Anti-Mullerian hormone levels do not predict response to pulsatile GnRH in women with hypothalamic amenorrhea

Abstract

Pulsatile GnRH is used to induce ovulation in women with hypothalamic amenorrhea (HA), but tools to predict response are lacking. We assessed whether baseline AMH levels are associated with response to pulsatile GnRH in 16 women with HA. AMH levels were compared between non-responders and women who achieved follicular development or pregnancy. Median AMH for the cohort was 2.2 ng/mL. AMH levels were undetectable or low in four women, normal in nine and high in three. Follicular development was observed in 13 (81%) women (82% of cycles) and pregnancy achieved in 10 (63%) women (29% of cycles). All four women with low or undetectable AMH had follicular response and three achieved pregnancy. Of the 12 women with normal or high AMH, 10 had a follicular response and seven achieved pregnancy. Median AMH levels were comparable in those who achieved follicular development and those who did not (2.2 ng/mL versus 1.3 ng/mL, p = 0.78) and in those who became pregnant and those who did not (2.2 ng/mL versus 1.9 ng/mL, p = 0.52). In summary, low AMH does not preclude response to ovulation induction in women with HA, suggesting that ovarian potential may not be the primary determinant of AMH concentrations in this population.

Chinese abstract

GnRH脉冲给药用于下丘脑性闭经女性的诱发排卵, 但缺少对其反应性的预测工具。我们对16名下丘脑性闭经女性进行研究, 评估抗苗勒管激素 (Anti-Mullerian hormone, AMH) 基础水平是否与患者对GnRH脉冲给药的反应性有关。我们比较了无反应患者和有卵泡发育患者或妊娠患者的AMH水平。整个研究人群的AMH中位数为2.2 ng/mL。4名患者的AMH未测到或低于正常。13名患者 (81%) 有卵泡发育 (82%周期) , 10名患者 (63%) 妊娠 (29%周期) 。AMH未测到或低于正常的4名患者均有卵泡发育且其中3人妊娠。12名患者的AMH水平正常或高于正常, 其中10人有卵泡发育, 7人妊娠。有卵泡发育患者和无卵泡发育患者的AMH水平相当 (2.2 ng/mL vs 1.3 ng/mL, p = 0.78) , 妊娠患者和未妊娠患者的AMH水平相当 (2.2 ng/mL vs 1.9 ng/mL, p = 0.52) 。综上, 低水平AMH不能阻碍下丘脑闭经女性的诱导排卵反应, 表明下丘脑性闭经女性AMH水平不是其卵巢潜能的主要决定因素。

Keywords:

• Anti-Mullerian hormone
• hypogonadotropic hypogonadism
• hypothalamic amenorrhea
• ovulation induction
• pulsatile GnRH

Acknowledgements

The authors would like to recognize the contributions of endocrine nurses Brenda Polzin and Susan Tychkowsky to this study.

Declaration of interest

The authors report no conflicts of interest.