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Division of Reproductive Medicine (J.S.E.L., A.G.M.G.J.M., B.C.J.M.F.), Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands; and Section of Endocrinology (J.A.V., A.P.T., F.H.D.J.), Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Address all correspondence and requests for reprints to: J. S. E. Laven, M.D., Ph.D., Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. E-mail: j.laven{at}erasmusmc.nl.
Anti-Müllerian hormone (AMH) concentrations correlate with the number of antral follicles as well as age and constitute an endocrine marker for ovarian aging. In normogonadotropic anovulatory infertile women [World Health Organization (WHO) class 2], the number of early antral follicles is usually increased. To investigate whether AMH concentrations are increased, serum levels in 128 WHO 2 women were compared with those in 41 normoovulatory premenopausal women of similar age.
Serum AMH concentrations are significantly (P < 0.001) elevated in WHO 2 patients [median, 7.6 µg/liter (range, 0.1–40.0)], compared with controls [median, 2.1 µg/liter (0.1–7.4)]. In 106 patients presenting with polycystic ovaries (PCOs) (
12 follicles/ovary measuring 2–9 mm and/or an ovarian volume > 10 ml), AMH levels were elevated [9.3 µg/liter (1.8–40.0)], compared with 22 patients without PCOs [6.4 µg/liter (0.1–22.1)] (P < 0.0001). In WHO 2 patients, AMH concentrations correlated with features characteristic for polycystic ovary syndrome such as LH concentrations (r = 0.331; P = 0.0001), testosterone levels (r = 0.477, P = 0.0001), mean ovarian volume (r = 0.421; P = 0.0001), and the number of ovarian follicles (r = 0.308; P = 0.0001). AMH levels correlated well with age in WHO 2 patients (r = -0.248; P = 0.002) as well as in controls (r = -0.465; P = 0.005). However, the relative decline in AMH with age is less pronounced in WHO 2 patients. In a subset of patients no significant correlation was found between AMH serum concentrations and the FSH response dose, the duration of stimulation, and the total number of ampoules of FSH used.
In conclusion, serum AMH concentrations are elevated in WHO 2 women, especially in those patients exhibiting PCOs. Because AMH concentrations correlated well with other clinical, endocrine, and ultrasound markers associated with polycystic ovary syndrome, AMH may be used as a marker for the extent of the disease. A less pronounced AMH decrease over time in these women may suggest retarded ovarian aging. The latter hypothesis, however, should be confirmed by longitudinal studies.
This work was supported by the "Stichting Voortplantingsgeneeskunde," Rotterdam, The Netherlands; Organon International, Oss, The Netherlands (Extra-Mural Funding Grant 2764005); and the European Commission (Grant QLK6-2000-00338).
Abbreviations: AD, Androstenedione; AMH, anti-Müllerian hormone; E2, estradiol; PCO, polycystic ovary; PCOS, PCO syndrome; T, testosterone.
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