Contribution of recruitable follicles to circulating anti-Müllerian hormone levels following maximal gonadotrophin stimulation in patients with limited ovarian reserve

Abstract

In women, the majority of anti-Müllerian hormone (AMH) measured in serum originate from small antral follicles measuring 2–10 mm. In gonadotrophin-stimulated cycles prior to assisted reproductive technology (ART), most of the recruitable follicles develop beyond 10 mm in size and thus lose their AMH secretion capacity causing declining serum AMH levels. The aim of this study was to define the residual serum AMH level after elimination of the AMH producing recruitable follicles following maximal gonadotrophin stimulation. We measured serum AMH and number of follicles according to size at several time points during a cycle of maximal gonadotrophin stimulation (fixed dose of 300 IE HP-hMG) in 107 women with low AMH (median AMH 5 pmol/L, interquartile range (IQR) 3.3–8.3). We found that AMH decreased gradually and reached a minimum level of −55.4% (95% CI −59.6; −50.7) of the baseline value four days after ovulation trigger. Our findings suggest that the residual AMH production origins from pre-antral and small antral follicles not visible by sonography and that they account for up to 40% of the circulating AMH.

摘要

在女性血清中检测到的大部分抗苗勒管激素（AMH）来源于2-10mm的小窦卵泡。在辅助生殖技术（ART）之前的促性腺激素刺激周期中, 大多数可募集卵泡的大小超过10mm, 因此失去了分泌AMH的能力, 导致AMH水平下降。本研究的目的是确定最大促性腺激素刺激后消除可产生AMH的募集卵泡后, 血清中残留的AMH水平。我们在107例低水平AMH的女性患者中（AMH中位数为5pmol/L, 四分位间距（IQR）3.3-8.3）, 在最大促性腺激素刺激（固定剂量为300 IE HP-hMG）周期的几个时间点, 测量了血清AMH值及卵泡数量的多少。我们发现, 诱发排卵后四天, AMH逐渐降低并达到基线值最低水平的55.4% （95% CI 59.6; 50.7)。我们的研究结果表明, 残留的AMH源自于窦前卵泡和小窦状卵泡, 它们占AMH循环的40%。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Anti-Müllerian hormone
• assisted reproductive technology
• folliculogenesis
• antral follicle count

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was supported by a scholarship from the Research Fund at Copenhagen University Hospital Hvidovre. A. G. A. G. was funded from September 2016 by ReproUnion (EU Interreg Öresund-Kattegat-Skagerrak). Roche Diagnostics provided free of charge products for the blood analyses.