DR NIMISH.R.SHELAT AWARD IN REPRODUCTIVE ENDOCRINOLOGY(2014)

DR DEBASHISH SARKARM.B.B.S. (HONS),M.S.(OBGYN),CERT.REPRODUCTIVE MEDICINE(HOMMERTON HOSPITAL,UK)E-MAIL-SARKARHOSPITALSPVTLTD@GMAIL.COM

LIFE MEMBER FOGSI LIFE MEMBER NARCHI MEMBER ICS(UK) MEMBER ISUOG SECURED 1ST POSITION IN M.B.B.S EXAMINATION PRESENTED 25 RESEARCH PAPERS IN NATIONAL AND INTERNATIONAL

CONFRENCES INCL. LISBON,VIENNA & LIVERPOOL(U.K.) AWARDED “DR SUBHROTO DAWN BEST PAPER AWARD” AT WORLD CONGRESS

NARCHI IN LUCKNOW AWARDED FOR “0UTSTANDING ACADEMIC ACHIEVEMENTS &

RESEARCH WORK” BY PADAMSHREE DR RP SOONAWALA AT JAIPUR HOBBIES- PIANIST & SINGER

GOOD AFTERNOON

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MAHATMA GANDHI UNIVERSITY OF MEDICAL SCIENCES & TECHNOLOGY

Guided By:-DR.V.ACHARYADR.M.L.SWARANKAR

Presenting Author:- DR.DEBASHISH SARKAR

DEPT. OF OBGYN

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ROLE OF ANTI MÜLLERIAN HORMONE (AMH) AS A BIOLOGICAL MARKER FOR PCOS

INTRODUCTION

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INTRODUCTION

Anti mullerian hormone (AMH): Anti mullerian Hormone (AMH),also known as

Mullerian inhibiting substance (MIS), is a dimeric glycoprotein belonging to the transforming growth factor-beta (TGF-β) superfamily.

The estimation of plasma AMH in women of reproductive age group ,helps to asses the ovarian reserve,with a greater specificity and sensitivitythan determination of FSH together with steroid hormones and inhibin

AMH(ANTIMULLERIAN HORMONE)

“A serum marker that reflects the number of follicles that have made the transition from the primordial pool into the growing follicle pool, and that is not controlled by gonadotropins, would benefit both patients and clinicians”

In recent years, accumulated data indicate that anti-Müllerian hormone (AMH) may fulfill this role.

(Visser, et al., 2006)

AMH & PCOS

The aromatase activity in PCOS patients might be

decreased because follicles from PCOS

women do not produce sufficient

amounts of E2

AMH lowers the sensitivity of follicles

to FSH, possibly contributing to

deranged follicle selection.

AMH also inhibits aromatase activity

suggesting its contribution to

severity of PCOS

Serum AMH levels are significantly

elevated in PCOS than in the Non- PCOS patients

Ref. Durlinger All, et. al. Endocrinology 2002, 142, 4891-4899 Laven et.al. Journal of endocrinology and metabolism 2004, 89, 318-323.

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AIM

The aim of my study was to determine the role of Anti Mullerian hormone as a biological marker in PCOS patients.

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OBJECTIVES

To select the infertile PCOS patients(TVS-R)

To asses the following biological markers -S.LH,S.FSH,S.Testosterone,Prolactin & S.Antimullerian Hormone.

To find out the use of Antimullerian Hormone as a predictor of pregnancy outcome in PCOS patients

The present prospective study was carried out on 100 infertile patients of PCOS identified at Jaipur Fertility and Research Centre(MGH,Jaipur) from July 2011 to August 2013.

A detailed clinical history was taken & clinical examination done in all the patients of PCOS.

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MATERIAL AND METHODS

MATERIAL AND METHODS

The patients were diagnosed as PCOS according to the Rotterdams criteria using transvaginal sonography (TVS-R)

These patients were subjected to a hormonal assay that included(S.LH,FSH,PROLACTIN,TESTOSTERONE & AMH)

The patients were then divided into 5 groups according to their AMH levels-

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GROUP 1 AMH

<5ng/dl

GROUP 2AMH

5-9 ng/dl

GROUP 3AMH

13-17 ng/dl

GROUP 4AMH

17-21 ng/dl

.

GROUP 3AMH 9-13 ng/dl

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OBSERVATIONS&

RESULTS

CLINICAL PRESENTATION(N=100)

62%18%

14%

6%

% of Patients

Hirsutism Acne Obesity Clinically NAD

AMH LEVELS AMH Level

(ng/ml)No. of patients

(N)Percentage

(%)

<5 (Group 1) 47 47%

5-9 (Group 2) 36 36%

9-13 (Group 3) 12 12%

13-17 (Group 4) 3 3%

17-21 (Group 5) 2 2%

Total 100 100

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AMH LEVELS

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<5 (Group 1)47%

5-9 (Group 2)36%

9-13 (Group 3)12%

13-17 (Group 4)3%

17-21 (Group 5)2%

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COMPARISION BETWEEN AMH AND TOTAL TESTOSTERONE(N=100)

<5 5-9 9-13 13-17 17-210.0

20.0

40.0

60.0

80.0

100.0

120.0

Correlation between Testosterone level & AMH Level

AMH Level

Mea

n T

esto

ster

one

leve

l

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COMPARISION BETWEEN AMH AND FSH(N=100)

<5 5-9 9-13 13-17 17-210.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

Correlation between Mean FSH Level & AMH Level

AMH Level

Mea

n F

S H

Lev

el

COMPARISION OF AMH AND FSH LEVELS

AMH Level

(ng/ml)

No. of patients

(N)

Mean FSH

(mIU/ml)SD

<5 (Group 1) 47 5.7 3.7

5-9 (Group 2) 36 6.0 4.6

9-13 (Group 3) 12 3.9 1.3

13-17 (Group 4) 3 3.7 0.8

17-21 (Group 5) 2 3.6 1.6

Grand Total 100 5.5 3.8

P Value <0.001*     22

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RESULTS AMH levels ranged from 2.1 to 20.8 ng/mL and the

mean level was 11.45 ± 6.1 ng/mL..

In our study out of 100 patients of PCOS – <5 ng/dl (Group 1)- 47 patients 5-9 ng/dl(Group 2)-36 patients 9-13 ng/dl (Group 3)-12 patients 13-17 ng/dl (Group 4)-3 patients 17-21 ng/dl (Group 5)-2 patients

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PREGNANCY OUTCOME IN PCOS PATIENTS (%)

AMH

Level(ng/dl) Not Conceived Conceived

TOTAL

PTNTS

<5 (Group 1) 28 19(40.4%) 47

5-9 (Group 2) 33 3(8.33%) 36

9-13 (Group 3) 12 0 12

13-17 (Group 4) 3 0 3

17-21 (Group 5) 2 0 2

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CONCEPTION RATES ACCORDING TO AMH LEVELS

<5 5-9 9-13 13-17 17-210

5

10

15

20

25

30

35

40

45

50

Not Concieved Concieved

AMH Level

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CONCLUSION:

In our study,we concluded that,Antimullerian hormone is an important biological marker in diagnosing PCOS patients,as compared to other markers.

AMH is useful for predicting treatment outcomes in PCOS patients.

AMH is also an important predictor of pregnancy outcomes in PCOS patients undergoing ART .

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REFERENCES

1. Pigny P, Merlen E, Robert Y, Cortet-Rudelli C, Decanter C, Jo- nard S, et al. Elevated serum level of anti-Müllerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest. J Clin Endo- crinol Metab 2012;88:5957-62. 2. Pigny P, Jonard S, Robert Y, Dewailly D. Serum anti-Müllerian hormone as a surrogate for antral follicle count for definition of the polycystic ovary syndrome. J Clin Endocrinol Metab 2006;91:941-5. 3. Themmen AP (2005) Anti-Mullerian hormone: its role in follicular growth initiation and survival and as an ovarian reserve marker. J Natl Cancer Inst Monogr 34,18–21. 4. Pellatt L, Rice S, Mason HD. Anti-Müllerian hormone and poly- cystic ovary syndrome: a mountain too high? Reproduction 2010;139:825-33.  5. Visser JA, de Jong FH, Laven JS, Themmen AP. Anti-Müllerian hormone: a new marker for ovarian function. Reproduction 2006;131:1-9.

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