Advances in Clinical and Experimental Medicine
2020, vol. 29, nr 7, July, p. 853–856
Publication type: original article
Is serum anti-Müllerian hormone (AMH) assay a satisfactory measure for ovarian reserve estimation? A comparison of serum and peritoneal fluid AMH levels
1 Department of Operative Gynecology and Gynecologic Oncology, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
2 Laboratory Diagnostics Center, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
3 Department of Perinatology, Obstetrics and Gynecology, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
4 Department of Gynecological Surgery and Oncology, Medical University of Lodz, Poland
Background. Clinical cases have been reported with women who got pregnant with confirmed low serum anti-Müllerian hormone (AMH) concentrations, thus demonstrating that low serum AMH concentration cut-points could be fairly specific for poor ovarian response (POR) to gonadotrophin stimulation, but not for pregnancy. That observation prompted the question whether serum AMH concentration accurately corresponded to the whole amount of AMH secreted by granulosa cells.
Objectives. To measure AMH levels in peritoneal fluid and their correlations with serum AMH concentrations.
Material and Methods. The reported study involved 48 female patients, aged 18–40 years, diagnosed with benign ovarian cysts and qualified for a laparoscopic cystectomy. Prior to surgery, the ovarian reserve was assessed using serum AMH concentration assay. The peritoneal fluid was also collected during the laparoscopy and AMH concentrations in peritoneal fluid were measured.
Results. The AMH present in the peritoneal fluid strongly correlated with AMH levels in blood serum (r = 0.54; p < 0.001) and higher serum AMH concentrations corresponded to higher AMH concentrations in the peritoneal fluid. There was also a significant correlation between AMH levels in serum and in peritoneal fluid, collected from patients with endometrioma and other benign cysts (r = 0.61; p = 0.001 vs r = 0.43; p = 0.03).
Conclusion. The AMH is present in the peritoneal fluid and its concentrations significantly correlate with AMH levels in serum. The assessment of AMH concentration in the peritoneal fluid may be a valuable complement to the evaluation of ovarian reserve and the diagnosis of infertility after adnexal surgery.
anti-Müllerian hormone, peritoneal fluid, ovarian reserve, endometrioma, fertility
- Weenen C, Laven JS, von Bergh AR, et al. Anti-Müllerian hormone expression pattern in the human ovary: Potential implications for initial and cyclic follicle recruitment. Mol Hum Reprod. 2004;10(2):77–83.
- Themmen AP. Anti-Müllerian hormone: Its role in follicular growth initiation and survival and as an ovarian reserve marker. J Natl Cancer Inst Monogr. 2005;34:18–21.
- Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve: A Committee opinion. Fertil Steril. 2015;103(3):e9–e17.
- La Marca A, Giulini S, Tirelli A, et al. Anti-Müllerian hormone measurement on any day of the menstrual cycle strongly predicts ovarian response in assisted reproductive technology. Hum Reprod. 2007;22(3):766–777.
- American College of Obstetricians and Gynecologists (ACOG). Committee opinion: Ovarian reserve testing. Fertil Steril. 2015;103(3):9–17.
- Bancsi LF, Broekmans FJ, Eijkemans MJ, de Jong FH, Habbema JD, te Velde ER. Predictors of poor ovarian response in in vitro fertilization: A prospective study comparing basal markers of ovarian reserve. Fertil Steril. 2002;77(2):328–336.
- Gnoth C, Schuring AN, Friol K, Tigges J, Mallmann P, Godehardt E. Relevance of anti-Müllerian hormone measurement in a routine IVF program. Hum Reprod. 2008;23(6):1359–1365.
- Penarrubia J, Fabregues F, Manau D, et al. Basal and stimulation day 5 anti-Müllerian hormone serum concentrations as predictors of ovarian response and pregnancy in assisted reproductive technology cycles stimulated with gonadotropin-releasing hormone agonist–gonadotropin treatment. Hum Reprod. 2005;20(4):915–922.
- Elgindy EA, El-Haieg DO, El-Sebaey A. Anti-Müllerian hormone: Correlation of early follicular, ovulatory and midluteal levels with ovarian response and cycle outcome in intracytoplasmic sperm injection patients. Fertil Steril. 2007;89(9):1670–1676.
- Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L. ESHRE consensus on the definition of “poor response” to ovarian stimulation for in vitro fertilization: The Bologna criteria. Hum Reprod. 2011;26(7):1616–1624.
- Fanchin R, Louafi N, Mendez Lozano DH, Frydman N, Frydman R, Taieb J. Per-follicle measurements indicate that anti-Müllerian hormone secretion is modulated by the extent of follicular development and luteinization and may reflect qualitatively the ovarian follicular status. Fertil Steril. 2005;84(1):167–173.
- Fanchin R, Taieb J, Lozano DH, Ducot B, Frydman R, Bouyer J. High reproducibility of serum anti-Müllerian hormone measurements suggests a multi-staged follicular secretion and strengthens its role in the assessment of ovarian follicular status. Hum Reprod. 2005;20(4):923–927.
- Fanchin R, Mendez Lozano DH, Frydman N, et al. Anti-Müllerian hormone concentrations in the follicular fluid of the pre-ovulatory follicle are predictive of the implantation potential of the ensuing embryo obtained by in vitro fertilization. J Clin Endocrinol Metab. 2007;92(5):1796–1802.
- Lekamge DN, Barry M, Kolo M, Lane M, Gilchrist RB, Tremellen KP. Anti-Müllerian hormone as a predictor of IVF outcome. Reprod Biomed Online. 2007;14(5):602–610.
- Hipp H, Loucks TL, Nezhat C, Sidell N, Session DR. Anti-Müllerian hormone in peritoneal fluid and plasma from women with and without endometriosis. Reprod Sci. 2015;22(9):1129–1133.
- Fallat ME, Siow Y, Marra M, Cook C, Carrillo C. Müllerian-inhibiting substance in follicular fluid and serum: A comparison of patients with tubal factor infertility, polycystic ovary syndrome, and endometriosis. Fertil Steril. 1997;67(5):962–965.