Chiofalo Francesco, Ciuoli Cristina, Formichi Caterina, Selmi Federico, Forleo Raffaella, Neri Ornella, Vuolo Giuseppe, Paffetti Patrizia, Pacini Furio
Department of Medical, Surgical and Neurological Sciences, University of Siena, Viale M. Bracci 16, 53100, Siena, Italy.
Department of Surgical Sciences, Bariatric Surgery Unit, University of Siena, Viale M. Bracci 16, 53100, Siena, Italy.
Obes Surg. 2017 Jul;27(7):1750-1754. doi: 10.1007/s11695-016-2528-y.
Obesity in fertile women has negative effect on fertility. Anti-mullerian hormone (AMH) represents a good index of fertility, and it is considered a marker of ovarian reserve and of polycystic ovarian syndrome (PCOS) gravity. Previous studies evaluated the relationship between obesity and AMH with contradictory results. The aim of the study was to investigate the relationship between obesity and AMH and the changes of AMH in obese women in reproductive age submitted to bariatric surgery.
Fifty-five obese patients between 18 and 39 years with (29 patients) and without PCOS (26 patients) were compared with a control group of normal weight women with (24 patients) and without PCOS (19 patients). Fourteen obese women with PCOS and 18 without PCOS underwent to bariatric surgery. Serum AMH, testosterone, androstenedione, and DHEAS were performed in all patients before and 1 year after surgical intervention.
AMH was significantly higher in the PCOS groups (p < 0.001), both in obese (5.84 ± 3.94 ng/ml) and non-obese women (7.35 ± 4.39 ng/ml). AMH was positively related to testosterone (p < 0.0001), androstenedione (p = 0.0005), and DHEAS (p = 0.003). After bariatric surgery, AMH levels were reduced in the both PCOS (p = 0.02) and non-PCOS group (p = 0.04).
AMH levels are elevated in PCOS patients regardless of the body weight. Bariatric surgery is effective in the normalization of AMH levels (a possible indirect marker of better fertility) only in obese patients with PCOS.
肥胖对育龄期女性的生育能力有负面影响。抗苗勒管激素（AMH）是生育能力的良好指标，被认为是卵巢储备和多囊卵巢综合征（PCOS）严重程度的标志物。先前的研究评估肥胖与AMH之间的关系，结果相互矛盾。本研究的目的是调查肥胖与AMH之间的关系，以及接受减肥手术的肥胖育龄期女性AMH的变化。
将55例年龄在18至39岁之间患有PCOS（29例）和未患PCOS（26例）的肥胖患者与一组体重正常且患有PCOS（24例）和未患PCOS（19例）的女性对照组进行比较。14例患有PCOS的肥胖女性和18例未患PCOS的肥胖女性接受了减肥手术。在手术干预前和术后1年对所有患者进行血清AMH、睾酮、雄烯二酮和硫酸脱氢表雄酮检测。
PCOS组的AMH显著更高（p < 0.001），肥胖女性（5.84 ± 3.94 ng/ml）和非肥胖女性（7.35 ± 4.39 ng/ml）均如此。AMH与睾酮（p < 0.0001）、雄烯二酮（p = 0.0005）和硫酸脱氢表雄酮（p = 0.003）呈正相关。减肥手术后，PCOS组（p = 0.02）和非PCOS组（p = 0.04）的AMH水平均降低。
无论体重如何，PCOS患者的AMH水平都会升高。减肥手术仅对患有PCOS的肥胖患者使AMH水平恢复正常（这可能是生育能力改善的一个间接标志物）有效。
