BACKGROUND: This study evaluated the effect of pituitary desensitization on the early growing follicle population through assessment of serum anti-Mullerian hormone (AMH) concentration. Other markers of ovarian reserve, basal follicular stimulating hormone (FSH), luteinizing hormone (LH), estradiol, inhibin-B and three-dimensional ultrasound ovarian parameters were also assessed for comparison. METHODS: One hundred and two subjects aged <40 years with FSH levels <12 IU/l underwent venepuncture and transvaginal ultrasound in the early follicular phase of the menstrual cycle and after 14 days of down-regulation using gonadotrophin releasing hormone (GnRH) agonists. Serum levels of AMH and other markers of ovarian reserve measured during the early follicular phase were compared with those measured following down-regulation. RESULTS: While AMH levels increased significantly by approximately 32% (P < 0.01), there was a significant decline of approximately 40-50% (P < 0.01) in the levels of inhibin-B, FSH, LH and estradiol. Down-regulation treatment was also associated with a decrease (P < 0.01) in mean ovarian volume and in ovarian blood flow, but no difference was seen in the antral follicle count. CONCLUSIONS: Pituitary desensitization results in a significant increase in AMH levels, which implies that either the secretion of AMH by early growing follicles is enhanced or that the size of this follicle cohort is increased. The number of antral follicles visualized on ultrasound in the early follicular phase and at down-regulation appears unchanged, suggesting that any effect is restricted to the smaller selectable follicles. Our results may explain the enhanced ovarian response to conventional controlled ovarian stimulation and higher pregnancy rates when pretreatment with GnRH-agonists is employed.
BACKGROUND: This study evaluated the effect of pituitary desensitization on the early growing follicle population through assessment of serum anti-Mullerian hormone (AMH) concentration. Other markers of ovarian reserve, basal follicular stimulating hormone (FSH), luteinizing hormone (LH), estradiol, inhibin-B and three-dimensional ultrasound ovarian parameters were also assessed for comparison. METHODS: One hundred and two subjects aged <40 years with FSH levels <12 IU/l underwent venepuncture and transvaginal ultrasound in the early follicular phase of the menstrual cycle and after 14 days of down-regulation using gonadotrophin releasing hormone (GnRH) agonists. Serum levels of AMH and other markers of ovarian reserve measured during the early follicular phase were compared with those measured following down-regulation. RESULTS: While AMH levels increased significantly by approximately 32% (P < 0.01), there was a significant decline of approximately 40-50% (P < 0.01) in the levels of inhibin-B, FSH, LH and estradiol. Down-regulation treatment was also associated with a decrease (P < 0.01) in mean ovarian volume and in ovarian blood flow, but no difference was seen in the antral follicle count. CONCLUSIONS: Pituitary desensitization results in a significant increase in AMH levels, which implies that either the secretion of AMH by early growing follicles is enhanced or that the size of this follicle cohort is increased. The number of antral follicles visualized on ultrasound in the early follicular phase and at down-regulation appears unchanged, suggesting that any effect is restricted to the smaller selectable follicles. Our results may explain the enhanced ovarian response to conventional controlled ovarian stimulation and higher pregnancy rates when pretreatment with GnRH-agonists is employed.
Authors: H Irene Su; Kevin Maas; Patrick M Sluss; R Jeffrey Chang; Janet E Hall; Hadine Joffe Journal: J Clin Endocrinol Metab Date: 2013-09-30 Impact factor: 5.958
Authors: Jori A Leijdekkers; Marinus J C Eijkemans; Theodora C van Tilborg; Simone C Oudshoorn; Ron J T van Golde; Annemieke Hoek; Cornelis B Lambalk; Jan Peter de Bruin; Kathrin Fleischer; Monique H Mochtar; Walter K H Kuchenbecker; Joop S E Laven; Ben Willem J Mol; Helen L Torrance; Frank J M Broekmans Journal: Hum Reprod Date: 2019-06-04 Impact factor: 6.918
Authors: Panagiotis Drakopoulos; Arne van de Vijver; Jose Parra; Ellen Anckaert; Johan Schiettecatte; Christophe Blockeel; Martin Hund; Wilma D J Verhagen-Kamerbeek; Ying He; Herman Tournaye; Nikolaos P Polyzos Journal: Front Endocrinol (Lausanne) Date: 2019-02-26 Impact factor: 5.555