Ovarian cortical follicle density in infertile women with low anti-Müllerian hormone

Abstract

Purpose To evaluate the association between anti-Müllerian hormone (AMH) and follicle density in infertile women with diminished ovarian reserve (DOR) versus women with normal ovarian reserve? Methods Case-control study comparing follicle densities in ovarian cortex from 20 infertile women with DOR (AMH ≤ 5 pmol/L) and 100 controls with presumed normal ovarian reserve. Results For all women > 25 years, the follicle densities correlated positively with AMH levels. For each single picomole per liter increase in AMH the follicle density increased by 6% (95% CI 3.3-8.5%) when adjusted for age. This was similar for women with DOR and controls. The follicle density was 1.8 follicles/mm 3 cortical tissue in women with DOR versus 7.0 in age-paired controls (p = 0.04). The women with DOR had a median AMH of 1.8 pmol/L versus 14.4 pmol/L in the age-paired control group (p < 0.001). The ratio of AMH/follicle density was 1:1 (1.8/1.8) in women with DOR and 2:1 (14.4/7.0) in the age-paired controls. Analyses for gonadotropin receptor polymorphisms could not explain the characteristics of women with DOR. The proportion of secondary follicles was higher in women with DOR compared with controls (4.6% versus 1.4%, p = 0.0003). Pooling all patients, the follicle density decreased significantly by 7.7% for every year added (p < 0.0001). The women with DOR had lower follicle densities than the controls, but the slopes were equal in the two cohorts. Conclusions Follicle density and AMH concentrations correlate also when AMH is low. However, AMH is only a reliable marker for the true ovarian reserve when age is included in the estimation and women with DOR may have more follicles than their AMH levels imply.

<p>Therapeutic Effects of Modified Gengnianchun Formula on Stress-Induced Diminished Ovarian Reserve Based on Experimental Approaches and Network Pharmacology</p>

“…A recent study indicates that women with DOR may have more follicles than their AMH levels imply. 44 Even in women with extremely low AMH levels, the probability of pregnancy remains. 45 We observed a significantly decreased serum FSH level and upregulated ovarian FSHR after MGNC treatment under stress conditions.…”

Histological analysis of (antral) follicle density in ovarian cortex tissue attached to stripped endometriomas

“…, as opposed to the current study. When comparing our findings to the follicle density in healthy ovarian tissue (16.3 follicles/mm 3 , n = 100), we observed a significantly lower follicle density [ 31 ]. These results are consistent with the findings from another study that compared follicle density in ovarian cortex tissue biopsies from healthy ovaries to tissue from ovaries affected by endometriomas [ 32 ].…”

Role of Ovarian Volume in Fertile and Infertile Women by Sonography at Swabi

“…It is estimated that at the onset of menarche, ovarian follicles number over 250,000, but only a few hundred to thousands remain by the end of a woman's reproductive age. Ovarian volume assessment is also a valuable screening tool for conditions such as polycystic ovarian syndrome (PCOS) and ovarian cancer (14)(15)(16)(17). Given the context of Swabi, a region with limited advanced medical facilities, the practice of measuring ovarian volume through sonography could be highly beneficial for diagnosing fertility issues.…”