The effect of medication on serum anti-müllerian hormone (AMH) levels in women of reproductive age: a meta-analysis

Abstract

Objective The study aims to address whether serum anti-müllerian hormone (AMH) levels fluctuate in the short term after medication application, including oral contraceptives (OCs), metformin (MET), Gonadotropin-releasing hormone agonist (GnRH-a), dehydroepiandrosterone (DHEA), vitamin D (VD), clomiphene citrate (CC), and letrozole (LET). Methods Published literature from PubMed, Embase, and Cochrane central was retrieved up until 19 September 2021. A total of 51 self-control studies with an average Newcastle–Ottawa quality assessment scale (NOS) score of 6.90 were analyzed. The extracted data were entered into Stata software, and the weighted mean difference/standardized mean difference (WMD/SMD) and 95% confidence interval (CI) were used for data analysis. Results After OCs treatment the AMH level showed a significant decline in women with normal ovarian function, which was significant within 3 months (WMD = -1.43, 95% CI: -2.05 to -0.80, P < 0.00001). After MET treatment, the serum AMH decreased in polycystic ovary syndrome (PCOS) patients (WMD = -1.79, 95% CI: -2.32 to -1.26, P < 0.00001), in both obese and non-obese patients. GnRH-a treatment in endometriosis patients led to dynamic changes in the serum AMH levels, that is, ascent at 1 month (P = 0.05), and descent at 3 months (P = 0.02). After DHEA treatment the serum AMH increased in diminished ovarian reserve (DOR) / poor ovarian response (POR) patients (WMD = 0.18, 95% CI: 0.09 to 0.27, P < 0.0001). After VD treatment the serum AMH increased, and it was obvious in non-PCOS patients (WMD = 0.78, 95% CI: 0.34 to 1.21, P = 0.0004). After CC treatment the serum AMH decreased significantly in PCOS patients, specifically in non-obese patients (WMD = -1.24, 95% CI: -1.87 to -0.61, P = 0.0001). Conclusions Serum AMH levels may be affected in the short term after drug application. Specifically, OC, MET and CC lead to decreased AMH level, DHEA and VD lead to increased AMH level, and GnRH-a leads to dynamic variation, which is correlated with PCOS, obesity, age, and duration of medication. The impacts of these medications should be taken into consideration when AMH is used as a marker of ovarian reserve.

Effects of Follicular Testosterone on Cumulus and Granulosa Cells during Ovarian Stimulation with Aromatase Inhibitors in Patients with Breast Cancer

“…Indeed, Yin et al reported that drug applications affected the serum AMH levels. For example, the Gonadotropin-releasing hormone agonist (GnRH-a) treatment in patients with endometriosis caused fluctuation in the serum AMH levels, that is, ascent initially then descent 17,18) .…”

Cancer Treatment-Related Ovarian Dysfunction in Women of Childbearing Potential: Management and Fertility Preservation Options

“…No outside referral is required before consultation with a fertility specialist, and many fertility clinics have expedited pathways to accommodate immediate referral in this patient population. ,5-7 Days 2-5 Good predictive value for response to ovarian stimulation 63,64 AFC levels are decreased 70,71 AMH ,1 ng/mL Any day High sensitivity; good predictive value for response to ovarian stimulation; minimal variability during menstrual cycle 63,72 Levels decrease with GnRHa, but effect of other hormone-replacement therapies is low 63,[73][74][75] FSH c .10 IU/L Days 2-5 High specificity for poor response to ovarian stimulation response; readily available 63,72 FSH serum levels decrease 76 Estradiol c .60-80 pg/mL d Days 2-5 Increases sensitivity of FSH in predicting diminished ovarian reserve d Levels may be altered 64 Abbreviations: AFC, antral follicular count; AMH, anti-M üllerian hormone; DOR, diminished ovarian reserve; FSH, follicle-stimulating hormone; GnRHa, gonadotropin-releasing hormone agonist. General gynecologists can also discuss the basics of fertility preservation with patients newly diagnosed with cancer; however, treatment depends on the specialized field of reproductive endocrinology and infertility.…”

“…Specifically, AMH testing may be useful for assessing ovarian reserve and confirming ovarian dysfunction in patients already on treatment, as it shows little susceptibility to alteration with hormone replacement therapy. [73][74][75]95 Although AMH is not considered a reliable indicator of ovarian function in patients actively using GnRHa, 75 it can be informative as early as 3 months after treatment cessation. 75…”

“…[73][74][75]95 Although AMH is not considered a reliable indicator of ovarian function in patients actively using GnRHa, 75 it can be informative as early as 3 months after treatment cessation. 75…”

Vitamin D and infertility

“…However, in the subset of women with infertility and diminished ovarian reserve, there is increasing evidence that repleting vitamin D levels may lead to improved ovarian reserve metrics. Supplementing Vitamin D in women with diminished ovarian reserve significantly increased AMH values in meta-analyses published in 2020 and 2022 [13 ▪ ,14], and at least two articles published since the meta-analysis continue to strengthen the association between vitamin D supplementation and increased AMH [15,16]. One article also looked at vitamin D supplementation and noted increased antral follicle count (AFC) [16].…”