serum anti-mullerian hormone(2009年會)

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Serum anti-MSerum anti-Mllerian hormone:llerian hormone:

a novel marker of ovariana novel marker of ovarian

responsiveness in IVF cyclesresponsiveness in IVF cyclesFeng-po Tsai, Chao-wen Chen, Hsun-mingFeng-po Tsai, Chao-wen Chen, Hsun-ming

Chang,Chao-chang Lin, Hsiao-ching Chen,Yueh-chiaoChang,Chao-chang Lin, Hsiao-ching Chen,Yueh-chiaoChang,Chun-chun Chen,Mone-li PengChang,Chun-chun Chen,Mone-li Peng

Poyuan Women Clinic IVF centrePoyuan Women Clinic IVF centre


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IntroductionIntroduction

Anti-MAnti-Mllerian hormone (AMH) expression starts in thellerian hormone (AMH) expression starts in thecolumnar granulosa cells of primary follicles immediatelycolumnar granulosa cells of primary follicles immediatelyafter differentiation from the flattened pregranulosa cells ofafter differentiation from the flattened pregranulosa cells ofprimordial follicles. Expression is highest in granulosa cellsprimordial follicles. Expression is highest in granulosa cellsof preantral and small antral follicles. AMH is no longerof preantral and small antral follicles. AMH is no longerexpressed during the FSH-dependant final stage of follicleexpressed during the FSH-dependant final stage of follicledevelopment. Therefore, AMH reflects the number ofdevelopment. Therefore, AMH reflects the number offollicles that have made the transition from the primordialfollicles that have made the transition from the primordialpool into the growing pool, and that is not controlled bypool into the growing pool, and that is not controlled bygonadotropins. In contrast to FSH, inhibin B and E2, AMHgonadotropins. In contrast to FSH, inhibin B and E2, AMH

level remain relatively constant during entire menstruallevel remain relatively constant during entire menstrualcycle. This characteristic benefits both patients andcycle. This characteristic benefits both patients andclinicians.clinicians.


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Material and methodMaterial and method

We review 50 IVF patients from DecemberWe review 50 IVF patients from December

1, 2007 till July 31, 2008 retrospectively.1, 2007 till July 31, 2008 retrospectively.

The ovarian response was determined byThe ovarian response was determined bythe E2 level on the day of HCG , the numberthe E2 level on the day of HCG , the number

of oocyt yield (mature and immature) andof oocyt yield (mature and immature) and

the number of embryos.the number of embryos.

..


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ResultResult

AMH levels showed a positive correlation with number ofAMH levels showed a positive correlation with number ofoocyte yield, immature oocytes, E2 level on the day ofoocyte yield, immature oocytes, E2 level on the day ofHCG injection, and the number of embryo. It also showed aHCG injection, and the number of embryo. It also showed anegative correlation with basal serum FSH level. Wenegative correlation with basal serum FSH level. We

divided 50 patients into 3 groups based on AMH level :divided 50 patients into 3 groups based on AMH level :group 1 (AMH


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y = 1.5185x + 2.2857

R2 = 0.3644

0

10

20

30

0 2 4 6 8 10 12

AMH

()

Fig1: AMH levels showed a positive correlation with number of oocyte yieldFig1: AMH levels showed a positive correlation with number of oocyte yield


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Fig2: AMH levels showed a negative correlation with basal serum FSH levelFig2: AMH levels showed a negative correlation with basal serum FSH level..

y = -0.3995x + 9.6584

R2 = 0.0872

0

2

4

6

8

10

12

14

16

18

0 5 10 15

AMH

day3FS

FSH/D3

FSH/D3


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Discussion(1)Discussion(1)

In this study, we demonstrate that high AMH is associatedIn this study, we demonstrate that high AMH is associatedwith higher number of oocyte yield and subsequentlywith higher number of oocyte yield and subsequentlyembryos available for transfer. This result is consistentembryos available for transfer. This result is consistentwith other studies that suggest AMH as a predictor ofwith other studies that suggest AMH as a predictor ofovarian response to gonadotropins in cycles of ART (vanovarian response to gonadotropins in cycles of ART (vanRooij et al.,2002,Fanchin et al.,2003,Hazout et al.,2004,Rooij et al.,2002,Fanchin et al.,2003,Hazout et al.,2004,Muttukrishna et al., 2004,2005, Penarrubia et al.,2005)Muttukrishna et al., 2004,2005, Penarrubia et al.,2005)

AMH has been shown to not fluctuate across the menstrualAMH has been shown to not fluctuate across the menstrualcycles (Cook et al.,2000, La Marca et al.,2004,2006),cycles (Cook et al.,2000, La Marca et al.,2004,2006),consistent with its role reflecting the continuous, non-cyclicconsistent with its role reflecting the continuous, non-cyclic

growth of small follicles in the ovary. This characteristic ofgrowth of small follicles in the ovary. This characteristic ofAMH makes it become a convenient test for patients andAMH makes it become a convenient test for patients andcliniciansclinicians


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Discussion(2)Discussion(2)

It is important for a clinician to be able to predictIt is important for a clinician to be able to predictboth extremes of response who are at risk ofboth extremes of response who are at risk ofovarian hyperstimulation syndrome and poorovarian hyperstimulation syndrome and poor

responders who are at risk of cycles cancellation.responders who are at risk of cycles cancellation.A reliable indicator of ovarian response toA reliable indicator of ovarian response tostimulation during IVF treatment can be used tostimulation during IVF treatment can be used tomodify therapeutic approaches individually.modify therapeutic approaches individually.

Due to the limited size of our study, we failed toDue to the limited size of our study, we failed todemonstrate the possible cut-off level of AMH todemonstrate the possible cut-off level of AMH topredict the occurrence of OHSS.predict the occurrence of OHSS.


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ConclusionConclusion

AMH level seems to be a reliable marker toAMH level seems to be a reliable marker to

forecast the ovarian response and may helpforecast the ovarian response and may help

individualization of therapy in IVF treatment.individualization of therapy in IVF treatment.

serum anti-mullerian hormone(2009年會)

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