POLİKİSTİK OVER SENDROMLU KADINLARDA SERUM AMH İLE LABORATUVAR VE FENOTİP İLİŞKİSİ: RETROSPEKTİF ÇALIŞMA
Abstract
Amaç: Bu çalışmanın amacı serum AMH değeri 4-10 ng/ml ve >10 ng/ml olan PCOS’lu kadınlardaki endokrin ve fenotipik özellikleri karşılaştırmak ve PCOS tanısında yüksek AMH seviyesinin önemini araştırmaktır.
Gereç ve Yöntem: Bu retrospektif cohort çalışmada tersiyer sağlık kuruluşunda infertilite polikliniğinde takipleri başlatılan, serum AMH değeri ≥4 ng/ml kadınların laboratuar, demografik özellikleri araştırıldı. Hastane kayıtlarından kadınların foliküler fazda açlık HOMA, LH, FSH, östradiol, androstenedion, total testosteron, prolaktin, 17 Oh progesteron, DHEAS ve AMH düzey sonuçları kaydedildi. Hastaların yaşı, gravidası, BMI, infertilite durumu, hirsutizm, adet düzeni ve ultrasonografik over morfolojisi kaydedildi. Hastalar serum AMH değeri 4-10 ng/ml ve >10 ng/ml olanlar olarak 2 gruba ayrıldı. AMH’ı 10 ng/ml’dan yüksek olan kadınlar ‘’ yüksek AMH grubu’’, AMH > 14 ng/ml olanlar da ‘’çok yüksek AMH grubu’’ olarak adlandırıldı. Hormon içeren ilaç kullanan kadınlar, metformin kullanan kadınlar, kronik bir ilaç kullanan kadınlar, endokrin organ tümörü tanısı olanlar ve over cerrahisi geçirmiş kadınlar çalışmaya alınmadı.
Bulgular: Hastalar 21- 38 yaş aralığındaydı. AMH değeri 4-10 ng/ml olan 54, 10-14 ng/ml arası 12 ve >14 ng/ml 16 kadın çalışmaya alınmıştı. 44 hasta primer infertildi; 28 hastada klinik hirsutizm şikayeti vardı. Yüksek AMH değeri olan kadınlarda daha çok primer infertilite ve hirsutizm vardı. 34 hastada adet düzensizliği vardı ve iki grup arasında adet düzensizliği açısından fark yoktu. Laboratuar değerlerinden total testosteron, androstenedion, LH/FSH oranı ile yüksek AMH arasında anlamlı ilişkili bulundu. Yüksek AMH olan kadınlarda daha çok primer infertilite ve hirsutizm vardı. Tüm >10 ng/ml AMH değeri olan kadınlarda PCOM görülmüştü. Adet düzensizliği açısından iki grup benzerdi. 2 grup arasında HOMA ve BMI kriterleri açısından fark yoktu. Diğer endokrin değerler AMH düzeyi ile ilişkili değildi.
Sonuç: Yüksek AMH değeri olan kadınlarda androjenler ile AMH arasında pozitif korelasyon vardır, AMH yüksekliği PCOS tanısı konulmasına ek bir marker olabilir. Hirsutizm ve yüksek androjen olan kadınlarda ve özellikle PCOM olan kadınlarda yüksek AMH olabileceği ve infertilite tedavilerinde buna bağlı ilaç dirençlerinin dikkate alınarak tedavinin düzenlenmesi gerektiğini düşünüyoruz.
Keywords
Supporting Institution
Yoktur
Project Number
Yoktur
Thanks
Yoktur
References
- 1. Tal R, Seifer DB. Ovarian reserve testing: a user’s guide. Am J Obstet Gynecol 2017;217(2):129-40. google scholar
- 2. Shrikhande L, Shrikhande B, Shrikhande A. AMH and Its Clinical Implications. J Obstet Gynaecol India 2020;70(5):337-41. google scholar
- 3. Garg D, Tal R. The role of AMH in the pathophysiology of polycystic ovarian syndrome. Reprod Biomed Online 2016;33(1):15-28. google scholar
- 4. Kataoka J, Larsson I, Lindgren E, Kindstrand LO, Schmidt J, Stener-Victorin E. Circulating Anti-Müllerian hormone in a cohort-study of women with severe obesity with and without polycystic ovary syndrome and the effect of a one-year weight loss intervention. Reprod Biol Endocrinol 2022;20(1):153. google scholar
- 5. Alebic MS, Stojanovic N, Duhamel A, Dewailly D. The phenotypic diversity in per-follicle anti-Müllerian hormone production in polycystic ovary syndrome. Hum Reprod 2015;30(8):1927-33. google scholar
- 6. Bedenk J, Vrtacnik-Bokal E, Virant-Klun I. The role of anti-Müllerian hormone (AMH) in ovarian disease and infertility. J Assist Reprod Genet 2020;37(1):89-100. google scholar
- 7. Balen AH, Laven JS, Tan SL, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update 2003;9(6):505-14. google scholar
- 8. Russell N, Gilmore A, Roudebush WE. Clinical Utilities of Anti-Müllerian Hormone. J Clin Med 2022;11(23):7209. google scholar
- 9. Tzeng CR, Huang Z, Asada Y, Zhang C, Ho MT, Li RHW, et al. Factors affecting the distribution of serum anti-müllerian hormone levels among infertile Asian women: a multi-nation, multi-centre, and multi-ethnicity prospective cohort study. Hum Reprod 2023;38(7):1368-78. google scholar
- 10. Laven JS, Imani B, Eijkemans MJ, Fauser BC. New approach to polycystic ovary syndrome and other forms of anovulatory infertility. Obstet Gynecol Surv 2002;57(11):755-67. google scholar
- 11. Liu S, Hong L, Mo M, Xiao S, Wang X, Fan X, et al. Association of anti-müllerian hormone with polycystic ovarian syndrome phenotypes and pregnancy outcomes of in vitro fertilization cycles with fresh embryo transfer. BMC Pregnancy Childbirth 2022;22(1):171. google scholar
- 12. Tal R, Seifer CM, Khanimov M, Seifer DB, Tal O. High serum Antimullerian hormone levels are associated with lower live birth rates in women with polycystic ovarian syndrome undergoing assisted reproductive technology. Reprod Biol Endocrinol 2020;18(1):20. google scholar
- 13. Saadia Z. Follicle Stimulating Hormone (LH: FSH) Ratio in Polycystic Ovary Syndrome (PCOS) - Obese vs. Non-Obese Women. Med Arch 2020;74(4):289-93. google scholar
- 14. Tal R, Seifer DB, Khanimov M, Malter HE, Grazi RV, Leader B. Characterization of women with elevated antimüllerian hormone levels (AMH): correlation of AMH with polycystic ovarian syndrome phenotypes and assisted reproductive technology outcomes. Am J Obstet Gynecol 2014;211(1):e1-8. google scholar
- 15. Carlsen SM, Vanky E, Fleming R. Anti-Müllerian hormone concentrations in androgen-suppressed women with polycystic ovary syndrome. Hum Reprod 2009;24(7):1732-8. google scholar
- 16. Butt MS, Saleem J, Aiman S, Zakar R, Sadique I, Fischer F. Serum anti-Müllerian hormone as a predictor of polycystic ovarian syndrome among women of reproductive age. BMC Women’s Health 2022;22(1):199. google scholar
Abstract
Objective: The aim of this study was to compare the endocrine and phenotypic characteristics of PCOS women with serum AMH levels of 4‑10 ng/mL and >10 ng/mL, and to investigate the importance of high AMH levels in the diagnosis of PCOS.
Materials and Methods: In this retrospective cohort study, the laboratory and demographic characteristics of women with serum AMH ≥4 ng/mL whose follow-up was initiated at the infertility outpatient clinic of a tertiary health care institution were investigated. Fasting levels of HOMA, LH, FSH, estradiol, androstenedione, total testosterone, prolactin, 17Oh progesterone, DHEAS and AMH were recorded from hospital records. Age, gravidity, BMI, infertility status, hirsutism, menstrual cycle and ultrasonographic ovarian morphology were recorded. Patients were divided into two groups, as those with serum AMH values of 4‑10 ng/mL and those with serum AMH values of >10 ng/mL. Women with AMH >10 ng/mL were defined as the “high AMH group” and those with AMH >14 ng/mL were defined as the “very high AMH group.” Women on hormone-containing drugs, metformin, and/or chronic medication, as well as women with endocrine organ tumors and/or who have had ovarian surgery were excluded.
Results: The patients were between 21 and 38 years of age. Fifty-four women with AMH values of 4‑10 ng/mL, 12 women with 10‑14 ng/mL and 16 women with >14 ng/mL were included in the study. Forty-four patients were primary infertile, and 28 patients had clinical hirsutism. Women with high AMH values had more primary infertility and hirsutism. Thirty-four patients had menstrual irregularities, and there was no statistically significant difference between the two groups in terms of menstrual irregularities. Among laboratory values, total testosterone, androstenedione, and the LH/FSH ratio were significantly associated with high AMH. Primary infertility and hirsutism were more common in women with high AMH. PCOM was seen in all the women with AMH >10 ng/mL. There was no difference between the two groups in terms of HOMA and BMI criteria. Other endocrine values were not associated with AMH levels.
Conclusion: There is a positive correlation between androgens and AMH in women with high AMH values, with the possibility of high AMH being an additional marker for the diagnosis of PCOS. We believe that women with hirsutism and high amounts of androgens and especially women with PCOM may have high AMH, and infertility treatments should be organized by taking into account the related drug resistance.
Keywords
Project Number
Yoktur
References
- 1. Tal R, Seifer DB. Ovarian reserve testing: a user’s guide. Am J Obstet Gynecol 2017;217(2):129-40. google scholar
- 2. Shrikhande L, Shrikhande B, Shrikhande A. AMH and Its Clinical Implications. J Obstet Gynaecol India 2020;70(5):337-41. google scholar
- 3. Garg D, Tal R. The role of AMH in the pathophysiology of polycystic ovarian syndrome. Reprod Biomed Online 2016;33(1):15-28. google scholar
- 4. Kataoka J, Larsson I, Lindgren E, Kindstrand LO, Schmidt J, Stener-Victorin E. Circulating Anti-Müllerian hormone in a cohort-study of women with severe obesity with and without polycystic ovary syndrome and the effect of a one-year weight loss intervention. Reprod Biol Endocrinol 2022;20(1):153. google scholar
- 5. Alebic MS, Stojanovic N, Duhamel A, Dewailly D. The phenotypic diversity in per-follicle anti-Müllerian hormone production in polycystic ovary syndrome. Hum Reprod 2015;30(8):1927-33. google scholar
- 6. Bedenk J, Vrtacnik-Bokal E, Virant-Klun I. The role of anti-Müllerian hormone (AMH) in ovarian disease and infertility. J Assist Reprod Genet 2020;37(1):89-100. google scholar
- 7. Balen AH, Laven JS, Tan SL, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update 2003;9(6):505-14. google scholar
- 8. Russell N, Gilmore A, Roudebush WE. Clinical Utilities of Anti-Müllerian Hormone. J Clin Med 2022;11(23):7209. google scholar
- 9. Tzeng CR, Huang Z, Asada Y, Zhang C, Ho MT, Li RHW, et al. Factors affecting the distribution of serum anti-müllerian hormone levels among infertile Asian women: a multi-nation, multi-centre, and multi-ethnicity prospective cohort study. Hum Reprod 2023;38(7):1368-78. google scholar
- 10. Laven JS, Imani B, Eijkemans MJ, Fauser BC. New approach to polycystic ovary syndrome and other forms of anovulatory infertility. Obstet Gynecol Surv 2002;57(11):755-67. google scholar
- 11. Liu S, Hong L, Mo M, Xiao S, Wang X, Fan X, et al. Association of anti-müllerian hormone with polycystic ovarian syndrome phenotypes and pregnancy outcomes of in vitro fertilization cycles with fresh embryo transfer. BMC Pregnancy Childbirth 2022;22(1):171. google scholar
- 12. Tal R, Seifer CM, Khanimov M, Seifer DB, Tal O. High serum Antimullerian hormone levels are associated with lower live birth rates in women with polycystic ovarian syndrome undergoing assisted reproductive technology. Reprod Biol Endocrinol 2020;18(1):20. google scholar
- 13. Saadia Z. Follicle Stimulating Hormone (LH: FSH) Ratio in Polycystic Ovary Syndrome (PCOS) - Obese vs. Non-Obese Women. Med Arch 2020;74(4):289-93. google scholar
- 14. Tal R, Seifer DB, Khanimov M, Malter HE, Grazi RV, Leader B. Characterization of women with elevated antimüllerian hormone levels (AMH): correlation of AMH with polycystic ovarian syndrome phenotypes and assisted reproductive technology outcomes. Am J Obstet Gynecol 2014;211(1):e1-8. google scholar
- 15. Carlsen SM, Vanky E, Fleming R. Anti-Müllerian hormone concentrations in androgen-suppressed women with polycystic ovary syndrome. Hum Reprod 2009;24(7):1732-8. google scholar
- 16. Butt MS, Saleem J, Aiman S, Zakar R, Sadique I, Fischer F. Serum anti-Müllerian hormone as a predictor of polycystic ovarian syndrome among women of reproductive age. BMC Women’s Health 2022;22(1):199. google scholar
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences (Other) |
| Journal Section | Research Articles |
| Authors | |
| Project Number | Yoktur |
| Publication Date | October 24, 2023 |
| Submission Date | July 5, 2023 |
| Published in Issue | Year 2023 Volume: 6 Issue: 3 |
