Anti-Müllerian hormone levels and spontaneous pregnancy in women undergoing surgery for benign ovarian cysts

This prospective study had the objective to compare anti-Müllerian hormone (AMH) serum levels among women with endometriomas and those with other benign ovarian cysts and verify a possible correlation between the AMH post-operative decline and the achievement of pregnancy. The study included 57 women undergoing laparoscopic surgery. Serum levels of AMH were measured preoperatively and at 6 and 12?months postoperatively. AMH serum levels decreased in both endometriomas and other benign cysts, but significant recovery was reported only in endometriomas (p?=?.029). Through an interview, information on reproductive outcome was obtained. The secondary endpoint was to identify other predictors of spontaneous pregnancy onset. After surgery 27 women attempted to conceive. At 18-months follow-up, 12 of them got pregnant, with a live birth of 37%. We did not record statistically significant differences in reproductive outcome between women with AMH serum levels lower and higher than 1.1?ng/ml (41.7 and 53.3% respectively). There was no statistically significant difference in AMH serum levels between pregnant and non-pregnant women, neither before nor after surgery. AMH did not appear to have a predictive role on reproductive outcome.     

Removal of unilateral endometriomas is associated with immediate and sustained reduction in ovarian reserve

Endometrioma surgery by stripping the cyst capsule has been associated with a reduction in ovarian reserve. It is still not clear whether the inflicted damage is immediate, sustained over time or associated with the use of electrocautery, nor which marker is more accurately reflects the post-operative reduction in ovarian reserve. This observational study assessed the damage inflicted by endometrioma removal with anti-Müllerian hormone (AMH) concentration and antral follicle count (AFC) pre and post-operatively. Twenty-five women with unilateral endometrioma underwent laparoscopic stripping of the endometrioma cyst capsule. There was a significant decrease both in AMH concentration (24%) and in AFC (11%) 1 month following surgery (P < 0.01). At 6 months post-operatively, the respective values were 24% and 15% less than preoperatively. AMH concentration and AFC showed no correlation with the use of bipolar electrocautery during surgery. Primordial follicles embedded adjacent to the cyst capsule were found in 61.5% of the specimens. Endometrioma surgery by stripping of the cyst capsule is associated with a significant reduction in ovarian reserve. The reduction is immediate and sustained over time. AMH appears to be a better indicator for post-operative quantification of the ovarian reserve.Endometrioma surgery by stripping the cyst capsule has been associated with a reduction in ovarian reserve. It is still not clear whether the inflicted damage is immediate, sustained over time or associated with the use of electrocautery, nor which marker more accurately reflects the post-operative reduction in ovarian reserve. In this observative study, we assessed the damage inflicted by endometrioma removal with anti-Müllerian hormone (AMH) and antral follicle count (AFC) pre- and post-operatively. Twenty-five women underwent laparoscopic stripping of the endometrioma cyst capsule. There was a 24% decrease in AMH concentration and an 11% decrease in AFC compared with the preoperative values 1 month following surgery. The values did not change 6 months after surgery over those recorded at 1 month post-operatively (24 and 15% less than preoperative values. Primordial follicles embedded adjacent to the cyst capsule were found in 61.5% of the specimens. Endometrioma surgery by stripping of the cyst capsule is associated with a significant reduction in ovarian reserve. The reduction is immediate and sustained over time. AMH appears to be a better indicator for post-operative quantification of the ovarian reserve.     

Pregnancy prognosis in women with anti-Müllerian hormone below the tenth percentile

Abstract

Although serum anti-Müllerian hormone (AMH) is considered a good predictor of ovarian response during in vitro fertilisation (IVF), pregnancies have been reported with low values, questioning its usefulness as a predictor of treatment outcome. A retrospective study was therefore carried out to assess the IVF treatment outcomes in women with AMH below the tenth percentile of the study population. In all, 134 women with AMH ≤3?pmol/L underwent 180 IVF cycles. The mean age at the time of treatment was 37?±?5 years. Fifty-three (29.4%) cycles were abandoned because of poor response to gonadotrophins, 12 (6.7%) due to absence of eggs at oocyte retrieval and 18 (10%) due to fertilisation failure. Seven (3.8%) had a biochemical pregnancy, 4 (2.2%) had a missed miscarriage and 8 (4.4%) had a live birth. When stratified by age, women older than 42 years had less number of follicles (p?<?0.05) and those older than 39 years had less oocytes (p?<?0.01) compared to those 35 years and younger. Live births declined with increasing age, when age was assessed as a continuous variable (p?=?0.023). Women with low AMH levels have a high probability of treatment cancellation, failure to proceed to embryo transfer and a low chance of achieving a viable pregnancy.     

Selective use of corifollitropin for controlled ovarian stimulation for IVF in patients with low anti-Müllerian hormone

Corifollitropin, a long-acting follicle-stimulating hormone (FSH) analogue used for in vitro fertilization (IVF), does not allow individualization of dosage, and the ovarian response is similar to around 300?IU of daily recombinant FSH. This has raised concerns about the risk of ovarian hyperstimulation syndrome (OHSS) when used in standard patients. We administered corifollitropin selectively to patients with anticipated low to moderate ovarian response based on antimüllerian hormone levels in the lower quartile. The end points were oocyte distribution and occurrence of OHSS in women with AMH ≤15?pmol/L. The study included a cohort of 368 patients treated in 599 cycles. Post hoc the cohort was subdivided according to AMH. With increasing baseline AMH, the number of oocytes increased from a mean of 2.7 (range 0–8 with AMH <3?pmol/L) to 6.3 (range 0–15 with AMH 10–15?pmol/L) oocytes. Cancellations of retrievals and transfers decreased significantly with increasing AMH. Overall, the ongoing live pregnancy rate per started cycle was 15.2%. None developed OHSS. No cycles were cancelled or needed triggering of ovulation using a GnRH agonist due to risk of OHSS. Selective use of corifollitropin in patients with AMH in the lower quartile is a safe and appropriate way of optimising stimulation.     

Ovarian reserve in young women with low birth weight and normal puberty: a pilot case–control study

Aim.?Studies indicate that women born small for gestational age (SGA) have impaired ovarian function. The origin of this ovarian dysfunction is still debatable. The aim of this study was to compare ovarian ageing between girls born appropriate for gestational age (AGA) and SGA. Therefore, we measured Luteinizing hormone (LH), Follicle-stimulating hormone (FSH), E2, Anti-Müllerian hormone (AMH) levels and the pituitary response to endogenous Gonadotropin-releasing hormone (GnRH) in adolescent girls born SGA and AGA.

Methods.?A case–controlled pilot study consisting of seven SGA women (birth weight?<10th percentile AGA) and 13 AGA women with regular menstrual cycles, age 19.9 (±0.42). Early follicular FSH, LH, Oestradiol (E2) and AMH levels were measured. After baseline samples, 100?μg GnRH was administered intravenously and at 30, 60 and 90?min blood samples were taken to measure gonadotropin levels and to compute the response to endogenous GnRH.

Results.?Mean follicular phase LH, FSH, E2 and AMH levels did not significantly differ between young women born SGA and AGA. Furthermore, the response to endogenous GnRH showed no significant differences either.

Conclusions.?We concluded against extension of this pilot study. Based on our observations it seems unlikely that limited ovarian reserve is a predominated problem in adolescent SGA.     

Cyst aspiration or GnRH antagonist administration for ovarian cysts detected at the start of fresh in vitro fertilization cycles*

The primary objective of this study is to investigate the effect of transvaginal ultrasonogram (TVUS)-guided cyst aspiration or gonadotropin releasing hormone antagonist (GnRH-ant) administration for the management of solitary ovarian cysts detected at the start of in vitro fertilization (IVF) cycles on the outcomes of the same cycles. This is a single-center, retrospective, cohort study of patients who had TVUS-guided cyst aspiration or GnRH-ant treatment for ovarian cysts detected at the start of IVF during a 5-year period. Four hundred and three patients met inclusion criteria: 41 (10.2%) underwent cyst aspiration and 362 (89.2%) were treated with GnRH-ant. There was no difference in the demographics or baseline IVF cycle characteristics of the two groups. Patients treated with GnRH-ant had a longer duration of ovarian stimulation (10.8?±?3.45 days versus 9.05?±?4.06 days, p?=?0.003) and required higher gonadotropin doses (3887.7?±?1097.8?IU versus 3293.7?±?990.5?IU; p?=?0.01) compared with the cyst aspiration group. There was no difference in the clinical pregnancy (43.9% versus 41.4%), spontaneous miscarriage (9.76% versus 8.01%) and live birth (34.1% versus 33.4%) rates between the groups. Our findings suggest that cyst aspiration is comparable to GnRH-ant administration for the management of solitary ovarian cysts detected at the start of IVF cycles.     

Anti-Müllerian hormone as a marker of ovarian reserve in patients with ovarian malignancies who have undergone fertility-preserving surgery and chemotherapy

Abstract

With proper and careful selection of patients, fertility-preserving surgery may be feasible in patients with ovarian malignancies. However, the loss of follicles by oophorectomy and chemotherapy results in decreased ovarian reserve, which consecutively affects reproductive capacity. We evaluated postoperative levels of serum anti-Müllerian hormone (AMH) in women with ovarian malignancies to assess the impact of the fertility-preserving surgery with or without the administration of chemotherapy on ovarian reserve. In 13 patients who underwent the fertility-preserving surgery with (n?=?9) or without (n?=?4) the administration of chemotherapy, serum AMH levels were measured and compared with serum AMH levels measured in patients undergone cystectomy for benign ovarian tumors as a control. We found that the mean AMH level in the treatment group measured 0.9?ng/mL, which was significantly lower than that measured in the control group (4.70?±?3.77?ng/mL). The possibility of decreased ovarian reserve occurring in patients with ovarian malignancies following treatment with fertility-preserving surgery with or without the administration of chemotherapy should be considered for fertility planning.     

Fetal ovarian cysts. Our clinical experience over 16 cases and review of the literature

Objective.?Fetal ovarian cysts are intra-abdominal structures frequently diagnosed prenatally, tending to present as isolated unilateral lesions in normal fetuses in the third trimester. These cysts may present with complications and their diameter and echogenicity are the main criteria for establishing their prognosis. Spontaneous regression of fetal ovarian cysts is very usual. In the present study, we present our clinical experience on fetal ovarian cyst surveillance and treatment, as well as a review of the literature in the same field.

Material and method.?In this study, we reviewed pre- and postnatal medical records and ultrasonography of 16 fetuses that were diagnosed with ovarian cysts, in Obstetrics Department of University Hospital of Alexandroupolis, between January 2000 and April 2010. We have also reviewed the available literature about fetal ovarian cysts.

Results.?In a total of 16 cases, postnatal surgery was performed in one infant due to ovarian cyst torsion. In the remaining 15 cases, cysts regressed completely in two fetuses during pregnancy and all the rest of the cysts, including four complex ones, resolved spontaneously after birth.

Conclusions.?When fetal ovarian cysts are detected, they should be followed up by serial ultrasonographic examinations. The majority of them will regress spontaneously in a period of 12 months after birth, independent of their sonographic findings. Only symptomatic cysts or cysts with a diameter >5 cm, which do not regress or enlarge, should be treated.     

Impact of laparoscopic cystectomy of endometriotic and non-endometriotic cysts on ovarian volume,antral follicle count (AFC) and ovarian doppler velocimetry

Objective: To evaluate the effect on ovarian reserve and blood flow of unilateral laparoscopic stripping of endometriotic versus non-endometriotic cysts.

Design: Prospective observational study.

Setting: Tertiary university gynecology unit.

Patients: During the study period, 71 subjects underwent the first laparoscopic surgery for removal of a monolateral benign ovarian cyst.

Interventions: Trans-vaginal ultrasound scans of the pelvis about six months after surgery.

Main outcome measures: Ovarian volume, Antral Follicle Count (AFC) and Resistance Index (RI) of ovarian artery of the operated and the contralateral ovary.

Results: Among 71 cysts, 39.4% were endometriotic and 60.6% non-endometriotic benign cysts. All the procedures were performed by the same experienced surgeons with a standardized technique. No major complications were reported during surgery. The mean (±SD) age and BMI of women were 31.0?±?6.8 years and 24.2?±?3.3?kg/m², respectively. Mean diameter of the removed cysts was smaller for endometriotic than non-endometriotic cysts (4.35?±?1.77?cm versus 6.33?±?3.71?cm, p?=?0.046). In comparison to non-operated, volume of the operated ovary was significantly lower and with a reduced AFC, with no difference between endometriotic and non-endometriotic cysts (?2.41?±?2.35 versus ?2.00?±?2.23?cm³, p?=?0.496) (?3.45?±?3.07 versus ?2.43?±?1.95, p?=?0.11). Ovarian artery RI was higher in the operated ovary with no difference between endometriotic and non-endometriotic cysts (0.19?±?0.14 versus 0.14?±?0.10, p?=?0.455). The difference in ovarian volume (r?=?0.178), AFC (r?=?0.094) and RI (r?=?0.079) between operated and non-operated ovary was not dependent on the diameter of the removed cyst.

Conclusion: Ovarian surgery is associated with a decline of ovarian reserve, independently on the histological type and the diameter of the removed cyst.     

Anti-Müllerian hormone trend after laparoscopic surgery in women with ovarian endometrioma

Abstract

Operative laparoscopy is the gold standard in the treatment of endometriotic ovarian cysts. Excisional surgery is the best technique to prevent recurrences and improve symptoms but it may result in ovarian reserve damage due to the removal of healthy ovarian cortex. The aim of this study was to investigate the extent of the ovarian reserve damage after stripping technique of unilateral endometriomas, by dosing the Anti-Müllerian Hormone (AMH). This prospective study was conducted at the Center of Minimally Invasive Pelvic Surgery of the Department of Health of Woman and Child, University of Padua, from October 2010 to June 2012. Twenty-five women underwent excision of monolateral endometriosis ovarian cyst by stripping without accessing a bipolar coagulation and performing an intracortical suture. The AMH serum levels were estimated in the early proliferative phase of the cycle, before surgery (time 0), 24?h after surgery (time 1), the first menstrual cycle after surgery (time 2) and the third menstrual cycle after surgery (time 3). We found a nonstatistically significant decreases in serum AMH levels after surgical excision of the cysts. Our results suggest that an appropriate surgical technique, without the use of the bipolar coagulation of ovarian border, does not determine a significant reduction of ovarian reserve.     

The use of clomiphene citrates for ovulation induction in women with functional ovarian cysts

Objective

To evaluate the effect of clomiphene citrates (CC) on inducing ovulation and on cyst persistence and size in women with functional ovarian cysts.

Study design

Randomized controlled trial.

Setting

University Maternity Hospital.

Subjects

60 women in 2 equal groups.

Methods

Clomiphene citrates treatment, follicle scanning, hormonal assay.

Main outcome measures

Ovulation rate, pregnancy rate, cyst persistence, changes in cyst size.

Results

CC increased both ovulation and pregnancy rates in women with functional ovarian cysts (56.7% versus 13.3%, p < 0.000 for ovulation and 23.0% versus 6.7%, p < 0.000 for pregnancy). CC also increased cyst persistence rate especially in cases achieving pregnancy (30% versus 6.7%, p < 0.000) but did not increase the size of the cyst, or cause complications in it.

Conclusion

Clomiphene citrates significantly increased ovulation, pregnancy and cyst persistence rates in women with functional ovarian cysts.     

Five-year study assessing the clinical utility of anti-Müllerian hormone measurements in reproductive-age women with cancer

Research questionAn important discussion point before chemotherapy is ovarian toxicity, a side-effect that profoundly affects young women with cancer. Their quality of life after successful treatment, including the ability to conceive, is a major concern. We asked whether serum anti-Müllerian hormone (AMH) measurements before chemotherapy for two most common malignancies are predictive of long-term changes in ovarian reserve?DesignA prospective cohort study measured serum AMH in 66 young women with lymphoma and breast cancer, before and at 1 year and 5 years after chemotherapy, compared with 124 healthy volunteers of the same age range (18–43 years). Contemporaneously, patients reported their menses and live births during 5-year follow-up.ResultsAfter adjustment for age, serum AMH was 1.4 times higher (95% CI 1.1 to 1.9; P < 0.02) in healthy volunteers than in cancer patients before chemotherapy. A strong correlation was observed between baseline and 5-year AMH in the breast cancer group (P < 0.001, regression coefficient = 0.58, 95% CI 0.29 to 0.89). No significant association was found between presence of menses at 5 years and serum AMH at baseline (likelihood ratio test from logistics regression analysis).ConclusionsReproductive-age women with malignancy have lower serum AMH than healthy controls even before starting chemotherapy. Pre-chemotherapy AMH was significantly associated with long-term ovarian function in women with breast cancer. At key time points, AMH measurements could be used as a reproductive health advisory tool for young women with cancer. Our results highlight the unsuitability of return of menstruation as a clinical indicator of ovarian reserve after chemotherapy.     

Live birth following vitrification of in vitro matured oocytes derived from sibling smaller follicles at follicle selection phase in the context of in vitro fertilization

In ovarian stimulation, a 31-year-old woman with polycystic ovary syndrome was at the risk of developing ovarian hyperstimulation syndrome, follicle aspiration was performed, and eight immature oocytes were collected from follicle fluids. After 28?h in vitro culture, six of them reached MII and were vitrified. The patient failed to conceive in her fresh in vitro fertilization cycle and next two replacement cycles. In the third replacement cycle, a successful pregnancy was obtained by vitrified-thawed oocytes. This case demonstrates that follicular aspiration during follicle selection phase has protective effects against developing ovarian hyperstimulation syndrome, and rescued immature oocytes are viable and could produce promising embryos for live birth.     

Assessment of ovarian reserve after unilateral diathermy with thermal doses adjusted to ovarian volume

Women with polycystic ovary syndrome seem to have a larger ovarian reserve. However, regardless of a greater reserve, diminished ovarian reserve has been reported after laparoscopic diathermy. The aim of this article was to determine whether the doses adjusted unilateral laparoscopic ovarian drilling with diathermy (ULOD) diminishes ovarian reserve to compare with bilateral laparoscopic ovarian drilling with diathermy (BLOD). Ninety-six women were assigned in two groups. One group underwent ULOD receiving thermal doses (0–840?J per ovary) adjusted to volume one ovary. The other group underwent BLOD receiving fixed doses (600?J per ovary). Ovarian reserve markers [anti-Müllerian hormone (AMH); antral follicle count (AFC) and ovarian volume] were measured before and after surgery (1 and 6 months). Both groups showed a decrease in AMH after surgery, but it was significantly more distinct in the BLOD versus ULOD group (2.0?ng/mL versus 1.3?ng/mL; p?=?0.018) in the first follow-up month and remained significantly different through the sixth follow-up month (1.9?ng/mL versus 1.15?ng/mL; p?=?0.023). In contrast, in the sixth month, the ULOD versus BLOD showed a significantly greater increase AFC (p?p?=?0.013). Our findings evidenced that the dose-adjusted unilateral diathermy (60?J/cm³) does not have significant and long-term effects on ovarian reserve.     

Large ovarian endometriomas are associated with high pre-operative anti-Müllerian hormone concentrations

Research questionAre large ovarian endometriomas associated with high pre-operative anti-Müllerian hormone (AMH) concentrations?DesignData from 332 women who underwent AMH measurement before surgery for endometriosis were prospectively recorded in a large database. Univariate analysis compared AMH concentrations in terms of the patients’ baseline characteristics. A multivariate model was used to identify variables having an independent relationship with AMH concentration.ResultsAmong 332 women included in the study, 47.6% were aged 18–30 years, 67.8% were infertile and 85.5% were nulliparous. A total of 66.3% had ovarian endometriomas, and 10.8% had cysts measuring over 6 cm. Bilateral cysts over 3 cm were recorded in 24.7% of the women. Univariate analysis identified two variables that had a statistically significant relationship with AMH concentration: the woman's age (P = 0.01) and cyst size (P < 0.001). Multivariate analysis revealed that ages of 36–40 years and over 40 years showed a significant association with lower AMH concentrations (P = 0.02 and P = 0.009, respectively), while a cyst size of over 6 cm was statistically associated with high AMH concentrations (P < 0.001), after adjustment for smoking, parity, rectosigmoid endometriotic nodules and a bilateral location of endometriomas.ConclusionsPre-operative AMH concentration was significantly increased in women with large endometriomas of over 6 cm, independent of their age or the presence of bilateral endometriomas. This is relevant for both surgeons and patients when planning surgery in women with an intention to conceive post-operatively.     

The dynamic changes of anti-Mullerian hormone and inhibin B during controlled ovarian hyperstimulation in decreased ovarian reserve women and the effect on clinical outcome

Abstract

Objective: To investigate the dynamics of anti-Mullerian hormone (AMH) and inhibin B (INHB) levels during controlled ovarian hyperstimulation (COH) in women with decreased ovarian reserve (DOR), and assess the effect of these dynamic changes on the prediction of clinical outcome in in-vitro fertilization (IVF).

Methods: A total of 124 women undergoing IVF cycles were divided into normal ovarian reserve (NOR) and DOR groups. AMH and INHB levels were measured in serum on menstrual cycle day 2 or 3 (D2/3), day 5 of stimulation (D5), hCG day (D-hCG) and follicular fluid (FF) on oocyte retrieval day.

Results: Serum AMH levels were gradually decreased while INHB levels were gradually increased from D2/3 to D-hCG during the COH in both groups. Serum AMH, INHB levels on D2/3 and FF AMH, INHB levels were highly positively correlated with AFC and oocytes retrieval. Multivariate logistic regression analysis revealed that clinical pregnancy did not directly correlate with serum and FF AMH and INHB levels.

Conclusion: Serum AMH and INHB levels were not directly related to clinical pregnancy, dynamic serum AMH and IHNB levels were positively correlated with COH outcomes.     

Persistent ovarian masses and pregnancy outcomes

Abstract

Objective: To determine if persistent ovarian masses in pregnancy are associated with increased adverse outcomes.

Methods: This is a retrospective cohort of 126 pregnant women with a persistent ovarian mass measuring 5?cm or greater who delivered at two university hospitals between 2001 and 2009. Maternal outcomes included gestational age (GA) at diagnosis, delivery and surgery as well as miscarriage, preterm birth (PTB), ovarian torsion and hospital admission for pain. Neonatal outcomes included birth weight, respiratory distress syndrome (RDS), intra-ventricular hemorrhage (IVH), death and sepsis.

Results: A total of 1225 ovarian masses were identified (4.9%) in 24?868 patients. A persistent ovarian mass was found in 0.7%. Average GA at diagnosis was 17.8 weeks. Miscarriage rate was 3.3%. Average GA at delivery was 37.9 weeks. Of the patients, 8.5% had ovarian torsion, 10.3% had admission for pain and 9.3% had PTBs. The mean cesarean delivery rate was 46.3%. The average neonatal weight was 3273?g. There was one neonatal death in this cohort. The rate of RDS was 2.8%, IVH 0.9% and neonatal sepsis 1.9%. The most common surgical pathologic diagnosis was dermoids (37.6%). No overt malignancies were seen.

Conclusion: A persistent ovarian mass in pregnancy does not confer an increased risk of adverse pregnancy outcomes.     

Outcomes from ovarian hyperstimulation following the sole administration of gonadotrophin-releasing hormone agonist in the context of in vitro fertilization: report of two cases and review of the literature

Objective: To report the outcomes from two cases of ovarian stimulation following the sole administration of gonadotrophin-releasing hormone agonist (GnRHa) in the context of in vitro fertilization (IVF). Design: A case study was conducted. Setting: National Referral Unit of Reproductive Medicine. Patients: Two infertile women undergoing IVF participated in the study. Interventions: Controlled ovarian hyperstimulation using a long protocol. GnRHa (Buserelin) was started in the luteal phase, in a dose of 600 µg/day, for 12 days. Main outcome measures: Number of retrieved oocytes, fertilization rate, number of embryos transferred, implantation rate, ongoing pregnancy, and live birth. Results: Both women underwent egg retrieval and transfer of good quality embryos. One of them conceived and recently gave birth to a healthy full-term baby. Conclusions: The ovarian hyperstimulation after the sole administration of GnRHa is a rare condition. Oocyte retrieval may be a reasonable treatment under these circumstances instead of cycle cancellation. As far as it is known, this is the third case reported of a live birth following the sole administration of GnRHa in the context of IVF.     

腹腔镜单侧卵巢子宫内膜异位囊肿剥除术对血清抗苗勒管激素水平变化的影响

目的:探讨腹腔镜下单侧卵巢子宫内膜异位囊肿剥除术对血清抗苗勒管激素(AMH)变化的影响。方法:测定128例单侧卵巢囊肿患者手术前及术后1周、3个月及6个月的AMH、FSH及E_2水平,并进行窦卵泡计数。结果:术后1周,AMH、FSH及E_2均发生改变,且差异有统计学意义(P0.05);术后3个月,血FSH和E_2水平已恢复正常,窦卵泡计数与术前无明显改变(P0.05),但AMH水平仍低于术前(P0.05);术后第6个月,AMH水平仍低于术前水平(P0.05),而FSH、E_2及窦卵泡数均较术前比较,差异无统计学意义(P0.05)。年龄35岁患者的术后AMH下降率显著高于年龄≤35岁者(P=0.001)。结论:单侧囊肿卵巢囊肿术后半年卵巢储备功能仍处于恢复阶段,AMH可作为敏感的卵巢储备标志物,优于基础FSH测定及窦卵泡计数。     

Effect of long-term using of hormonal contraception on anti-Müllerian hormone secretion

Anti-Müllerian hormone (AMH) is an important factor associated with female fertility and the ovarian reserve. There are several past studies available concerning the influence of hormonal contraception (HC) on serum AMH levels. Recent studies have reported that AMH levels in women using HC can be about 30% lower compared to those not using HC. However, earlier studies showed no reduction in AMH levels in HC users. We decided to evaluate the effects of long-term HC use (mean duration of HC use: 11.4 years) on AMH levels in women. To exclude potential shorter and reversible decreasing effects of HC on fertility function, we decided to include women in the study who had stopped using HC 1 year before the AMH sample collection. We examined 105 women who used HC and 44 women who had never used HC. The median concentration of AMH in the group of long-term users of HC was 2.89 and 3.37 ng/ml in the group of women who had never used HC. We found no statistically significant difference (p?=?0.3261). In conclusion, we observed no negative impact of HC on the AMH serum levels. AMH can be used as an ovarian reserve marker for these women.