Hormona antimülleriana (AMH) como herramienta diagnóstica en la mujer

La hormona antimülleriana (AMH) es producida por el testículo fetal e infantil en altas cantidades y por el testículo adulto y el ovario, en cantidades más moderadas. En el ovario, la expresión de la AMH se limita a las células de la granulosa de los folículos primarios, secundarios y antrales; los folículos preantrales y antrales pequeños son los principales productores. Los niveles de AMH persisten relativamente estables durante la infancia y la pubertad, y disminuyen progresivamente en la cuarta y quinta décadas de la vida hasta hacerse indetectables aproximadamente 5 años antes del último ciclo menstrual. Así, la determinación de AMH sérica es una herramienta útil para valorar la masa de células foliculares: los niveles bajos o indetectables de AMH reflejan una escasa o nula reserva folicular (por ejemplo: insuficiencia ovárica primaria congénita o adquirida), en tanto que los niveles elevados indican un exceso de folículos pequeños (por ejemplo: síndrome de ovario poliquístico y tumores de la granulosa). La determinación de la AMH se ha transformado en un marcador esencial en la evaluación de pacientes que recurren a técnicas de reproducción asistida, ya que permite estimar las probabilidades de éxito y también decidir el protocolo de estimulación por utilizar de modo de evitar el riesgo de una hiperestimulación ovárica.Anti-müllerian hormone (AMH) is synthesized by the fetal and prepubertal testis in high levels, and by the adult testis and the ovary in lower levels. In the ovary, AMH expression is limited to granulosa cells of primary, secondary and antral follicles; preantral and small antral follicles are the main AMH source. In the female, serum AMH levels are relatively stable during childhood and puberty, and subsequently decrease in the fourth and fifth decades of life to become undetectable approximately 5 years prior to the last menstrual cycle. Serum AMH is a useful tool to assess the amount of granulosa cells present in the gonads: low or undetectable AMH indicates a poor or absent ovarian reserve (for instance, in primary ovarian insufficiency), whereas high AMH levels are indicative of excessive follicles (for instance, in the polycystic ovary syndrome and granulosa cell tumors). Serum AMH determination has thus become an essential marker in the assessment of patients undergoing assisted reproduction technology treatments, since it allows to estimate the success rate as well as to decide the most adequate stimulation protocol in order to avoid an ovary hyperstimulation syndrome. Key words: anti-müllerian hormone, granulose cells, folicular reserve, primary ovarian insufficiency, polycystic ovary syndromeFil: Rey, Rodolfo Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Bedecarraz, Patricia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas; ArgentinaFil: Brugo Olmedo, Santiago. Centro Médico Seremas; ArgentinaFil: de Vincentiis, Sabrina. Centro Médico Seremas; ArgentinaFil: Calamera, Patricio. Centro Médico Seremas; ArgentinaFil: Blanco, Ana María. Centro de Estudios Bioquímicos, Andrológicos y Ginecológicos; ArgentinaFil: Grinspon, Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas; ArgentinaFil: Freire, Analía. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas; ArgentinaFil: Buffone, Mariano Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental (i); Argentina. Centro Médico Seremas; Argentin

Use of metaphase I oocytes matured in vitro is associated with embryo multinucleation

Objective: To evaluate the impact of oocyte maturational stage at retrieval on embryo multinucleation. Design: Retrospective study. Setting: Private institution for assisted reproduction. Patient(s): A total of 412 patients undergoing 500 intracytoplasmic sperm injection (ICSI) cycles between August 2006 and September 2010. Intervention(s): Routine ICSI laboratory procedures. Main Outcome Measure(s): Normal and abnormal fertilization; embryo development; arrest at pronuclear stage; failure to undergo first mitotic division; presence of embryo multinucleation; embryo quality; pregnancy, implantation, and miscarriage rates. Result(s): A significantly lower percentage of multinucleation was found in embryos originating from metaphase II (MII) oocytes when compared with MI–II- and MI-derived oocytes. Significantly fewer multinucleated cells per embryo were observed in MII-derived oocytes. Clinical pregnancy and implantation rates were significantly higher when only embryos derived from MII oocytes were transferred. Conclusion(s): Embryo multinucleation rate increases when in vitro–matured (2–5 hours incubation) MI (MI–II) oocytes are used instead of in vivo–matured oocytes in ICSI. Furthermore, all other ICSI outcome parameters are also compromised. The use of donated gametes does not modify these results. (Fertil Steril! 2013;99:414–21. "2013 by American Society for Reproductive Medicine.)Fil: de Vincentiis, Sabrina. Centro Médico Seremas; ArgentinaFil: de Martino, Evelyn. Centro Médico Seremas; ArgentinaFil: Buffone, Mariano Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Brugo Olmedo, Santiago. Centro Médico Seremas; Argentin

Effect of thawing temperature on the motility recovery of cryopreserved human spermatozoa

Objective To investigate the effects of thawing temperature on sperm function after cryopreservation. The technical aspects of sperm cryopreservation have significantly improved over the last few decades. However, a standard protocol designed to optimize sperm motility recovery after thawing has not yet been established. Design Prospective study. Setting Private infertility institute and university-based research laboratory. Patient(s) Eighty consenting normozoospermic patients consulting for infertility. Intervention(s) Spermatozoa from donor semen samples were thawed at different temperatures. Main Outcome Measure(s) Sperm motility, viability, adenosine-5'-triphosphate (ATP) content, acrosomal status, and DNA integrity were evaluated as a function of thawing temperature in cryopreserved human sperm samples. Result(s) Thawing at 40°C resulted in a statistically significant increase in sperm motility recovery compared with thawing at temperatures between 20°C and 37°C. There were no statistically significant differences in sperm viability, acrosomal status, ATP content, and DNA integrity after thawing at 40°C compared with thawing at temperatures between 20°C and 37°C. Conclusion(s) Sperm thawing at 40°C could be safely used to improve motility recovery after sperm cryopreservation.Fil: Calamera, Juan C.. Laboratorio de Estudios de la Reproducción LER; ArgentinaFil: Buffone, Mariano Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental (i); Argentina; Argentina. University of Pennsylvania; Estados UnidosFil: Doncel, Gustavo F.. Eastern Virginia Medical School. Jones Institute For Reproductive Medicine; Estados UnidosFil: Brugo Olmedo, Santiago. Centro Médico Seremas; ArgentinaFil: de Vincentiis, Sabrina. Centro Médico Seremas; ArgentinaFil: Calamera, Maria M.. Laboratorio de Estudios de la Reproducción LER; ArgentinaFil: Storey, Bayard T.. University of Pennsylvania; Estados UnidosFil: Alvarez, Juan G.. Instituto Marques; España. Fundación Leonardo Marques; Españ

Absolute risk (risk rate) of good response to ovarian stimulation, defined as ≥ 5 oocytes retrieved at the time of aspiration, as a function of AMH levels.

<p>Patients were grouped according to age or FSH levels. Rates are shown for serum AMH at 3, 6, 9, 12 and 15 pmol/L (equivalences for AMH in ng/mL are given at the bottom of the figure). Dotted lines represent the 95% confidence interval.</p

Absolute risk (risk rate) of cancelled cycles as a function of AMH levels.

<p>Patients were grouped according to age or FSH levels. Rates are shown for serum AMH at 3, 6, 9, 12 and 15 pmol/L (equivalences for AMH in ng/mL are given below the X axis of each graph). Dotted lines represent the 95% confidence interval.</p