Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea.
Hum Reprod. 2010 Oct;25(10):2597-604. doi: 10.1093/humrep/deq204. Epub 2010 Aug 20.
Anti-Müllerian hormone (AMH) has been suggested as a marker of ovarian reserve and predictor of ovarian response to controlled ovarian hyperstimulation (COH). Several studies have demonstrated AMH changes during follicular and luteal phases during COH, but not after human chorionic gonadotrophin (hCG) administration. The objectives of this study were to investigate changes in AMH levels during the entire COH cycle and to clarify the regulatory mechanism of AMH secretion. In addition, we analyzed the COH outcome parameters to determine the optimal timing for AMH measurement to predict outcome.
The study included 74 women who underwent in vitro fertilization (IVF) cycles with a GnRH agonist or antagonist protocol. Serum AMH and inhibin B levels were measured at baseline, Day 5 of stimulation (d5), day of hCG administration (dhCG), day of oocyte retrieval (dOPU) and 14 days after oocyte retrieval (dPO14). Follicular fluid (FF) from dominant follicles upon oocyte retrieval were also analyzed for AMH and inhibin B concentrations. AMH levels were analyzed for changes during the cycle and for correlations with COH outcome parameters.
Serum AMH levels decreased progressively during COH until dhCG, then increased on dOPU and further increased on dPO14. Serum and FF AMH levels and dynamic changes were not different between the GnRH agonist and antagonist cycles. Serum AMH levels on every sample day and the FF AMH levels were significantly correlated with outcomes of COH, such as dose of gonadotrophins used, estradiol level on dhCG and number of retrieved oocytes; the strength of the relationship was highest for baseline AMH.
The results of the present study suggest that changes in the hormonal milieu during stimulation and after the LH surge may affect AMH secretion. Serum AMH levels during COH are good markers to predict ovarian response, but the baseline serum level seems to be the most predictive marker.
抗缪勒管激素（AMH）已被认为是卵巢储备的标志物和控制性卵巢过度刺激（COH）反应的预测因子。几项研究表明，在 COH 期间，AMH 在卵泡期和黄体期都会发生变化，但在人绒毛膜促性腺激素（hCG）给药后不会发生变化。本研究的目的是探讨整个 COH 周期中 AMH 水平的变化，并阐明 AMH 分泌的调节机制。此外，我们分析了 COH 的结局参数，以确定测量 AMH 以预测结局的最佳时机。
该研究纳入了 74 名接受 GnRH 激动剂或拮抗剂方案进行体外受精（IVF）周期的女性。在基础、刺激第 5 天（d5）、hCG 给药日（dhCG）、取卵日（dOPU）和取卵后 14 天（dPO14）测量血清 AMH 和抑制素 B 水平。还分析了取卵时优势卵泡的卵泡液（FF）中 AMH 和抑制素 B 的浓度。分析了 AMH 水平在周期中的变化及其与 COH 结局参数的相关性。
血清 AMH 水平在 COH 期间逐渐下降，直到 dhCG，然后在 dOPU 时增加，并在 dPO14 时进一步增加。GnRH 激动剂和拮抗剂周期之间的血清和 FF AMH 水平及其动态变化没有差异。每个样本日的血清 AMH 水平和 FF AMH 水平与 COH 的结局参数显著相关，如使用的促性腺激素剂量、dhCG 时的雌二醇水平和取出的卵母细胞数量；基础 AMH 的相关性最强。
本研究结果表明，刺激期间和 LH 激增后的激素环境变化可能会影响 AMH 的分泌。COH 期间的血清 AMH 水平是预测卵巢反应的良好标志物，但基础血清水平似乎是最具预测性的标志物。
