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GnRHa may depreciate anti-Müllerian hormone as ovarian reserve marker
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Changes to the anti-Müllerian hormone were significant in the first 4 weeks after healthy women were administered depot leuprolide, suggesting that the hormone may not be a reliable marker for ovarian reserve in patients with cancer during the first month of gonadotropin-releasing hormone agonist treatment, researchers reported in the Journal of Clinical Endocrinology and Metabolism.
“Our data also show that changes in [anti-Müllerian hormone] levels did not correlate with concurrently measured [luteinizing hormone] and [follicle-stimulating hormone], raising the possibility of a direct, gonadotropin-independent effect of [gonadotropin-releasing hormone agonists] on granulosa cells,” H. Irene Su, MD, MSCE, assistant professor of medicine in the department of reproductive medicine at the University of California, San Diego, and colleagues wrote.
H. Irene Su
Early follicular phase and mid-luteal phase anti-Müllerian hormone (AMH) levels were similar before depot leuprolide (3.75 mg) was administered to 33 healthy, premenopausal women aged 18 to 45 years with regular menses, according to data.
After 7 days of gonadotropin-releasing hormone agonist (GnRHa) treatment, researchers reported that AMH levels decreased by a median of 24% relative to mid-luteal phase levels (P<.001). Subsequently, these levels increased above the pretreatment levels by day 14 (13%) and day 30 (32%) after GnRHa treatment (P<.001), researchers wrote.
The changes to AMH were independent of gonadotropins, estradiol or progesterone level changes, according to data.
“The clinical question of how to measure ovarian reserve in females treated with prolonged GnRHa remains unanswered,” Su and colleagues wrote. “However, the finding that fluctuations in AMH levels occurred independent of gonadotropins — whether the result of a direct effect of GnRHa on granulosa cell AMH expression and/or an indirect effect of GnRHa on follicle pool development and/or dynamics — supports continued efforts to elucidate the role of GnRHa in fertility preservation.”
Disclosure: Su reports serving on the advisory board of Ferring Pharmaceuticals. Other researchers report various financial ties with Cephalon/Teva, Noven Pharmaceuticals and Sunovion Pharmaceuticals.
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