Changes in Circulating ProAMH and Total AMH during Healthy Pregnancy and Post-Partum: A Longitudinal Study

Abstract

Circulating Anti-Müllerian hormone (AMH) is derived from the gonads, and is a mixture of the prohormone (proAMH), which does not bind to AMH receptors, and receptor-competent AMH. The functions of a hormone are partially defined by the factors that control its levels. Ovarian reserve accounts for 55~75% of the woman-to-woman variation in AMH level, leaving over 25% of the biological variation to be explained. Pregnancy has been reported to decrease circulating AMH levels, but the observations are inconsistent, with the effect of pregnancy on the bioactivity of AMH being unknown. We have therefore undertaken a longitudinal study of circulating proAMH and total AMH during pregnancy. Serum samples were drawn at 6–8 gestational time-points (first trimester to post-partum) from 25 healthy women with prior uneventful pregnancies. The total AMH and proAMH levels were measured at each time-point using ELISA. The level of circulating total AMH progressively decreased during pregnancy, in all women (p<0.001). On average, the percentage decline between the first trimester and 36–39 weeks’ gestation was 61.5%, with a standard deviation of 13.0% (range 30.4–81.2%). The percentage decline in total AMH levels associated with maternal age (R = -0.53, p = 0.024), but not with the women’s first trimester AMH level. The postpartum total AMH levels showed no consistent relationship to the woman’s first trimester values (range 31–273%). This raises the possibility that a fundamental determinant of circulating AMH levels is reset during pregnancy. The ratio of proAMH to total AMH levels exhibited little or no variation during pregnancy, indicating that the control of the cleavage/activation of AMH is distinct from the mechanisms that control the total level of AMH.

Successful embryo cryopreservation immediately following a full-term delivery in a woman with newly diagnosed Ewing’s sarcoma

“…The enlarged postpartum uterus can limit the ability to visualize the ovaries, obtain a baseline antral follicle count, and monitor follicular growth, especially during the early stages of the stimulation. Moreover, AMH and other ovarian reserve markers, often used to direct the initial decision of gonadotropin starting doses, are difficult to interpret in the postpartum period due to suppression during pregnancy, and the results of these tests are not always immediately available before initiating the cycle [8]. Furthermore, there is lack of data on the expected response of postpartum ovaries to stimulation and concern over premature luteinization or inability to induce final oocyte maturation in the setting of increased serum hCG levels.…”

“…With this knowledge, and considering that after uncomplicated deliveries hCG levels decrease according to a half-life of 24-36 h [8], we chose to postpone the start of this patient's IVF cycle by 4 days (postpartum day 6) until serum hCG reached a level of 71 mIU/mL. We hypothesized that a cutoff of < 100 mIU/mL on the first day of IVF treatment could safely allow for successful ovarian stimulation and effective response to the final hCG trigger without excessively delaying the start of her cancer treatment.…”

Brief Report: The Euro‐Lupus Low‐Dose Intravenous Cyclophosphamide Regimen Does Not Impact the Ovarian Reserve, as Measured by Serum Levels of Anti–Müllerian Hormone

“…First, the well‐known effect of aging on lowering AMH levels was taken into account by age adjustment of the measured serum values. Second, pregnant patients were excluded, because AMH titers decrease during pregnancy . Third, it has been suggested that SLE per se is associated with lower AMH titers, regardless of CYC exposure, disease duration, and disease activity .…”

Η Αντιμυλλέριος Ορμόνη (ΑΜΗ) Ως Προγνωστικός Παράγων Για Επίτευξη Εγκυμοσύνης Σε Προγράμματα Εξωσωματικής Γονιμοποίησης

“…(23) Η κυκλοφορούσα ΑΜΗ είναι μια ανάμειξη της proAMH (που δεν συνδέεται με τους υποδοχείς) και της δραστικής ΑΜΗ. (24) Σχήμα 5. (26) Έχουν ανιχνευθεί αρκετά γονίδια που δρουν ρυθμιστικά στην παραγωγή της ΑΜΗ, όπως τα SF1, GATA1, WT1, DAX1, SOX9 (27) .…”

“…(191) Οι Dolleman et al ανέφεραν μικρότερες τιμές ΑΜΗ στην κύηση, αλλά θετική συσχέτιση των τιμών ΑΜΗ ορού με τον αριθμό των γεννήσεων μιας γυναίκας (154) . (24) Έχουν, μάλιστα, γίνει προσπάθειες να προσδιορισθούν τα φυσιολογικά επίπεδα ΑΜΗ ορού στη διάρκεια της κύησης (Masse et al, Δεκ 2011) (192) . Οι Hamilton et al (Νοε 2016) διεπίστωσαν ότι η ΑΜΗ είχε μέγιστη τιμή περιωορρηκτικά και ακολούθως μέχρι την 7 η εβδομάδα κύησης εμφάνισε τάση ελάττωσης -αν και όχι στατιστικώς σημαντική -στις κυήσεις μετά από φυσική σύλληψη, σταθερή αύξηση ή σταθερή ελάττωση στις κυήσεις που προέκυψαν με υποβοηθούμενη αναπαραγωγή και σποραδικές μεταβολές στις παλίνδρομες κυήσεις με εναλλαγή αύξησης και ελάττωσης στην ίδια ασθενή (193) .…”