Farah Amer Abed1, Raya Ezzat Maroof2, Ulfat Mohammed Ali Al-Nakkash3. 1. Ministry of Science and Technology, Baghdad. 2. College of Health and Medical Technology, Baghdad. 3. Consultant Gynecologist, Director of Elwyia Maternity Hospital, Baghdad. All authors contributed equally to this work.
Abstract
BACKGROUND: In women premature ovarian failure (POF) is a devastating disease impacting women under the age of 40. This involves a significant decrease in a women's quantity and quality of oocytes, or ovarian reserve (OR). POF can result in long-term physical and psychological health consequences. The earlier treatment can occur to manage this disease, the less likely the individual is going to suffer from the potential consequences. Accurate diagnosis is a critical proponent to ensuring immediate care. A traditional diagnostic marker includes follicular stimulating hormone (FSH). This individual test cannot be used to make a diagnosis in isolation due to the large variability in FSH levels among different women, and throughout a women's menstrual cycle. Anti-Müllerian hormone (AMH) is an alternative diagnostic marker for determining a women's OR. Serum levels of AMH have been shown to be associated with the size of the resting primordial follicle pool. When the levels of AMH are low, this is generally considered to be an indicator of a decline in fertility. In this study, we examined the specificity, sensitivity and accuracy of the FSH assay, against the more recently emerged AMH assay for diagnosing and predicting POR via Receiver Operator Characteristic curve (ROC) analysis. METHODS: A total of 60 participants were enrolled in the study. The POF group included 30 infertile women with POF, the infertile control group included 13 women without POF, and the fertile control group included 17 healthy women. Participants were recruited from the Kamal Al-Samarray Hospital in Bagdad city from December 2017 to March 2018. The age of participants ranged from 19-39 years of age. On day 2 of the menstrual cycle, peripheral blood samples were collected from each participant and the serum levels of AMH and FSH were examined using ELISA. RESULTS: Statistical analysis examining the FSH and AMH assays indicate that measuring AMH levels leads to an increased sensitivity, specificity and accuracy in determining the presence or absence of POF among the control fertile and POF groups. However, when comparing the specificity, sensitivity, and accuracy of AMH to FSH among the POF group and infertile controls, there were no differences among sensitivity, furthermore there was a slight decrease in the accuracy and specificity of AMH compared to FSH. CONCLUSION: Our findings indicate that the serum levels of AMH have higher sensitivity, specificity and accuracy in detecting POR than FSH when comparing the POF patients to healthy fertile controls. As the AMH levels have minimal within-menstrual cycle variation they can therefore be assessed whenever necessary, opposed to FSH, in which the levels vary throughout the menstrual cycle. The role of AMH may therefore hold a more useful role in the early diagnosis of POF.
BACKGROUND: In women premature ovarian failure (POF) is a devastating disease impacting women under the age of 40. This involves a significant decrease in a women's quantity and quality of oocytes, or ovarian reserve (OR). POF can result in long-term physical and psychological health consequences. The earlier treatment can occur to manage this disease, the less likely the individual is going to suffer from the potential consequences. Accurate diagnosis is a critical proponent to ensuring immediate care. A traditional diagnostic marker includes follicular stimulating hormone (FSH). This individual test cannot be used to make a diagnosis in isolation due to the large variability in FSH levels among different women, and throughout a women's menstrual cycle. Anti-Müllerian hormone (AMH) is an alternative diagnostic marker for determining a women's OR. Serum levels of AMH have been shown to be associated with the size of the resting primordial follicle pool. When the levels of AMH are low, this is generally considered to be an indicator of a decline in fertility. In this study, we examined the specificity, sensitivity and accuracy of the FSH assay, against the more recently emerged AMH assay for diagnosing and predicting POR via Receiver Operator Characteristic curve (ROC) analysis. METHODS: A total of 60 participants were enrolled in the study. The POF group included 30 infertile women with POF, the infertile control group included 13 women without POF, and the fertile control group included 17 healthy women. Participants were recruited from the Kamal Al-Samarray Hospital in Bagdad city from December 2017 to March 2018. The age of participants ranged from 19-39 years of age. On day 2 of the menstrual cycle, peripheral blood samples were collected from each participant and the serum levels of AMH and FSH were examined using ELISA. RESULTS: Statistical analysis examining the FSH and AMH assays indicate that measuring AMH levels leads to an increased sensitivity, specificity and accuracy in determining the presence or absence of POF among the control fertile and POF groups. However, when comparing the specificity, sensitivity, and accuracy of AMH to FSH among the POF group and infertile controls, there were no differences among sensitivity, furthermore there was a slight decrease in the accuracy and specificity of AMH compared to FSH. CONCLUSION: Our findings indicate that the serum levels of AMH have higher sensitivity, specificity and accuracy in detecting POR than FSH when comparing the POF patients to healthy fertile controls. As the AMH levels have minimal within-menstrual cycle variation they can therefore be assessed whenever necessary, opposed to FSH, in which the levels vary throughout the menstrual cycle. The role of AMH may therefore hold a more useful role in the early diagnosis of POF.