Non-equivalence of anti-Müllerian hormone automated assays—clinical implications for use as a companion diagnostic for individualised gonadotrophin dosing

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A Validated Model of Serum Anti-Müllerian Hormone from Conception to Menopause

Background Anti-Müllerian hormone (AMH) is a product of growing ovarian follicles. The concentration of AMH in blood may also reflect the non-growing follicle (NGF) population, i.e. the ovarian reserve, and be of value in predicting reproductive lifespan. A full description of AMH production up to the menopause has not been previously reported. Methodology/Principal Findings By searching the published literature for AMH concentrations in healthy pre-menopausal females, and using our own data (combined ) we have generated and robustly validated the first model of AMH concentration from conception to menopause. This model shows that 34% of the variation in AMH is due to age alone. We have shown that AMH peaks at age 24.5 years, followed by a decline to the menopause. We have also shown that there is a neonatal peak and a potential pre-pubertal peak. Our model allows us to generate normative data at all ages. Conclusions/Significance These data highlight key inflection points in ovarian follicle dynamics. This first validated model of circulating AMH in healthy females describes a transition period in early adulthood, after which AMH reflects the progressive loss of the NGF pool. The existence of a neonatal increase in gonadal activity is confirmed for females. An improved understanding of the relationship between circulating AMH and age will lead to more accurate assessment of ovarian reserve for the individual woman.Publisher PDFPeer reviewe

Biological versus chronological ovarian age:implications for assisted reproductive technology

<p>Abstract</p> <p>Background</p> <p>Women have been able to delay childbearing since effective contraception became available in the 1960s. However, fertility decreases with increasing maternal age. A slow but steady decrease in fertility is observed in women aged between 30 and 35 years, which is followed by an accelerated decline among women aged over 35 years. A combination of delayed childbearing and reduced fecundity with increasing age has resulted in an increased number and proportion of women of greater than or equal to 35 years of age seeking assisted reproductive technology (ART) treatment.</p> <p>Methods</p> <p>Literature searches supplemented with the authors' knowledge.</p> <p>Results</p> <p>Despite major advances in medical technology, there is currently no ART treatment strategy that can fully compensate for the natural decline in fertility with increasing female age. Although chronological age is the most important predictor of ovarian response to follicle-stimulating hormone, the rate of reproductive ageing and ovarian sensitivity to gonadotrophins varies considerably among individuals. Both environmental and genetic factors contribute to depletion of the ovarian oocyte pool and reduction in oocyte quality. Thus, biological and chronological ovarian age are not always equivalent. Furthermore, biological age is more important than chronological age in predicting the outcome of ART. As older patients present increasingly for ART treatment, it will become more important to critically assess prognosis, counsel appropriately and optimize treatment strategies. Several genetic markers and biomarkers (such as anti-Müllerian hormone and the antral follicle count) are emerging that can identify women with accelerated biological ovarian ageing. Potential strategies for improving ovarian response include the use of luteinizing hormone (LH) and growth hormone (GH). When endogenous LH levels are heavily suppressed by gonadotrophin-releasing hormone analogues, LH supplementation may help to optimize treatment outcomes for women with biologically older ovaries. Exogenous GH may improve oocyte development and counteract the age-related decline of oocyte quality. The effects of GH may be mediated by insulin-like growth factor-I, which works synergistically with follicle-stimulating hormone on granulosa and theca cells.</p> <p>Conclusion</p> <p>Patients with biologically older ovaries may benefit from a tailored approach based on individual patient characteristics. Among the most promising adjuvant therapies for improving ART outcomes in women of advanced reproductive age are the administration of exogenous LH or GH.</p

De mercader a vitivinicultor: Alianzas y herencia de un portugués en San Juan de la Frontera (1727-1820)

Una larga trayectoria vitivinícola ha sustentado la economía de la ciudad de San Juan desde tiempos coloniales. Las élites locales consolidaron sus fortunas sobre la base de esta actividad dominante, que en el transcurso del siglo XVIII promovió la diversificación y especialización de funciones entre viñateros, bodegueros y trasladistas. En este artículo, desde la perspectiva de la historia de la familia, en un sentido dinámico como es el que le confieren las redes de parentesco, se analiza la participación de sus miembros y el sistema de prácticas sucesorias a través de un caso particular como es el de Alvarez Cortiñas. En el lapso de una centuria es posible observar la articulación de los actores involucrados y los mecanismos de reproducción social, partición del patrimonio y los consiguientes desmembramientos de la explotación. El trabajo se apoya básicamente en testamentarias, escrituraciones de ventas de propiedades, capellanías e inventarios recopilados en la Sección Tribunales del Archivo General de la Provincia de San Juan y de la Corte de JusticiaA long trajectory vitivinícola has sustained the economy of the San Juan city from colonial time. The local elites consolidated their fortunes on the base of this dominant activity that promoted the diversification and specialization of functions among viñateros, grocers and trasladistas in the course of the XVIII century. In this article, from the perspective of the history of the family, in a dynamic sense as it is the one that confer him the relationship nets, it is analyzed the participation of their members and the system of practical successoral through a particular case as it is that of the Alvarez Cortiñas. In an a hundred year-old lapse it is possible to observe the articulation of the involved actors and the practices of social reproduction, partition of the patrimony and the consequent desmembramientos of the exploitation. The work leans on basically in probate, escrituraciones of sales of estates, haplaincies and inventories gathered in the Section Tribunals of the General Archive of San Juan's Province and of the Court of Justic