Objective: This study aimed to determine the threshold of $anti-M{\ddot{u}}llerian$ hormone (AMH) as predictor of follicular growth failure in polycystic ovary syndrome (PCOS) patients treated with clomiphene citrate (CC). Methods: Fifty female subjects with PCOS were recruited and divide...
Objective: This study aimed to determine the threshold of $anti-M{\ddot{u}}llerian$ hormone (AMH) as predictor of follicular growth failure in polycystic ovary syndrome (PCOS) patients treated with clomiphene citrate (CC). Methods: Fifty female subjects with PCOS were recruited and divided into two groups based on successful and unsuccessful follicular growth. Related variables such as age, infertility duration, cigarette smoking, use of Moslem hijab, sunlight exposure, fiber intake, body mass index, waist circumference, AMH level, 25-hydroxy vitamin D level, and growth of dominant follicles were obtained, assessed, and statistically analyzed. Results: The AMH levels of patients with successful follicular growth were significantly lower (p= 0.001) than those with unsuccessful follicular growth ($6.10{\pm}3.52$ vs. $10.43{\pm}4.78ng/mL$). A higher volume of fiber intake was also observed in the successful follicular growth group compared to unsuccessful follicular growth group (p= 0.001). Our study found the probability of successful follicle growth was a function of AMH level and the amount of fiber intake, expressed as Y =-2.35+($-0.312{\times}AMH\;level$)+($0.464{\times}fiber\;intake$) (area under the curve, 0.88; 95% confidence interval, 0.79-0.98; p< 0.001). Conclusion: The optimal threshold of AMH level in predicting the failure of follicle growth in patients with PCOS treated with CC was 8.58 ng/mL.
Objective: This study aimed to determine the threshold of $anti-M{\ddot{u}}llerian$ hormone (AMH) as predictor of follicular growth failure in polycystic ovary syndrome (PCOS) patients treated with clomiphene citrate (CC). Methods: Fifty female subjects with PCOS were recruited and divided into two groups based on successful and unsuccessful follicular growth. Related variables such as age, infertility duration, cigarette smoking, use of Moslem hijab, sunlight exposure, fiber intake, body mass index, waist circumference, AMH level, 25-hydroxy vitamin D level, and growth of dominant follicles were obtained, assessed, and statistically analyzed. Results: The AMH levels of patients with successful follicular growth were significantly lower (p= 0.001) than those with unsuccessful follicular growth ($6.10{\pm}3.52$ vs. $10.43{\pm}4.78ng/mL$). A higher volume of fiber intake was also observed in the successful follicular growth group compared to unsuccessful follicular growth group (p= 0.001). Our study found the probability of successful follicle growth was a function of AMH level and the amount of fiber intake, expressed as Y =-2.35+($-0.312{\times}AMH\;level$)+($0.464{\times}fiber\;intake$) (area under the curve, 0.88; 95% confidence interval, 0.79-0.98; p< 0.001). Conclusion: The optimal threshold of AMH level in predicting the failure of follicle growth in patients with PCOS treated with CC was 8.58 ng/mL.
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문제 정의
Additional studies to determine the most useful clinical value of the hormone level were needed. This study was conducted to define the threshold of the AMH level as a predictor of follicular growth failure in patients with PCOS treated with CC.
This study aimed to determine the threshold of AMH level as the predictor of follicular growth failure in patients with PCOS treated with CC by using the ROC curve analysis. Based on the result of ROC curve, AMH level had a high AUC and a significant difference between groups (0.
This study determined a threshold AMH level as a predictor of follicular growth failure following CC treatment. Despite the high sensitivity and specificity of the AMH threshold level (i.
However, calculating or estimating the daily amount of fiber intake in clinical settings would be complicated, and fiber intake would be unsuitable for predicting successful follicular growth. Therefore, it was considered as one component in the successful follicular growth probability table according to various AMH levels and as preliminary data for further studies. The patients’ symptoms like oligoovulation or anovulation could be related to high cortisol level, or also high production of TSH and insulin, even though the clinical signs did not include hypercortisolism, high TSH levels, or glucose intolerance.
제안 방법
The inclusion criteria were women < 40 years, who had been previously diagnosed with PCOS based on Rotterdam consensus criteria (two or three criteria: oligoovulation or anovulation, hyperandrogenemia, and sonographic appearance of polycystic ovaries), had been infertile, were willing to participate in this study, and had not consumed any medications (CC or metformin) within 3 months.
Subjects were recruited using the consecutive sampling method. This study assessed several variables, which consisted of the age of patient, duration of infertility, cigarette smoking exposure, use of Moslem hijab, sun exposure, fiber intake, BMI, waist circumference, AMH level, 25-hydroxy (25-OH) vitamin D level, and follicular growth. BMI was classified based on the World Health Organization criteria for Asians, where BMI > 23.
Only variables that showed significant correlation (p-value < 0.25) with follicular growth were used for further multivariate analysis.
Multivariate analysis was established using the binary logistic regression test. Bivariate analysis was done between follicular growth and each of the following variables: age, BMI, waist circumference, AMH level and 25-OH vitamin D level, and the amount of fiber intake. Only variables that showed significant correlation (p-value < 0.
The 50 female subjects with PCOS enrolled this study were divided into two groups based on the assessment of follicular growth. Twenty-three subjects (46%) had successful follicular growth and 27 subjects (56%) had unsuccessful follicular growth.
Based on the correlation test, eligible variables for the logistic regression test were BMI, waist circumference, AMH level, fiber intake, use of Moslem hijab, and cigarette exposure. Binary logistic regression test was performed to determine the probability of having successful follicular growth with CC treatment (Table 3), resulting in the following function (Formula 1):
This study was conducted in female subjects with PCOS receiving CC treatment (dose of 100 mg) and observed for successful or unsuccessful follicular growth. The successful follicular growth rate in subjects with CC treatment found in this study was 46% (Table 2), which is consistent with rates (40%–80%) reported in a previous study by Messinis and Milingos [14] .
7 ng/mL with 78% sensitivity and 76% specificity. These studies had parallel results with ours, corroborating the role of AMH in predicting the failure of follicle growth. The somewhat different thresholds of AMH level among studies were presumably related to the variation of the AMH kits used in those studies.
대상 데이터
This cross-sectional observational study was conducted in the Endocrinology and Gynecology Clinic in Cipto Mangunkusumo Hospital from June 2013 to April 2014. This study included 50 female subjects with PCOS who were infertile, willing to participate in this study, and had not been under either CC or metformin therapy within the previous 3 months. The Rotterdam consensus was used to exclude subjects without PCOS, although we did not check the level of cortisol, thyroid-stimulating hormone (TSH), and insulin in these patients.
0 kg/m2 is overweight [13]. Anamnesis, physical examination, and transvaginal ultrasonography (TVU) were performed on the eligible study subjects. Venous blood samples were taken to measure serum levels of AMH (AMH Gen II ELISA; Beckman Coulter, Fullerton, CA, USA) and 25-OH vitamin D (chemiluminescent immunoassay method, Liaison 25 OH vitamin D total assay; DiaSorin, Stillwater, MN, USA).
데이터처리
Successful and unsuccessful follicular growth was compared according to the subjects’ respective AMH levels. These values were entered into a diagnostic test using statistical analysis and the receiver operating characteristic (ROC) curve. Dietary intake assessment using a 24-hour food recall method was taken by a designated trained interviewer to collect data concerning the amount of daily fiber intake.
이론/모형
05 was used. Multivariate analysis was established using the binary logistic regression test. Bivariate analysis was done between follicular growth and each of the following variables: age, BMI, waist circumference, AMH level and 25-OH vitamin D level, and the amount of fiber intake.
성능/효과
The role of AMH in follicle development was confirmed in a study demonstrating that continuous low dose recombinant FSH administration significantly lowered the AMH level in follicles. A decline of AMH level interrupted the inhibition mechanism in the follicles; therefore they could develop as mature follicles [11].
Determination of threshold value was based on the sensitivity and specificity. The threshold of AMH level found in this study was 8.58 ng/mL, and it had a moderately high specificity (67%) and sensitivity (78%), although it only contributed 40% towards predicting failure of follicular growth according to Formula 1 (Table 4).
This study aimed to determine the threshold of AMH level as the predictor of follicular growth failure in patients with PCOS treated with CC by using the ROC curve analysis. Based on the result of ROC curve, AMH level had a high AUC and a significant difference between groups (0.75, p= 0.001), with 8.58 ng/mL as the threshold with 78% sensitivity and 67% specificity. This finding indicates that PCOS patients with AMH level of < 8.
In this study there were equivalent results to these previous studies, indicating a BMI difference of 24.74 kg/m2 in the successful follicular growth group and 26.76 kg/m2 in the unsuccessful follicular growth group, although the difference was statistically insignificant (p= 0.2).
후속연구
Previous studies reported that AMH could also be useful in the prediction of ovarian response to CC in obese women with anovulation [12]. Additional studies to determine the most useful clinical value of the hormone level were needed. This study was conducted to define the threshold of the AMH level as a predictor of follicular growth failure in patients with PCOS treated with CC.
We did not check the level of cortisol, TSH, and insulin, which is a weakness of this study. Further studies are needed to assess those variables in a normal population as a comparison to our study, to validate the predictors found in this study, and to observe thoroughly the effects of fiber intake on the follicular growth in patients with PCOS with a larger prospective cohort or randomized controlled trial.
참고문헌 (25)
1 Hart R Norman R Polycystic ovarian syndrome: prognosis and outcomes Best Pract Res Clin Obstet Gynaecol 2006 20 751 778 16766228
3 Balen A Ovulation induction Obstet Gynaecol Reprod Med 2004 14 261 268
4 Ghobadi C Nguyen TH Lennard MS Amer S Rostami-Hodjegan A Ledger WL Evaluation of an existing nomogram for predicting the response to clomiphene citrate Fertil Steril 2007 87 597 602 17156783
5 Eijkemans MJ Imani B Mulders AG Habbema JD Fauser BC High singleton live birth rate following classical ovulation induction in normogonadotrophic anovulatory infertility (WHO 2) Hum Reprod 2003 18 2357 2362 14585887
6 Imani B Eijkemans MJ te Velde ER Habbema JD Fauser BC Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility J Clin Endocrinol Metab 1998 83 2361 2365 9661609
7 Kurabayashi T Suzuki M Fujita K Murakawa H Hasegawa I Tanaka K Prognostic factors for ovulatory response with clomiphene citrate in polycystic ovary syndrome Eur J Obstet Gynecol Reprod Biol 2006 126 201 205 16337728
8 Dumesic DA Lesnick TG Stassart JP Ball GD Wong A Abbott DH Intrafollicular antimullerian hormone levels predict follicle responsiveness to follicle-stimulating hormone (FSH) in normoandrogenic ovulatory women undergoing gonadotropin releasing-hormone analog/recombinant human FSH therapy for in vitro fertilization and embryo transfer Fertil Steril 2009 92 217 221 18675414
9 Mashiach R Amit A Hasson J Amzalzg S Almog B Ben-Yosef D Follicular fluid levels of anti-Mullerian hormone as a predictor of oocyte maturation, fertilization rate, and embryonic development in patients with polycystic ovary syndrome Fertil Steril 2010 93 2299 2302 19261276
10 Lee JR Kim SH Kim SM Jee BC Ku SY Suh CS Follicular fluid anti-Mullerian hormone and inhibin B concentrations: comparison between gonadotropin-releasing hormone (GnRH) agonist and GnRH antagonist cycles Fertil Steril 2008 89 860 867 18249372
11 Catteau-Jonard S Pigny P Reyss AC Decanter C Poncelet E Dewailly D Changes in serum anti-Mullerian hormone level during low-dose recombinant follicular-stimulating hormone therapy for anovulation in polycystic ovary syndrome J Clin Endocrinol Metab 2007 92 4138 4143 17698904
12 El-Halawaty S Rizk A Kamal M Aboulhassan M Al-Sawah H Noah O Clinical significance of serum concentration of anti-Mullerian hormone in obese women with polycystic ovary syndrome Reprod Biomed Online 2007 15 495 499 18028738
13 World Health Organization The Asia-Pacific perspective: redefining obesity and its treatment Sydney Health Communications Australia 2000
14 Messinis IE Milingos SD Current and future status of ovulation induction in polycystic ovary syndrome Hum Reprod Update 1997 3 235 253 9322100
15 Li L Chen X Mo Y Chen Y Wenig M Yang D Elevated serum antimullerian hormone in adolescent and young adult Chinese patients with polycystic ovary syndrome Wien Klin Wochenschr 2010 122 519 524 20809108
16 Piltonen T Morin-Papunen L Koivunen R Perheentupa A Ruokonen A Tapanainen JS Serum anti-Mullerian hormone levels remain high until late reproductive age and decrease during metformin therapy in women with polycystic ovary syndrome Hum Reprod 2005 20 1820 1826 15802325
17 Iliodromiti S Kelsey TW Anderson RA Nelson SM 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 3340 23775353
18 Sahmay S Atakul N Aydogan B Aydin Y Imamoglu M Seyisoglu H Elevated serum levels of anti-Mullerian hormone can be introduced as a new diagnostic marker for polycystic ovary syndrome Acta Obstet Gynecol Scand 2013 92 1369 1374 23980726
19 Amer SA Li TC Ledger WL The value of measuring anti-Mullerian hormone in women with anovulatory polycystic ovary syndrome undergoing laparoscopic ovarian diathermy Hum Reprod 2009 24 2760 2766 19640893
20 Mahran A Abdelmeged A El-Adawy AR Eissa MK Shaw RW Amer SA The predictive value of circulating anti-Mullerian hormone in women with polycystic ovarian syndrome receiving clomiphene citrate: a prospective observational study J Clin Endocrinol Metab 2013 98 4170 4175 23979947
21 di Clemente N Goxe B Remy JJ Cate RL Josso N Vigier B Inhibitory effect of AMH upon the expression of aromatase and LH receptors by cultured granulosa cells of rat and porcine immature ovaries Endocrine 1994 2 553 558
22 Das M Gillott DJ Saridogan E Djahanbakhch O Anti-Mullerian hormone is increased in follicular fluid from unstimulated ovaries in women with polycystic ovary syndrome Hum Reprod 2008 23 2122 2126 18550512
23 Gaskins AJ Mumford SL Zhang C Wactawski-Wende J Hovey KM Whitcomb BW Effect of daily fiber intake on reproductive function: the BioCycle Study Am J Clin Nutr 2009 90 1061 1069 19692496
24 Thomson RL Spedding S Buckley JD Vitamin D in the aetiology and management of polycystic ovary syndrome Clin Endocrinol (Oxf) 2012 77 343 350 22574874
25 Crosignani PG Colombo M Vegetti W Somigliana E Gessati A Ragni G Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet Hum Reprod 2003 18 1928 1932 12923151
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