) and antral follicle count (AFC) as an ovarian reserve marker in hypogonadotropic hypogonadism (HH) patients and to find a limit value for the gonadotropin levels in the diagnosis of HH patients. STUDY DESIGN: It is a retrospective cross-sectional single-center study. One hundred ninety-nine women with HH and 171 healthy controls with no cycle disorders were included into this study. Continuous variables were expressed as mean ± standard deviation. Statistical comparisons were carried out according to the intention to treat by Student's t-test, Mann-Whitney U test, where appropriate. Receiver operating characteristic curve-ROC was used to represent the sensitivity and specificity pair corresponding to decision threshold of FSH and LH levels in HH diagnosis. P < 0.05 was accepted to be statistically significant. RESULTS: There was not any statistically significant difference between HH and control group regarding the age (23.94 ± 6.56 vs. 23.92 ± 3.01, respectively; p = 0.09). Serum AMH levels didn't show statistically significant difference between HH and control group (3.26 ± 2.61 ng/mL vs. 3.15 ± 1.46 ng/mL, respectively; p = 0.11). The difference of AFC between HH and control group was statistically significant (6.67 ± 6.33 vs. 10.91 ± 2.92, respectively; p < 0.001). Follicle-stimulating hormone (FSH), Luteinizing-hormone (LH) and Estradiol (E2) levels between the groups were found to be significantly different. Area under the receiver operating characteristic curve-ROC for FSH was 0.98 and for LH was 0.96. For the diagnosis of HH, FSH levels lower than 3.05 IU/L (with a sensitivity of 92% and specificity of 94%) and LH levels lower than 1.55 IU/L (with a sensitivity of 91% and specificity of 92%) can be used. CONCLUSION: In conclusion, serum AMH levels reflect the follicle cohort in HH cases validly with negligible underestimation of ovarian reserve. FSH < 3.05 IU/L and LH < 1.55 IU/L could be used with high sensitivity and specificity for the diagnosis of HH.

Serum anti-Müllerian hormone and antral follicle count as predictive markers of OHSS in ART cycles.

OBJECTIVE: To evaluate predictive role of day-3 serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) in ovarian hyperstimulation syndrome (OHSS) in patients undergoing IVF/ICSI cycles. MATERIALS AND METHODS: Forty-one women with moderate/severe OHSS and 41 age matched women without OHSS were compared to evaluate the predictive value of certain risk factors for OHSS. AFC, and E(2), FSH, LH, AMH, inhibin-B levels measured on day 3 of the menstrual cycle before controlled ovarian hyperstimulation. RESULTS: Mean FSH was significantly lower (p < 0.0001); and mean LH, AFC and AMH were significantly higher in women with OHSS compared to women without OHSS (p = 0.049, p < 0.0001 and p < 0.0001, respectively). There was no significant difference in inhibin B (p = 0.112) and estradiol (p = 0.706) between the groups. The ROC area under curve (AUC) for AMH presented the largest AUC among the listed risk factors. AMH (AUC = 0.87) and AFC (AUC = 0.74) had moderate accuracy for predicting OHSS while Inhibin B (AUC = 0.58) and LH (AUC = 0.61) had low accuracy. The cut-off value for AMH 3.3 ng/mL provided the highest sensitivity (90%) and specificity (71%) for predicting OHSS. It's positive (PPV) and negative predictive values (NPV) were 61% and 94%, respectively. The cut-off value for AFC was 8 with 78% sensitivity, 65% specificity, 52% PPV and 86% NPV. CONCLUSION: Measurement of basal serum AMH and AFC can be used to determine the women with high risk for OHSS.

Different serum anti-Müllerian hormone concentrations are associated with oocyte quality, embryo development parameters and IVF-ICSI outcomes.

OBJECTIVE: To evaluate the association between different basal serum levels of anti-Müllerian hormone (AMH) and oocyte-embryo quality and IVF outcomes. MATERIALS AND METHODS: Two hundred and nine infertile women who underwent in vitro fertilization treatment with intracytoplasmic sperm injection (ICSI) between January 2009 and February 2011 were included in the study. Mean age, BMI, FSH, E(2), inhibin B, duration of infertility, total gonadotropin dose, antral follicle count, morphology of all oocytes, percentage of MII, early cleavage rate, the number of good quality embryos in transfer and ongoing pregnancy (>12 weeks) rates were evaluated. RESULTS: Six groups were formed according to the percentiles as <10% (≤0.89 ng/ml; n = 21), 10-25% (0.89-1.40 ng/ml; n = 31), 25-50% (1.40-2.89 ng/ml; n = 53), 50-75% (2.89-4.83 ng/ml; n = 28), 75-90% (4.83-8.06 ng/ml; n = 55), >90% (>8.06 ng/ml; n = 21). Central granulation, cytoplasmic granulation, oocyte postmaturity, percentage of embryos, early cleavage and percentage of transferred good quality embryos were significantly different in five groups (ANOVA test). Ongoing pregnancy rate (PR) was the lowest in <10% (9.5%), and the highest in 50-75% group (39.3%). (P = 0.040) CONCLUSION: Different AMH levels may predict the quality of oocytes, presence of postmaturity and nucleoli Z score, early cleavage and ICSI outcomes.

Serum anti-Müllerian hormone level as a predictor of poor ovarian response in in vitro fertilization patients.

PURPOSE: To evaluate the clinical value of day 3 serum anti-Müllerian hormone (AMH) compared with day 3 serum follicle-stimulating hormone (FSH) and human chorionic gonadotropin (hCG) day estradiol (E2) levels and antral follicle count (AFC) in the prediction of poor ovarian response in controlled ovarian hyperstimulation (COH). METHODS: AMH, FSH and AFC on day 3 as well as hCG day E2 levels were determined in 164 subjects. Receiver operating curve analyses and area under curves (AUC) of the study parameters were performed. Predictive values of the levels of day 3 AMH, FSH, AFC, and hCG day E2 as clinical parameters of ovarian response to COH were studied. RESULTS: Thirty-eight women were defined as poor responders. The day 3 AMH and hCG day E2 levels and AFC of normal responders were significantly higher than those of the poor responders. In predicting poor response, the AUC of day 3 AMH level was significantly higher than that of day 3 FSH level but was similar to the hCG day E2 level. Day 3 AMH, FSH and hCG day E2 levels and AFC were found to predict a poor response. Day 3 AMH and hCG day E2 levels were more predictive compared with day 3 FSH level and AFC. The cut-off level of AMH was ≤2 with a sensitivity of 78.9% and a specificity of 73.8%. CONCLUSION: Day 3 AMH has the ability to predict a poor response to COH and it is more predictive than day 3 FSH and AFC.

Serum anti-müllerian hormone concentrations in reproductive age women with and without polycystic ovary syndrome: the influence of body mass index.

PURPOSE: To evaluate the correlation between anti-müllerian hormone (AMH) and body mass index (BMI) in patients with and without polycystic ovarian syndrome (PCOS). METHODS: Serum AMH levels of 332 women in their reproductive period and below 45 years of age who were admitted to our reproductive endocrinology clinic with infertility were investigated in a cross-sectional study. Patients were divided into two groups as BMI under and equal or over 25 kg/m2. Both groups were divided into two subgroups as PCOS and non-PCOS. AMH levels of patients were analyzed for each group. RESULTS: Mean AMH values of BMI <25 and ≥25 kg/m2 groups were 3.87 ± 2.95 and 3.58 ± 2.93 ng/mL, respectively (P > 0.05) in all patients. Means of AMH were not significantly different in BMI quartiles (r = -0.008401, P = 0.96). Among 107 patients with PCOS, means of AMH were 6.85 ± 2.95 ng/mL in 56 patients with BMI <25 kg/m2 and 6.66 ± 3.18 ng/mL in 51 patients with BMI ≥25 kg/m2 (P > 0.05). In the group of 225 non-PCOS patients, means of AMH were 2.27 ± 1.12 ng/mL in 104 patients with BMI <25 kg/m2 and 2.28 ± 1.49 ng/mL in 121 patients with BMI ≥25 kg/m2 (P > 0.05). CONCLUSIONS: Body mass index does not seem to have an effect on serum AMH levels in reproductive age women both with and without PCOS.

Serum AMH levels and insulin resistance in women with PCOS.

OBJECTIVE: To compare the serum AMH levels between women with and without insulin resistance (IR) in polycystic ovary syndrome (PCOS). STUDY DESIGN: 293 women with PCOS according to the Rotterdam criteria were enrolled into our study. Insulin resistance was diagnosed according to the Homeostatic model assessment insulin resistant (HOMA-IR) formula and the cut-off point was set to more than 2.5. Women were grouped according to the presence of insulin resistance (IR) (HOMA-IR ≥ 2.5). Serum AMH and other hormones were compared between the IR (+) and IR (-) groups. Additionally, AMH percentiles were (<25, 25-75, >75) constructed; HOMA-IR and BMI values in women with/without IR were compared in different percentiles. Further, HOMA-IR, BMI and AMH values were measured across different PCOS phenotypes. RESULTS: The prevalence of IR was 45%. The prevalence of IR was 57% in women with BMI ≥ 25. Serum AMH levels were not significantly different among women with and without IR. Also, HOMA-IR values were not significant among different AMH percentiles. However, in each AMH percentile BMI were found to be higher in women with IR than in women without IR. The median HOMA-IR values were the highest in women with BMI ≥ 25 in both IR (+) and IR (-) groups. No significant difference was found among PCOS phenotypes in terms of HOMA-IR and BMI. Positive correlations were found between BMI, free testosterone and HOMA-IR. However, no correlation was found between AMH and HOMA-IR. CONCLUSION: The serum AMH levels between women with IR and without IR in PCOS were not significantly different. Also, we did not reveal a correlation between serum AMH levels and IR in women with PCOS. IR was not correlated with different PCOS phenotypes either. We found a positive correlation between BMI and IR. IR should be investigated in women with PCOS having a BMI ≥ 25, independent of their phenotype or AMH levels.

In Vitro Fertilization, Levels of Pro-Inflammatory Factors and Lipid Peroxidation.

BACKGROUND: Infertility is a problem concerning 10-15% of the individuals in the fertile period. This study investigated effects of proinflammatory factors as well as lipid hydroperoxides (LPO) levels upon in vitro fertilization (IVF) success. MATERIALS AND METHODS: In this prospective, non-randomized, controlled clinical study, sera obtained from 26 fertile (group-1), 26 infertile women before (group-2) and after (group-3) IVF treatment were analyzed. Leptin, leptin receptor, resistin, tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) were analyzed using enzyme-linked immunosorbent assay (ELISA). LPO was determined spectrophotometrically. Mann- Whitney U test, paired samples t test, Wilcoxon signed-rank test as well as Pearson correlation analysis by SPSS were performed for statistical analysis. RESULTS: TNF-α, resistin and LPO levels increased (P=0.020, P=0.003, P=0.001, respectively) in group-3 compared to group-2. A significant increase in LPO was noted both in group-2 and -3 compared to controls (P=0.000). LPO were higher in non-pregnants than pregnants in group-2. For pregnants, significant correlations were observed between leptin and resistin in group-2 and TNF-α and leptin in group-3. None of these correlations were found for the women, who could not conceive. CONCLUSION: LPO, leptin-resistin correlation, associations with TNF-α may be helpful during the interpretation of IVF success rates.

May AMH levels distinguish LOCAH from PCOS among hirsute women?

OBJECTIVE: To determine whether women with polycystic ovary syndrome (PCOS) would be distinguishable from women with late onset congenital adrenal hyperplasia (LOCAH) on the basis of antimullerian hormone (AMH) levels. STUDY DESIGN: PCOS was diagnosed in 170 women; 105 were polycystic ovary morphology (PCOM)+/oligo-anovulation (OA)+/hyperandrogenism (HA)+, 40 PCOM+/OA-/HA+ and 25 PCOM-/OA+/HA+. These three groups were compared with 25 women in whom LOCAH was diagnosed. RESULTS: The mean serum AMH levels were 8.12±1.85ng/ml in PCOM+/OA+/HA+ group, 5.34±1.82ng/ml in PCOM+/OA-/HA+ group, 3.02±1.76ng/ml in PCOM-/OA+/HA+ group and 4.43±1.29ng/ml in LOCAH group. The mean AMH level in PCOM+/OA+/HA+ group was approximately twofold higher than the mean AMH level measured in LOCAH group (p<0.001). Women with PCOM+/OA-/HA+ had higher serum AMH levels than those with LOCAH, women with LOCAH had higher serum AMH levels than those with PCOM-/OA+/HA+ but these differences were not statistically significant (p>0.05). CONCLUSIONS: AMH is not suitable for distinguishing LOCAH from all types of hyperandrogenic patterns of PCOS, but is only applicable for a specific subtype, such as PCOS patients with three main diagnostic criteria. Therefore, ACTH stimulation test remains an essential clinical tool to diagnose LOCAH.

Serum AMH levels in the differential diagnosis of hyperandrogenemic conditions.

OBJECTIVE: To investigate the diagnostic potential of anti-Müllerian hormone (AMH) in the differential diagnosis of various hyperandrogenemic conditions. STUDY DESIGN: Among 2241 consecutive women of reproductive age who were seen at a tertiary care university hospital with complaints of acne, hirsutism, androgenetic alopecia, and menstrual dysfunction (oligomenorrhea and/or amenorrhea), 107 patients with serum 17α-hydroxyprogesterone (17α-OHP) levels higher than 2 ng/ml were recruited for this study. An ACTH stimulation test was performed, and basal serum hormonal parameters and AMH levels were measured for all patients. RESULTS: 25 patients were diagnosed with late-onset congenital adrenal hyperplasia (LOCAH), and 59 patients with polycystic ovary syndrome (PCOS) had significantly higher serum AMH levels than all other groups. CONCLUSION: Among hyperandrogenemic patients with serum 17α-OHP levels >2 ng/ml, serum AMH levels might be introduced as a marker to be utilized clinically in the differential diagnosis of hyperandrogenemic patients, especially for identifying patients with PCOS.