Ovarian reserve function is an important indicator for assessing female fertility. Commonly used reference indicators in clinical practice include age, hormone detection, ovarian dynamics test, ovarian ultrasound, etc., follicle-producing hormone (FSH) and sinus follicle count (AFC) Measuring the number of ovarian reserve follicles is also a commonly used indicator. However, these indicators have many requirements in terms of testing time and operating experience. The detection of anti-Mullerian hormone (AMH) can better solve these problems and become the most direct measure of ovarian reserve function.
At the menopause conference, Professor Sun Aijun, chief physician of the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, and Professor Pan Baishen, director of the Laboratory Department of Zhongshan Hospital affiliated to Shanghai Fudan University, discussed and shared the clinical application of AMH testing. Professor Sun Aijun said: "The latest research finds that AMH has great medical value throughout the reproductive and reproductive stages for both ordinary women and patients with gynecological tumors, and its clinical application potential is huge.
AMH: helping women's reproductive health management from multiple perspectives
AMH is an active factor secreted by the granulosa cells of the ovarian sinus follicles, which plays an important role in ovarian reserve function and follicular development, and can reflect follicular activity throughout the life cycle. Among the many indicators for evaluating ovarian reserve function, AMH is the earliest indicator that changes with age, and can sensitively assess age-related decline in fertility.
1 AMH testing is superior to other traditional testing items
"At present, AFC is commonly used in clinical evaluation of ovarian reserve function, but the subjective count deviation is large, which brings inconvenience to diagnosis and treatment. AMH test does not require experienced personnel or ultrasound equipment, the detection value is relatively stable, and it is consistent with AFC and can be carried out routinely The test can be performed on any day of the menstrual cycle, with little difference between the menstrual cycle and the week. "
Professor Pan Baishen pointed out, "The specificity and sensitivity of AMH testing are superior to other traditional testing items, which can reflect changes in ovarian reserve function earlier, thereby effectively assessing fertility. Therefore, testing AMH can effectively evaluate ovarian reserve function and menopause The age range of occurrence can not only well predict the age of menopause, but also provide important reference information for scientifically formulating an individualized fertility plan. "
In addition to assessing ovarian reserve function, AMH testing is also widely used in the field of assisted reproduction. Multi-center studies of the long-acting gonadotropin-releasing hormone (GnRH) agonist program and GnRH antagonist program have found that compared with AFC testing, AMH testing has a stronger correlation with the number of eggs obtained, which can better predict ovarian stimulation. reaction. Therefore, through the detection of AMH, the clinic can customize the most suitable individualized ovarian stimulation protocol (COS) to improve the pregnancy rate and cycle birth rate of patients, reduce the incidence of ovarian hyperstimulation syndrome and fertilization failure rate, and reduce drugs and medical treatment cost.
2 AMH indicators are gradually applied in the diagnosis of female reproductive diseases
At the same time, AMH indicators are gradually being used in the diagnosis of female reproductive diseases, including child sexual development disorders, endocrine disorders common to women of childbearing age, such as premature ovarian failure (POF), polycystic ovary syndrome (PCOS), Granuloma (GCT) and so on. Among them, the level of AMH in patients with POF is lower than the 5th percentile of women with normal ovulation, while the level of AMH in patients with PCOS is usually 2 to 3 times higher than that in the normal group. This information is helpful for clinical diagnosis. The specificity of AMH expressed only by Granulosa cells makes it possible to become a marker of GCT. In addition, AMH levels are positively correlated with GCT size, which is helpful for clinical diagnosis and follow-up of GCT.
AMH levels can also help clinically formulate endocrine adjuvant therapies for women with premenopausal chemotherapy. A prospective study involving 27 patients with breast cancer who followed up for 18 months found that the younger the age, the higher the baseline level of AMH, and the better the recovery of ovarian reserve after chemotherapy. In addition, AMH testing can also be applied to cancer treatment, because cancer treatment usually brings unavoidable effects on ovarian reserve function, and AMH can help predict ovarian function after cancer treatment, guide clinical selection of appropriate adjuvant hormone therapy and evaluate different toxic effects of chemotherapy regimens. Therefore, for patients with a fertility plan, it is recommended to perform AMH testing before and after cancer treatment in order to develop an individual fertility-preserving strategy.
Preliminary study of AMH reference range for Chinese population to guide clinical diagnosis and treatment
The American Society for Clinical and Laboratory Standards (CLSI) pointed out that in clinical applications, for different detection methods and different populations, the corresponding AMH reference values need to be established. At present, white people have related AMH reference value research data, and the AMH reference value for the Chinese population is urgently needed in China to guide clinical application. Recently, Peking Union Medical College Hospital and Zhongshan Hospital affiliated to Shanghai Fudan University have successively carried out research on the reference range of the Chinese population.
Peking Union Medical College Hospital's study included nearly 800 healthy people resident in Beijing. Using the 2.5th percentile to the 97.5th percentile to develop a 95% normal reference value range. The study found that the 20 to 24 year-old group had the highest AMH. The median value was 3.71 ng / ml, and then decreased with age. The median AMH of the 35 to 39-year-old group was 1.79 ng / ml, and the 45- to 50-year-old group was 0.18 ng / ml. The study showed that Chinese women's median AMH data was similar to that of white women, and AMH's decreasing trend with age was similar to that of white women.
Professor Pan Baishen said, "The results of Zhongshan Hospital are close to those of Peking Union Medical College Hospital. The two studies corroborate each other and strengthen the reference value of the study. The establishment of the AMH reference range for the domestic population will help us to further optimize clinical diagnosis and treatment and improve China. Female reproductive health management. "
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