Department of Reproductive Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
BMC Endocr Disord. 2022 Jun 14;22(1):158. doi: 10.1186/s12902-022-01065-9.
The study aims to address whether serum anti-müllerian hormone (AMH) levels fluctuate in the short term after medication application, including oral contraceptives (OCs), metformin (MET), Gonadotropin-releasing hormone agonist (GnRH-a), dehydroepiandrosterone (DHEA), vitamin D (VD), clomiphene citrate (CC), and letrozole (LET).
Published literature from PubMed, Embase, and Cochrane central was retrieved up until 19 September 2021. A total of 51 self-control studies with an average Newcastle-Ottawa quality assessment scale (NOS) score of 6.90 were analyzed. The extracted data were entered into Stata software, and the weighted mean difference/standardized mean difference (WMD/SMD) and 95% confidence interval (CI) were used for data analysis.
After OCs treatment the AMH level showed a significant decline in women with normal ovarian function, which was significant within 3 months (WMD = -1.43, 95% CI: -2.05 to -0.80, P < 0.00001). After MET treatment, the serum AMH decreased in polycystic ovary syndrome (PCOS) patients (WMD = -1.79, 95% CI: -2.32 to -1.26, P < 0.00001), in both obese and non-obese patients. GnRH-a treatment in endometriosis patients led to dynamic changes in the serum AMH levels, that is, ascent at 1 month (P = 0.05), and descent at 3 months (P = 0.02). After DHEA treatment the serum AMH increased in diminished ovarian reserve (DOR) / poor ovarian response (POR) patients (WMD = 0.18, 95% CI: 0.09 to 0.27, P < 0.0001). After VD treatment the serum AMH increased, and it was obvious in non-PCOS patients (WMD = 0.78, 95% CI: 0.34 to 1.21, P = 0.0004). After CC treatment the serum AMH decreased significantly in PCOS patients, specifically in non-obese patients (WMD = -1.24, 95% CI: -1.87 to -0.61, P = 0.0001).
Serum AMH levels may be affected in the short term after drug application. Specifically, OC, MET and CC lead to decreased AMH level, DHEA and VD lead to increased AMH level, and GnRH-a leads to dynamic variation, which is correlated with PCOS, obesity, age, and duration of medication. The impacts of these medications should be taken into consideration when AMH is used as a marker of ovarian reserve.
本研究旨在探讨血清抗苗勒管激素（AMH）在药物应用后短期内是否会发生波动，包括口服避孕药（OCs）、二甲双胍（MET）、促性腺激素释放激素激动剂（GnRH-a）、脱氢表雄酮（DHEA）、维生素 D（VD）、枸橼酸氯米酚（CC）和来曲唑（LET）。
检索截至 2021 年 9 月 19 日 PubMed、Embase 和 Cochrane 中心的已发表文献。共分析了 51 项平均 Newcastle-Ottawa 质量评估量表（NOS）评分 6.90 的自身对照研究。提取的数据输入 Stata 软件，采用加权均数差/标准化均数差（WMD/SMD）和 95%置信区间（CI）进行数据分析。
OCs 治疗后，正常卵巢功能的女性 AMH 水平明显下降，3 个月内有显著差异（WMD=-1.43，95%CI：-2.05 至-0.80，P<0.00001）。MET 治疗后，多囊卵巢综合征（PCOS）患者血清 AMH 降低（WMD=-1.79，95%CI：-2.32 至-1.26，P<0.00001），肥胖和非肥胖患者均如此。GnRH-a 治疗子宫内膜异位症患者导致血清 AMH 水平发生动态变化，即 1 个月时升高（P=0.05），3 个月时下降（P=0.02）。DHEA 治疗后，卵巢储备功能减退（DOR）/卵巢反应不良（POR）患者血清 AMH 升高（WMD=0.18，95%CI：0.09 至 0.27，P<0.0001）。VD 治疗后，血清 AMH 升高，非 PCOS 患者更为明显（WMD=0.78，95%CI：0.34 至 1.21，P=0.0004）。CC 治疗后，PCOS 患者血清 AMH 明显下降，尤其是非肥胖患者（WMD=-1.24，95%CI：-1.87 至-0.61，P=0.0001）。
药物应用后短期内血清 AMH 水平可能受到影响。具体而言，OC、MET 和 CC 导致 AMH 水平降低，DHEA 和 VD 导致 AMH 水平升高，而 GnRH-a 导致动态变化，与 PCOS、肥胖、年龄和用药时间有关。在将 AMH 用作卵巢储备标志物时，应考虑这些药物的影响。
