Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Hum Reprod. 2014 Mar;29(3):592-600. doi: 10.1093/humrep/det447. Epub 2013 Dec 18.
What is the daily variation in serum inhibin B (InhB) and anti-Müllerian hormone (AMH) in relation to the LH surge in women of reproductive age.
AMH is secreted in a biphasic follicular/luteal pattern in women with higher AMH secretion, while InhB secretion is episodic in the early to mid-follicular phase and immediately after the LH surge but not in the luteal phase.
In women of reproductive age with a mean serum AMH >1 ng/ml, levels are highest in Days 2-7 of the cycle. InhB concentrations are highest in the follicular phase of the cycle.
STUDY DESIGN, SIZE, DURATION: In this cohort study conducted in an academic center, blood samples were collected daily from 20 women during one normal menstrual cycle.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Regularly menstruating 30- to 40-year-old women had daily serum InhB, AMH, LH and FSH levels measured. Intracycle variability of InhB and AMH were assessed after aligning to the LH surge.
When classified into quartiles of AMH concentration, the lowest AMH levels did not vary across the cycle; the highest AMH levels showed a mid-follicular increase, mid-cycle decrease and mid-luteal increase. A surge of InhB was noted following the LH surge in 16/20 cycles. Episodic increases in InhB occurred in 17/20 cycles prior to the LH surge. In the luteal phase, InhB decreased or became undetectable and did not demonstrate episodic secretion. Old and new assays for AMH and InhB were compared in all samples, with the AMH assays demonstrating good correlation (Rsq = 0.9625) but the InhB assays showing less correlation (Rsq = 0.4903).
LIMITATIONS, REASONS FOR CAUTION: The study population is small and in the mid-to-late reproductive age group. Single daily sampling may not detect more frequent variability (i.e. pulses) in hormone levels.
These data suggest different regulatory mechanisms for InhB and AMH secretion, and confirm an 'aging ovary' pattern of AMH and InhB secretion, which is consistent with decreased ovarian reserve. We also demonstrated comparability of the AMH Gen II assay with the previous version in standard usage but our data raised concerns about comparability of the InhB Gen II assay.
STUDY FUNDING/COMPETING INTEREST(S): General Clinical Research Center for phlebotomy work has been supported in part by NIH grant UL1RR024986. Recruitment and data analyses were supported by the Center for Integrated Approaches to Complex Diseases (SD Harlow, Director). The authors report no conflicts of interest.
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在生育期妇女中，血清抑制素 B（InhB）和抗苗勒管激素（AMH）的日变化与 LH 峰有何关系。
在 AMH 分泌较高的女性中，AMH 呈双相滤泡/黄体模式分泌，而 InhB 分泌在早卵泡期和中卵泡期呈间歇性，LH 峰后立即出现，但在黄体期不出现。
在生育期女性中，平均血清 AMH >1ng/ml 时，水平在周期的第 2-7 天最高。InhB 浓度在周期的卵泡期最高。
研究设计、大小、持续时间：这项在学术中心进行的队列研究中，从 20 名正常月经周期的女性中每天采集血液样本。
参与者/材料、设置、方法：定期行经的 30-40 岁女性每天测量血清 InhB、AMH、LH 和 FSH 水平。在对齐 LH 峰后，评估 InhB 和 AMH 的周期内变异性。
当按 AMH 浓度四分位数分类时，最低 AMH 水平在整个周期内没有变化；最高 AMH 水平在卵泡中期增加，在中期减少，在黄体中期增加。在 20 个周期中的 16 个周期中观察到 InhB 的 LH 峰后激增。在 LH 峰前，17/20 个周期中出现了间歇性的 InhB 增加。在黄体期，InhB 减少或无法检测到，并且没有表现出间歇性分泌。在所有样本中比较了 AMH 和 InhB 的新旧检测方法，AMH 检测方法显示出良好的相关性（Rsq=0.9625），但 InhB 检测方法显示出较低的相关性（Rsq=0.4903）。
局限性、谨慎的原因：研究人群规模较小，处于生育期的中晚期。每日单次采样可能无法检测到激素水平更频繁的变化（即脉冲）。
这些数据表明 InhB 和 AMH 分泌的不同调节机制，并证实了 AMH 和 InhB 分泌的“衰老卵巢”模式，这与卵巢储备减少一致。我们还证明了 AMH Gen II 检测与之前版本在标准使用中的可比性，但我们的数据对 InhB Gen II 检测的可比性提出了担忧。
研究资金/利益冲突：部分支持 NIH 拨款 UL1RR024986 的普通临床研究中心的采血工作。招募和数据分析得到综合复杂疾病方法中心（SD Harlow，主任）的支持。作者没有报告利益冲突。
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