Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkiye, Türkiye.
Reproductive Health Research Center, Ankara University, Ankara, Türkiye.
J Ovarian Res. 2024 Oct 25;17(1):209. doi: 10.1186/s13048-024-01517-x.
Anti-Müllerian hormone (AMH) is a widely used marker for estimating ovarian reserve, and it may predict response to ovarian stimulation. While AMH is considered a stable, cycle-independent marker, studies have shown it can exhibit significant fluctuations based on factors like age, reproductive stage, and menstrual cycle phase. The fluctuations in AMH levels can make it challenging to predict individual responses accurately, particularly when the AMH is not measured in the COS cycle. The aim of this study was to assess the inter-cycle variability of serum AMH levels in two consecutive menstrual cycles and their correlation with response to controlled ovarian stimulation outcome in the latter.
In this single-centre retrospective cohort study, data of normal and low responder patients who underwent intracytoplasmic sperm injection following a GnRH antagonist cycle at a university hospital infertility clinic between January 2022 and December 2023 were reviewed. Serum AMH levels were measured in the early follicular phase of two consecutive menstrual cycles with Elecsys-AMH Roche system (Roche Diagnostics, Meylan, France). Correlations between AMH levels and controlled ovarian stimulation outcomes, including total oocyte and mature oocyte (MII) counts, were assessed. The study included normal and poor responder women to maintain data integrity.
A total of 79 patients were included in the final analyses. Significant cycle-to-cycle variation in serum AMH levels was observed, with a median variation of 44.3%. Normal responders exhibited a mean change of 0.60 ± 0.46 ng/ml, while poor responders had a mean change of 0.28 ± 0.28 ng/ml. Approximately 20% of patients were reclassified between normal and poor responder categories based on the second AMH measurement. The controlled ovarian stimulation cycle AMH levels showed a stronger correlation with both total oocyte count (r = 0.871, P < 0.001) and MII oocyte count (r = 0.820, P < 0.001) compared to preceding cycle AMH levels.
AMH levels can exhibit significant variations between consecutive cycles, potentially leading to misclassification of patients. Measuring AMH in the early follicular phase of the COS cycle provides a more accurate prediction of the numbers of total and MII oocytes collected. Consistent and repeated AMH measurements can help clinical decision-making.
抗苗勒氏管激素（AMH）是一种广泛用于评估卵巢储备功能的标志物，它可以预测卵巢刺激反应。虽然 AMH 被认为是一种稳定的、与周期无关的标志物，但研究表明，它的水平会根据年龄、生殖阶段和月经周期阶段等因素出现显著波动。AMH 水平的波动使得准确预测个体反应变得具有挑战性，尤其是当 AMH 不是在 COS 周期中测量时。本研究旨在评估两个连续月经周期中血清 AMH 水平的周期间变异性及其与后者控制性卵巢刺激反应结果的相关性。
这是一项单中心回顾性队列研究，对 2022 年 1 月至 2023 年 12 月在一家大学医院不孕不育诊所接受 GnRH 拮抗剂周期后行胞浆内单精子注射的正常和低反应患者的数据进行了回顾。采用罗氏 Elecsys-AMH Roche 系统（罗氏诊断公司，梅兰，法国）在两个连续月经周期的早卵泡期测量血清 AMH 水平。评估 AMH 水平与控制性卵巢刺激结果（包括总卵母细胞和成熟卵母细胞（MII）计数）之间的相关性。本研究纳入了正常和不良反应者，以保持数据的完整性。
最终分析共纳入 79 例患者。观察到血清 AMH 水平存在显著的周期间变化，中位数变化为 44.3%。正常反应者的平均变化为 0.60±0.46ng/ml，而不良反应者的平均变化为 0.28±0.28ng/ml。约 20%的患者根据第二次 AMH 测量结果在正常和不良反应者之间重新分类。控制性卵巢刺激周期 AMH 水平与总卵母细胞计数（r=0.871，P<0.001）和 MII 卵母细胞计数（r=0.820，P<0.001）的相关性均强于前一周期 AMH 水平。
AMH 水平在连续周期之间可能会出现显著变化，从而导致患者分类错误。在 COS 周期的早卵泡期测量 AMH 水平可更准确地预测总卵母细胞和 MII 卵母细胞的采集数量。一致和重复的 AMH 测量有助于临床决策。
