Ayar Madenli Asena, Oz Inci
Department of Gynaecology of Obstetrics, Istinye University Faculty of Medicine, Istanbul, Turkiye.
Department of Gynaecology and Obstetrics, Liv Hospital Vadistanbul, Istanbul, Turkiye.
Medicine (Baltimore). 2025 Jun 27;104(26):e42842. doi: 10.1097/MD.0000000000042842.
Accurate assessment of ovarian reserve remains challenging in clinical practice, particularly when conventional markers like anti-müllerian hormone (AMH) and antral follicle count show inconsistent results. Despite widespread use, AMH has limitations in predicting reproductive lifespan and oocyte quality. This study evaluated 2 emerging biomarkers, insulin-like peptide-3 (INSL3) and tumor necrosis factor receptor 2 (TNFR2), for ovarian reserve assessment. We included 179 women aged 20 to 40 years. Participants underwent ultrasound evaluation for antral follicle count and blood sampling for hormone measurements. Women were classified using decreased ovarian reserve (DOR) and premature ovarian insufficiency (POI) criteria. INSL3 showed moderate effectiveness in detecting both DOR (area under the curve [AUC]: 0.685) and POI (AUC: 0.711), though not as strong as AMH. TNFR2 was statistically significant in predicting DOR (AUC: 0.651) but ineffective for POI identification. While AMH remained the strongest marker, INSL3 may serve as a supportive indicator for evaluating ovarian reserve, especially in identifying women at risk of POI. TNFR2, despite its biological relevance, shows limited clinical usefulness. These findings indicate INSL3's potential as a complementary marker to improve individualized assessment of ovarian function.
在临床实践中，准确评估卵巢储备仍然具有挑战性，尤其是当抗苗勒管激素（AMH）和窦卵泡计数等传统标志物显示出不一致的结果时。尽管AMH被广泛使用，但在预测生殖寿命和卵母细胞质量方面存在局限性。本研究评估了两种新兴的生物标志物，即胰岛素样肽-3（INSL3）和肿瘤坏死因子受体2（TNFR2），用于卵巢储备评估。我们纳入了179名年龄在20至40岁之间的女性。参与者接受了超声检查以评估窦卵泡计数，并进行了血液采样以测量激素水平。根据卵巢储备功能下降（DOR）和卵巢早衰（POI）标准对女性进行分类。INSL3在检测DOR（曲线下面积[AUC]：0.685）和POI（AUC：0.711）方面显示出中等有效性，尽管不如AMH强。TNFR2在预测DOR方面具有统计学意义（AUC：0.651），但在识别POI方面无效。虽然AMH仍然是最强的标志物，但INSL3可以作为评估卵巢储备的辅助指标，特别是在识别有POI风险的女性方面。TNFR2尽管具有生物学相关性，但其临床实用性有限。这些发现表明INSL3作为一种补充标志物具有潜力，可改善卵巢功能的个体化评估。
