Lie Fong Sharon, Schipper Izaak, Valkenburg Olivier, de Jong Frank H, Visser Jenny A, Laven Joop S E
Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus MC, Room Na-1503, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus MC, Room Na-1503, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2015 Mar;186:75-9. doi: 10.1016/j.ejogrb.2015.01.007. Epub 2015 Jan 23.
The World Health Organization (WHO) has defined three classes of anovulatory infertility, based on serum gonadotrophin and oestradiol levels: low gonadotrophin and oestradiol levels in women with WHO 1 anovulation, normal hormone levels in WHO 2 anovulation and high gonadotrophin but low oestradiol levels in WHO 3 anovulation. The number of follicles on the ovary also seems to be different in the three classes of anovulatory infertility. Serum anti-Müllerian hormone (AMH) levels correlate well with the number of pre-antral and small antral follicles. The objective of our study was to investigate whether a single AMH measurement might simplify the classification of the WHO classes of anovulatory dysfunction.
In a tertiary hospital, 1863 patients with either oligomenorrhea or secondary amenorrhea were recruited. Standardized screening was performed, including transvaginal ultrasound and serum AMH measurement. Serum AMH levels were compared with those in 348 age-matched controls.
Serum AMH levels were slightly elevated in women with hypogonadotropic anovulation (n=128) (P<0.001) as compared with controls. Normogonadotropic anovulatory women (n=1.465) had distinctly higher serum AMH levels than controls (P<0.001) and serum AMH levels were low in women with hypergonadotropic anovulation (n=270) (P<0.001). Although median AMH levels were distinctly different in each class of anovulatory dysfunction, serum AMH levels were comparable in hypogonadotropic women and normogonadotropic women without polycystic ovary syndrome.
The clinical applicability of serum AMH as a diagnostic tool to differentiate between the different classes of anovulatory dysfunction seems to be limited to the prediction of hypergonadotropic anovulation.
世界卫生组织（WHO）根据血清促性腺激素和雌二醇水平定义了三类无排卵性不孕症：WHO 1型无排卵女性的促性腺激素和雌二醇水平低，WHO 2型无排卵女性的激素水平正常，WHO 3型无排卵女性的促性腺激素高但雌二醇水平低。在这三类无排卵性不孕症中，卵巢上的卵泡数量似乎也有所不同。血清抗苗勒管激素（AMH）水平与窦前卵泡和小窦卵泡的数量密切相关。我们研究的目的是调查单次AMH测量是否可以简化WHO无排卵功能障碍类别的分类。
在一家三级医院招募了1863例月经过少或继发性闭经的患者。进行了标准化筛查，包括经阴道超声检查和血清AMH测量。将血清AMH水平与348名年龄匹配的对照组进行比较。
与对照组相比，低促性腺激素性无排卵女性（n = 128）的血清AMH水平略有升高（P < 0.001）。正常促性腺激素性无排卵女性（n = 1465）的血清AMH水平明显高于对照组（P < 0.001），高促性腺激素性无排卵女性（n = 270）的血清AMH水平较低（P < 0.001）。尽管在每类无排卵功能障碍中，AMH的中位数水平明显不同，但在低促性腺激素女性和无多囊卵巢综合征的正常促性腺激素女性中，血清AMH水平相当。
血清AMH作为区分不同类无排卵功能障碍的诊断工具的临床适用性似乎仅限于预测高促性腺激素性无排卵。
