Abstract
Background: The chronological age at which menopause happens is evocative that reproductive aging is flexible amongst females, and shows that age is not a lone factor indicating the females’ reproductive potential. Various tests have been used to determine ovarian reserve, they are primarily used in Infertility clinics. Endocrine markers like anti-Mullerian hormone, estrogen and follicle stimulating hormone and inhibin B indirectly specify the increasing follicle count. The aim of the present study was to compare the antral follicle count and AMH level for ovarian reserve.
Materials and Methods: The present study was conducted in the department of gynecology for a period of 1 year. Plasma was separated and frozen at -70 degree Celsius. The demographic details of all the subjects was recorded in the forms. All the subjects were asked about age at menarche. The level of AMH was estimated in ng/ml. Student t test was used as a test of significance and probability value of less than 0.05 was considered as significant.
Results: The study involved 57 females with the mean age between 35.78 +/- 5.32 years. The median age of the subjects was 34 years with the range between 28-39 years. Between 20-25 years of age, the mean antral follicle count was 15.6+/-4.1. Between 26-30 years of age, the mean antral follicle count was 14.5+/- 4.9. The level of AMH amongst subjects who smoked was 1.8 (0.8–3.5) and those who didn’t smoke was 2.2 (1.2–3.2). The level of AMH amongst subjects who consumed alcohol was 2.2 (1.0–3.3) and those who didn’t was 1.7 (1.2–3.2).
Conclusion: From the above study, we can conclude that levels of AMH and AFC significantly correlate with reproductive age.
Keywords: Antral follicle, Infertility, Mullerian.
References
- te Velde ER, Scheffer GJ, Dorland M, Broekmans FJ, Fauser Developmental and endocrine aspects of normal ovarian aging. Mol Cell Endocrinol 1998;145:67–73.
- Menken J, Trussell J, Larsen Age and infertility. Science 1986; 233:1389–1394.
- van Noord-Zaadstra BM, Looman CW, Alsbach H, Habbema JD, te Velde ER, Karbaat J. Delaying childbearing: effect of age on fecundity and outcome of pregnancy. BMJ 1991;302:1361–1365.
- El-Toukhy T, Khalaf Y, Hart R, Taylor A, Braude P. Young age does not protect against the adverse effects of reduced ovarian reserve—an eight year study. Hum Reprod2002;17:1519–1524.
- Faddy MJ, Gosden RG, Gougeon A, Richardson SJ, Nelson JF. Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menop-ause. Hum Reprod1992;7:1342–1346.
- Hansen KR, Knowlton NS, Thyer AC, Charleston JS, Soules MR, Klein NA. A new model of reproductive aging: the decline in ovarian non-growing follicle number from birth to Hum Reprod 2008;23: 699–708.
- Broekmans FJ, de Ziegler D, Howles CM, Gougeon A, Trew G, Olivennes F. The antral follicle count: practical reco-mmendations for better standardization. FertilSteril2010;94:1044–1051.
- Hendriks DJ, Mol BW, Bancsi LF, Te Velde ER, Broekmans FJ. Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: a meta-analysis and co-mparison with basal follicle-stimulating hormone level. FertilSteril 2005;83:291–301.
- Kline J, Kinney A, Levin B, Warburton D. Trisomic pregnancy and earlier age at menopause. Am J Hum Genet 2000; 67:395–404.
- de Vet A, Laven JS, de Jong FH, Themmen AP, Fauser BC. Anti-mu¨ llerian hormone a putative marker for ovarian aging. Fertil Steril2002;77:357–362.
- Fanchin R, Schona¨uer LM, Righini C, Guibourdenche J, Frydman R, Taieb J. Serum anti-Mu¨ llerian hormone is more strongly related to ovaran follicular status than inhibin B, estradiol, FSH and LH on day 3. Hum Reprod 2003;18: 323–327.
- Muttukrishna S, Suharjono H, McGarrigle H, Sathanandan M. Inhibin B and anti-Mu¨ llerian hormone: markers of ovarian response in IVF/ICSI patients? Br J Obstet Gynaecol 2004; 111:1248–1253.
- Visser JA, Themmen AP. Anti-mu¨ llerian hormone and folliculogenesis. Mol Cell Endocrinol 2004;234:81–86.
- Josso N, di Clemente N. TGF-b family members and gonadal development. Trends Endocrinol Metab 1999;10: 216–222.
- Broer SL, van Disseldorp J, Broeze KA, et al. Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach. Hum Reprod Update 2013;19:26–36.
- Broer SL, Dolleman M, van Disseldorp J, et Prediction of an excessive response in in vitro fertilization from patient characteristics and ovarian reserve tests and comparison in subgroups: an individual patient data metaanalysis. FertilSteril2013;100:420–9 e7.
- Nelson SM, Yates RW, Lyall H, et al. Anti-Mullerian hormone-based approach to controlled ovarian stimulation for assisted Hum Reprod 2009;24:867–75.
- Yates AP, Rustamov O, Roberts SA, et al. Anti-Mullerian hormone-tailored stimuli-tion protocols improve outcomes whilst reducing adverse effects and costs of IVF. Hum Reprod2011;26:2353–62.
- La Marca A, Grisendi V, Giulini S, et al. Individualization of the FSH starting dose in IVF/ICSI cycles using the antral follicle count. J Ovarian Res 2013;6:11.
- La Marca A, Papaleo E, Grisendi V, Argento C, Giulini S, Volpe A. Development of a nomogram based on markers of ovarian reserve for the individualisation of the follicle-stimulating hormone starting dose in in vitro fertilisation cycles. BJOG 2012;119:1171–9.
- Dewailly D, Lujan ME, Carmina E, et Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update 2014;20:334–52.
- Iliodromiti S, Kelsey TW, Anderson RA, Nelson Can anti-Mullerian hormone predict the diagnosis of polycystic ovary syndrome? A systematic review and meta-analysis of extracted data. J Clin Endocrinol Metab 2013;98:3332–40.
- Broer SL, Eijkemans MJ, Scheffer GJ, et al. Anti-Mullerian hormone predicts menopause: a long-term follow-up study in normoovulatory women. J Clin Endocrinol Metab2011;96:2532–9.
- Wellons MF, Bates GW, Schreiner PJ, Siscovick DS, Sternfeld B, Lewis CE. Antral follicle count predicts natural menopause in a population-based sample: the Coronary Artery Risk Develop-ment in Young Adults Women’s Menopause 2013;20:825–30.
- Tremellen K, Savulescu J. Ovarian reserve screening: a scientific and ethical analysis. Hum Reprod2014;29:2606–14.
- Toner JP, Philput CB, Jones GS, Muasher SJ. Basal follicle-stimulating hormone level is a better predictor of in vitro fertilization performance than age. FertilSteril1991;55:784–791.
- Rajpert-De Meyts E, Jorgensen N, Graem N, Muller J,Cate RL, Skakkebaek NE. Expression of anti-Mu¨ llerianhormone during normal and pathological gonadal development:association with different-iation of Sertoli and granulosacells. J Clin Endocrinol Metab1999;84:3836–3844.
- Lee MM, Donahoe PK, Hasegawa T, Silverman B, Crist GB,Best S, Hasegawa Y, Noto RA, Schoenfeld D, Mac Laughlin DT. Mullerian inhibiting substance in humans: normal levelsfrom infancy to adulthood. J Clin Endocrinol Metab 1996;81:571–576.
- Durlinger AL, Visser JA, Themmen AP. Regulation of ovarianfunction: the role of anti-mu¨ llerian hormone. Reproduction 2002; 124:601–609.
- Baarends WM, Uilenbroek JT, Kramer P, Hoogerbrugge JW,van Leeuwen EC, Themmen AP, Grootegoed JA. Anti-Mu¨ llerian hormone and anti-Mu¨ llerian hormone type IIreceptor messenger ribonucleic acid expression in rat ovariesduring postnatal development, the estrous cycle, and gonadotrophin-induced follicle growth. Endocrinology 1995;136:4951–4962.
- Vigier B, Picard JY, Tran D, Legeai L, Josso N. Production ofanti-Mu¨ llerian hormone: another homology between Sertoliand granulosa cells. Endocrinology 1984;114:1315–1320.
- Cook CL, Siow Y, Taylor S, Fallat ME. Serum mu¨ llerian inhibiting substance levels during normal menstrual cycles. Fertil Steril2000;73:859–861.
- Weenen C, Laven JS, von Bergh AR, CranfieldM, Groome NP,Visser JA, Kramer P, Fauser BC, Themmen AP. Anti-Mu¨ llerianhormone expression pattern in the human ovary: potentialimplications for initial and cyclic follicle recruitment. MolHumReprod2004;10:77–83.
- Fauser BC, van Heusden AM. Manipulation of humanovarian function: physiological concepts and clinical consequences. Endocr Rev 1997;18:71–106.
- Ueno S, Takahashi M, Manganaro TF, Ragin RC,Donahoe PK. Cellular localization of mu¨ llerian inhibiting substancein the developing rat ovary. Endocrinology 1989;124:1000–1006.
Corresponding Author
Dr Shrikant Adsul
DNB FCPS DGO MBBS Gyneacology
Assistant Professor At Rajiv Gandhi Medical College Kalwa
DOI: https://dx.doi.org/10.18535/jmscr/v6i7.78
