Serum ske razine Anti-Müllerova hormona u žena s redovitim menstruacijskim ciklusom

Antimüllerian hormone (AMH ) is produced by Sertolli cells of the testes and granulosa cells of the ovaries. Recent studies have indicated that AMH may be a novel measure of ovarian reserve. Also, earlier reports have presented minimal fluctuations of AMH levels throughout the menstrual cycle. The aim of this preliminary study was to demonstrate the relation of serum AMH levels and age in women with regular menstrual cycles and normal hormonal regulation of ovarian function. The study included 35 women divided into two groups of women aged 30 or younger and those older than 30. Hormone concentrations were assessed by measurements of lutropin (LH ), follitropin (FSH), estradiol (E2), testosterone (T), sex hormone binding globulin (SHBG) and AMH on cycle day 3-5 (follicular phase); and LH , FSH and E2 on cycle day 13-15 (ovulation). Progesterone level was determined on cycle day 19-23 (luteal phase). Median age differed significantly between the two groups of study subjects (p=0.001). Study results confirmed regular ovarian response to physiological gonadotropin stimulation, which is the assumption for normo-ovulatory cycles. Some decrease in the mean serum AMH levels was recorded in women over 30 years of age, although the difference was not statistically significant (p=0.0693). There was no statistically significant difference in serum AMH concentrations between follicular phase and ovulation in study women (p=0.3124). Our preliminary results, although obtained in a limited number of women, support the diagnostic value of AMH as a reliable marker of ovarian reserve.Anti-Müllerov hormon (AMH ) sintetizira se u Sertolijevim stanicama testisa u muškaraca i granuloza stanicama jajnika u žena. Dosadašnje studije dokazale su važnost određivanja anti-Müllerovog hormona kao novog biljega u procjeni ovarijske rezerve. Također, ranije objavljeni rezultati pokazali su neznačajnu promjenjivost koncentracija AMH u serumu tijekom menstruacijskog ciklusa. Cilj ovoga preliminarnog istraživanja bio je ustanoviti odnos koncentracije AMH u žena s redovitim ciklusima i normalnim hormonskim statusom u odnosu na njihovu dob. Uključeno je 35 žena podijeljenih u skupine od 30 godina i mlađih te starijih od 30 godina. Hormonsku regulaciju menstruacijskog ciklusa smo potvrdili određivanjem koncentracija lutropina (LH ), folitropina (FSH), estradiola (E2), ukupnog i slobodnog testosterona (T), proteinskog nosača spolnih hormona (SHBG) te AMH u folikularnoj fazi ciklusa (3.-5. dan). U ovulacijskoj fazi (13.-15. dan) određivali smo koncentracije LH , FSH, E2 i AMH , odnosno progesterona (P) u luteinskoj fazi (20.-23. dan). Medijani dobi u mlađoj i starijoj skupini bili su statistički značajno različiti (p=0,001). Rezultati su potvrdili urednu hormonsku regulaciju djelovanja osovine hipofiza-jajnici u izabranih ispitanica. Ustanovili smo relativno niže koncentracije AMH u žena iznad 30 godina u usporedbi sa skupinom mlađih, iako razlika nije bila statistički značajna (p=0,0693). Također, prosječne koncentracije AMH u folikularnoj fazi i ovulaciji nisu bile statistički značajno različite (p=0,3124). Preliminarni rezultati ovoga istraživanja, iako na ograničenom broju ispitanica, podupiru dijagnostičku važnost AMH kao osjetljivog biljega u procjeni ovarijske rezerve

Nemjerljiva razina serumskog anti-müllerova hormona u žene sa sindromom hiperstimulacije jajnika tijekom in vitro fertilizacije i uspješan ishod trudnoće: prikaz slučaja

We report a unique case of undetectable serum levels of anti-müllerian hormone (AMH) in women with polycystic ovary syndrome (PCOS) who developed ovarian hyperstimulation syndrome (OHSS) during in vitro fertilization (IVF). A case is described of a 28-year-old woman with clinical symptoms of PCOS and AMH serum level below analytical sensitivity (<1.0 pmol/L). After undergoing controlled ovarian stimulation, the patient developed OHSS. After follicle aspiration, seven oocytes were recovered. Three of them were used for intracytoplasmic sperm injection (ICSI) and fertilized, but with unsuccessful pregnancy outcome. A successful pregnancy was achieved in the second IVF/ICSI cycle with six oocytes retrieved and three embryos transferred. At 39 weeks of gestation, the patient delivered a healthy baby weighing 3930 g and 50 cm long. In conclusion, although AMH is considered a useful tool in ovarian reserve assessment and in predicting response to controlled ovarian hyperstimulation, the case presented shows that AMH should not be used as an independent ovarian marker.Opisan je jedinstven slučaj nemjerljive serumske razine anti-Müllerova hormona (AMH) u žene sa sindromom policističnih jajnika (PCOS) koja je razvila sindrom hiperstimulacije jajnika (OHSS) tijekom in vitro oplodnje (IVF). Prikazujemo slučaj 28-godišnje žene s kliničkim simptomima PCOS-a i razine AMH u serumu ispod analitičke osjetljivosti (<1,0 pmol/L). Nakon što je prošla kroz kontroliranu stimulaciju jajnika, bolesnica je razvila OHSS. Aspiracijom folikula dobiveno je sedam jajnih stanica. Tri su oplođene metodom intracitoplazmatskog ubrizgavanja spermija (ICSI), ali s neuspješnim ishodom trudnoće. Do trudnoće je došlo u drugom ciklusu IVF/ICSI sa šest oocita i tri prenesena zametka. U 39. tjednu trudnoće žena je rodila zdravo dijete teško 3930 g i dugo 50 cm. U zaključku, iako se AMH smatra korisnim testom u procjeni rezerve jajnika i u predviđanju odgovora na kontroliranu hiperstimulaciju jajnika, ovaj slučaj pokazuje da se AMH ne smije rabiti kao samostalan test procjene rezerve jajnika

CROATIAN GUIDELINES FOR IN VITRO DIAGNOSIS OF IGE MEDIATED HYPERSENSITIVITY

In vitro dijagnostika alergijskih bolesti temelji se na određivanju koncentracije ukupnih i speciičnih IgE antitijela u serumu, koncentraciji IgG antitijela, plazmatske triptaze, eozinoilnog kationskog proteina te testu aktivacije bazoilnih leukocita. Upotreba in vitro dijagnostičkih testova mora biti temeljena na korelaciji anamneze, kliničke slike te in vivo provokativnih testova. Kliničko značenje povišene serumske koncentracije ukupnih IgE antitijela u dijagnostici alergijskih bolesti jest ograničena, budući da se ona susreće i u drugim nealergijskim bolestima. Povišene koncentracije speciičnih IgE protutijela, zajedno s pozitivnom anamnezom, indikativne su za klinički značajnu alergijsku bolest. Preporučena laboratorijska metoda za određivanje koncentracije IgE protutijela u serumu jest luoroenzimimunokemijska metoda. Povišene serumske koncentracije IgG protutijela nemaju dokazanu ulogu u dijagnostici alergije na hranu, a mogu poslužiti u procjeni uspješnosti speciične imunoterapije na alergene kukaca te procjeni rizika razvoja anailaksije uzrokovane ovom skupinom alergena. Povišena koncentracija serumske triptaze (podtip ), indikator je degranulacije mastocita uzrokovane speciičnim alergenom. Porast koncentracije eozinoilnog kationskog proteina (EKP) nastupa tijekom kasne faze alergijske reakcije te se može koristiti u praćenju alergijskih i drugih upalnih stanja u kojima eozinoili imaju glavnu ulogu. Test aktivacije bazoilnih (BAT) leukocita temelji se na određivanju staničnih razlikovnih obilježja, CD 63 i CD203c metodom protočne citometrije. BAT je koristan u dijagnostici alergija na alergene kukaca, nutritivnih te medikamentnih alergija. Alergološka dijagnostika temeljena na ekstraktima alergena može se koristiti u monosenzibiliziranih bolesnika s jasnom kliničkom slikom te u bolesnika kojima se planira prepisati samo simptomatska terapija. U suvremenoj su kliničkoj praksi razvijenih zemalja mnogo češći polisenzibilizirani bolesnici s kompleksnom simptomatologijom te sumnjom na križnu reaktivnost. Kod ovih se bolesnika preporuča koristiti molekularnu alergološku dijagnostiku.In vitro diagnostic procedure in allergology includes determination of serum levels of total and allergen speciic IgE antibodies, allergen speciic IgG antibodies, plasma tryptase, eosinophil cationic protein (ECP) and basophil activation test (BAT). In vitro tests should be used according to clinical history, physical examination, and in vivo methods for allergy testing. Clinical relevance of elevated total IgE in allergy diagnosis is modest, since it can be caused by other conditions. Elevated serum levels of allergen speciic IgE antibodies, together with positive medical history, are indicative of clinically relevant allergy. A recommendedlaboratory method for total and speciic IgE concentration measurement is the sandwich-type luoroimmunoassay ImmunoCAP, considered as an ideal immunoassay. Serum levels of allergen speciic IgG antibodies have no proved clinical relevance in food allergy diagnosis. They can be useful to monitor venom immunotherapy success, as well as to estimate the risk of venom induced anaphylaxis. Elevated plasma tryptase (subtype ) level is an indication of mast cell activation caused by speciic allergen. It should be obtained within 4 hours after an anaphylactic episode. Elevated level of ECP can be detected in patient blood during late phase of allergic reaction. It can be used to monitor patients with chronic allergenic and inlammatory conditions in which eosinophils play a central role. BAT includes measurement of CD 63 (cluster of differentiation) and CD 203 antigens of the molecular surface by low cytometry. It is useful in the diagnosis of venom, food and drug allergy, estimation of severity of allergic disease and natural tolerance to allergens. In vitro tests based on allergen extracts can be used for in vitro diagnosis in monosensitized patients with clear medical history and symptomatic treatment. Molecular allergy diagnosis should be performed in special clinical indications such as diagnosis of cross reactivity, prescription of speciic immunotherapy (especially in polysensitized patients with complex symptoms), diagnosis of idiopathic or cofactor induced anaphylaxis, latex allergy, and assessment of the risk of allergic reaction to speciic allergen

The impact of temporal variability of biochemical markers PAPP-A and free β-hCG on the specificity of the first-trimester Down syndrome screening: a Croatian retrospective study

<p>Abstract</p> <p>Background</p> <p>The variability of maternal serum biochemical markers for Down syndrome, free β-hCG and PAPP-A can have a different impact on false-positive rates between the 10+0 and 13+6 week of gestation. The study population comprised 2883 unaffected, singleton, spontaneously conceived pregnancies in Croatian women, who delivered apparently healthy child at term. Women were separated in 4 groups, dependently on the gestational week when the analyses of biochemical markers were performed. The concentrations of free β-hCG and PAPP-A in maternal serum were determined by solid-phase, enzyme-labeled chemiluminiscent immunometric assay (Siemens Immulite). Concentrations were converted to MoMs, according to centre-specific weighted regression median curves for both markers in unaffected pregnancies. The individual risks for trisomies 21, 18 and 13 were computed by Prisca 4.0 software.</p> <p>Findings</p> <p>There were no significant differences between the sub-groups, regarding maternal age, maternal weight and the proportion of smokers. The difference in log₁₀MoM free β-hCG values, between the 11^thand 12^thgestational week, was significant (p = 0.002). The difference in log₁₀MoM PAPP-A values between the 11^thand 12^th, and between 12^thand 13^thweek of gestation was significant (p = 0.006 and p = 0.003, respectively). False-positive rates of biochemical risk for trisomies were 16.1% before the 11^thweek, 12.8% in week 12^th, 11.9% in week 13^thand 9.9% after week 13^th. The differences were not statistically significant.</p> <p>Conclusions</p> <p>Biochemical markers (log₁₀MoMs) showed gestation related variations in the first-trimester unaffected pregnancies, although the variations could not be attributed either to the inaccuracy of analytical procedures or to the inappropriately settled curves of median values for the first-trimester biochemical markers.</p

Undetectable Serum Levels of Anti-Müllerian Hormone in Women with Ovarian Hyperstimulation Syndrome during In Vitro Fertilization and Successful Pregnancy Outcome: Case Report

We report a unique case of undetectable serum levels of anti-müllerian hormone (AMH) in women with polycystic ovary syndrome (PCOS) who developed ovarian hyperstimulation syndrome (OHSS) during in vitro fertilization (IVF). A case is described of a 28-year-old woman with clinical symptoms of PCOS and AMH serum level below analytical sensitivity (<1.0 pmol/L). After undergoing controlled ovarian stimulation, the patient developed OHSS. After follicle aspiration, seven oocytes were recovered. Three of them were used for intracytoplasmic sperm injection (ICSI) and fertilized, but with unsuccessful pregnancy outcome. A successful pregnancy was achieved in the second IVF/ICSI cycle with six oocytes retrieved and three embryos transferred. At 39 weeks of gestation, the patient delivered a healthy baby weighing 3930 g and 50 cm long. In conclusion, although AMH is considered a useful tool in ovarian reserve assessment and in predicting response to controlled ovarian hyperstimulation, the case presented shows that AMH should not be used as an independent ovarian marker