Evaluation of ovarian reserve in Hashimoto's thyroiditis

Human ovary is commonly the target of an autoimmune attack in cases of organ- or non-organ-specific autoimmune disorders. Hashimoto’s thyroiditis (HT) is likely to be associated with ovarian dysfunction and diminished ovarian reserve. In this study, we aimed to evaluate the possible negative association between this significantly prevalent autoimmune disease and the ovarian reserve. Thirty-two premenopausal women with primary hypothyroidism, who under replacement therapy with thyroxine were recruited. Forty-nine healthy female subjects who had normal anti-thyroid antibody levels and were comparable with the HT group in terms of age and BMI values, comprised the control group. There was no statistically significant difference between the study and the control patients in terms of antral follicle count. Serum anti-Müllerian hormone (AMH) levels were significantly higher in woman with HT compared to the control group. The results of this study found no impairment in ovarian reserve parameters of patients with HT. Interestingly, the results revealed a significant increase in serum AMH levels of the patients with HT compared to controls. Hashimoto's thyroiditis may share a common etiologic linkage with polycystic ovary syndrome; therefore, leading to elevated serum AMH levels, which we are currently unable to define elaborately.     

维生素D与不孕女性卵巢储备标志物的相关性分析

目的探讨血清维生素D水平与卵巢储备标志物抗苗勒管激素(anti-Müllerian hormone,AMH)和窦卵泡数(antral follicle count,AFC)之间的关系。方法回顾性分析2016年5月—2017年6月第一次接受辅助生殖助孕技术治疗的不孕症患者共2 391例,根据患者血清25(OH)D_3水平分为≤30 nmol/L组(A组,n=417)、30.1~49.9 nmol/L组(B组,n=626)和≥50 nmol/L组(C组,n=1 348)。分析患者血清25(OH)D_3水平与不孕女性卵巢储备标志物血清AMH水平和AFC之间的相关性。结果 (1)各组患者间的年龄、体质量指数(BMI)、基础FSH、不孕原因构成比及不同季节的维生素D水平的差异均无统计学意义(P0.05);(2)3组患者的AMH水平分别为(4.07±3.53)ng/mL、(4.12±3.43)ng/mL和(4.10±3.18)ng/mL;AFC分别为14.0±6.7、13.7±5.9和14.1±6.1,组间差异均无统计学意义(P0.05);(3)调整潜在的混杂因素后,运用相关因素多重线性回归分析显示,血清AMH水平的偏回归系数(B)=-0.005,标准误差(sx)=0.007,P=0.506;AFC的B=-0.122,sx=0.019,P=0.214,与血清25(OH)D_3水平之间均无相关性(P0.05)。结论不孕女性维生素D和卵巢储备标志物血清AMH水平及AFC之间不存在相关性,对维生素D缺乏的不孕女性通过补充维生素D以改善卵巢储备功能可能没有作用。     

Argon beam coagulator versus cystectomy for endometrioma treatment in infertile women and the impact on ovarian reserve. A case control study

ObjectiveTo evaluate the impact of two different surgical modalities, traditional cystectomy and argon beam coagulator vaporization–ablation (ABC) of ovarian endometrioma on the ovarian reserve in terms of antimullerian hormone (AMH) and antral follicle count (AFC).Patients and methodsEighty infertile women with ovarian endometrioma were included in this case control study. Patients were selected to undergo either traditional cystectomy (Group I, n = 40) or argon coagulator beam vaporization (Group II, n = 40). Mean serum AMH changes and antral follicle counts (AFC) were the primary and secondary outcomes of this study.ResultsAt 2 weeks follow-up, postoperative mean serum AMH levels were markedly decreased, though not significantly different between both treatment groups and mean AFC was higher in both groups, though statistically significant in the ABC group.ConclusionOur study clearly demonstrated that the surgical management of endometrioma, with either ovarian cystectomy or argon beam coagulator vaporization causes a significant decrease in ovarian reserve in terms of AMH levels in women of reproductive age.     

Phenotypic variation in anti-Mullerian hormone (AMH) production per follicle in women with polycystic ovary syndrome (PCOS) and isolated polycystic ovarian morphology (PCOM): an observational cross-sectional study

This observational study compares the ratio of serum anti-Mullerian hormone (AMH) to the total antral follicle count (AFC) (as a marker of AMH production per follicle) in the various phenotypes of women with polycystic ovary syndrome (PCOS) and isolated polycystic ovarian morphology (PCOM). Two hundred and sixty-two women were recruited. Women with PCOS were divided into four phenotypes based on the diagnostic inclusion criteria of oligo-anovulation (OA), hyperandrogenism (HA) and polycystic ovarian morphology (PCOM). These included Group A (OA?+?HA?+?PCOM), Group B (OA?+?HA), Group C (HA?+?PCOM) and Group D (OA?+?PCOM). A ratio of serum AMH to total AFC was calculated and expressed as the AMH/AFC ratio which was compared in the phenotypes of PCOS and isolated PCOM. The median AMH/AFC ratios in PCOS-A, PCOS-D, PCOS-C and PCOM were 1.5, 1.6, 1.2 and 1.1, respectively. There were significant differences in the groups compared [F(3, 238)?=?6.14, p?=?0.000)]. The ratios were significantly higher in the oligo-anovulatory phenotypes PCOS-A and PCOS-D than the PCOM (p?=?0.004 and 0.002, respectively). There was no significant difference in the ratio between ovulatory phenotype PCOS-C and PCOM (p?=?0.59). The role of androgens and LH in per-follicle AMH production remains limited. The findings support the hypothesis of a key role for AMH in the mechanism of anovulation in PCOS.     

Genetic associations with diminished ovarian reserve: a systematic review of the literature

Purpose

Diminished ovarian reserve (DOR) affects 10 % of women seeking fertility treatment. Although it is much more prevalent than premature ovarian failure, less is known about its etiology. The purpose of this article is to review the possible genetic causes of, and associations with, pathologic DOR.

Methods

A systematic review was conducted using PubMed from 1966 through November 2013.

Results

Twenty-one articles identified genes associated with DOR: one gene mutation (FMR1), three polymorphisms (GDF9, FSHR, and ESR1), and seven genes differentially expressed between women with DOR and controls (AMH, LHCGR, IGF1, IGF2, IGF1R, IGF2R and GREM1). Six candidate genes were discovered in mice, including Foxl2, Gdf9, Bmp15, Aire, Wnt4, and Gpr3. Two case reports of chromosomal translocations were also identified.

Conclusions

While the etiology of pathologic DOR is likely multifactorial, it is possible that many cases attributed to an idiopathic cause may have a genetic component. Larger studies are needed to expose the impact gene mutations, polymorphisms, and epigenetics have on pathologic DOR.     

AMH in women with diminished ovarian reserve: potential differences by FMR1 CGG repeat level

Purpose

We explored whether AMH, as a surrogate for oocyte supply, varies by FMR1 genotype in women diagnosed with diminished ovarian reserve (DOR), a subset of the Primary Ovarian Insufficiency phenotype. Research is inconsistent on the relationship between AMH and FMR1 repeat length, controlling for age.

Method

Seventy-nine cycling women diagnosed with DOR, and without a family history of fragile X syndrome, provided blood for FMR1 and AMH testing. DOR was defined as elevated FSH and/or low AMH and/or low antral follicle count, with regular menses. FMR1 CGG repeats were stratified by the larger allele <35 repeats (n = 70) v. ≥35 repeats (n = 9). Quadratic and linear models were fit to predict log (AMH) controlling for age. The AMH sample used as the outcome variable was drawn at a later date than the diagnostic AMH.

Results

Serum AMH concentration median was 0.30 ng/mL; Ages ranged from 26–43 years. A quadratic model (including age²) did not show a relationship with FMR1 CGG level (p-value = 0.25). A linear model of log (AMH), corresponding to an exponential decline of AMH with increasing age, was significantly different, and had a steeper slope, for women with ≥ 35 CGG repeats than women with < 35 repeats (p = 0.035).

Conclusion

Findings suggest a greater rate of follicular loss that starts at later ages in women with DOR and ≥ 35 CGG repeats.     

年龄与卵巢功能——对卵巢衰老的认识

女性生育力高峰出现在20~30岁的中、晚阶段,此后生育力逐渐降低直到绝经。生育力下降发生在FSH水平上升,抑制素B下降和月经周期长度改变之前。抗苗勒管激素是较抑制素B出现更早的标志物。窦卵泡数的变化和月经周期长度可变性增强反映生殖衰老加速。生殖衰老过程,在人群存在一个普遍适用的规律;但每个个体的衰老进程是她所受多种复杂因素相互作用的结果。     

Dehydroepiandrosterone supplementation improves predictive markers for diminished ovarian reserve: serum AMH,inhibin B and antral follicle count

Objective

To evaluate the effect of dehydroepiandrosterone (DHEA) supplementation on ovarian reserve by measuring markers such as antral follicle count, serum anti-Müllerian hormone (AMH) and inhibin B in patients with diminished ovarian reserve.

Study design

This prospective study was undertaken at Dr. Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey. Forty-one patients with diminished ovarian reserve were included in the study and received supplementation with DHEA 25 mg, t.i.d., for at least 6 weeks. Serum AMH, inhibin B, follicle-stimulating hormone (FSH) and oestradiol, and antral follicle count were determined before and after DHEA supplementation. Baseline ovarian reserve parameters such as antral follicle count, FSH, oestradiol, AMH, inhibin B, clinical and laboratory IVF outcomes, and pregnancy rates were studied.

Results

There were significant differences in day 3 FSH, oestradiol, antral follicle count, AMH and inhibin B levels before and after DHEA supplementation in all patients (p = 0.001, 0.001, 0.002, 0.001 and 0.001, respectively). The study population was divided into two age groups (<35 and ≥35 years) to determine whether there was a difference in the effect of DHEA supplementation between younger and older patients with diminished ovarian reserve. Significant differences were found in all of the parameters in both study groups (p < 0.05).

Conclusions

DHEA supplementation is an effective option for patients with diminished ovarian reserve. Prior to assisted reproductive technology, patients with diminished ovarian reserve should be offered DHEA supplementation as an alternative to oocyte donation.