Köninger A, Koch L, Enekwe A, Birdir C, Kasimir-Bauer S, Kimmig R, Strowitzki T, Schmidt B
Department of Gynecology and Obstetrics, University of Duisburg-Essen , Essen , Germany .
Gynecol Endocrinol. 2015 Jan;31(1):26-30. doi: 10.3109/09513590.2014.959436. Epub 2014 Sep 15.
Anti-Mullerian-hormone (AMH) does not seem to fluctuate significantly during the menstrual cycle in healthy women. However, little is known about cycle fluctuations of AMH levels in patients with polycystic ovarian syndrome (PCOS). The purpose of this study was to examine AMH fluctuations during the follicular phase in PCOS patients receiving antiestrogens or recombinant follicle-stimulating hormone (FSH). About 40 PCOS patients diagnosed according to Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group 2003 and 19 controls were prospectively enrolled. PCOS patients received either antiestrogens or recombinant FSH for monoovulation induction and controls received antiestrogens. AMH levels were determined (1) between the 2nd and the 5th day of follicular phase and (2) when a single large dominant follicle ≥18 mm had appeared. Our study shows that AMH levels do not change during follicular development in controls as well as in PCOS patients with AMH levels < 5 ng/ml, irrespective of antiestrogen or FSH therapy. However, in PCOS patients with AMH levels ≥5 ng/ml, AMH declines significantly during follicular development (p < 0.01). We conclude that AMH levels should be determined in the early follicular phase in PCOS patients without the influence of antiestrogens or exogenous FSH, because these interventions may lower AMH values in patients with high levels.
抗苗勒管激素（AMH）在健康女性的月经周期中似乎没有显著波动。然而，关于多囊卵巢综合征（PCOS）患者AMH水平的周期波动情况却知之甚少。本研究的目的是检测接受抗雌激素或重组促卵泡生成素（FSH）治疗的PCOS患者在卵泡期的AMH波动情况。根据2003年鹿特丹ESHRE/ASRM主办的PCOS共识研讨会小组标准诊断的约40例PCOS患者和19例对照者被前瞻性纳入研究。PCOS患者接受抗雌激素或重组FSH进行单卵泡诱导，对照组接受抗雌激素治疗。分别在卵泡期的第2至5天以及出现单个直径≥18 mm的优势大卵泡时测定AMH水平。我们的研究表明，无论接受抗雌激素还是FSH治疗，对照组以及AMH水平<5 ng/ml的PCOS患者在卵泡发育过程中AMH水平均无变化。然而，在AMH水平≥5 ng/ml的PCOS患者中，卵泡发育过程中AMH显著下降（p<0.01）。我们得出结论，PCOS患者应在卵泡早期测定AMH水平，且不受抗雌激素或外源性FSH的影响，因为这些干预措施可能会降低高水平患者的AMH值。
