Uloga anti-Müllerovog hormona u predviđanju ishoda liječenja metodama pomognute oplodnje

master's thesis

• Title (english): The role of anti-Müllerian hormone in predicting assisted reproductive technology outcomes
• Author: Lana Kavur
• Mentor: Dinka Pavičić Baldani (mentor)
• Committee member: Lana Škrgatić (predsjednik povjerenstva)
• Committee member: Željko Duić (član povjerenstva)
• Committee member: Dinka Pavičić Baldani (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Anti-Müllerov hormon (AMH) proizvodi se u granuloza stanicama rastućih folikula u jajniku. Njegova koncentracije mjerena u serumu visoko korelira s brojem antralnih folikula (AFC) i predstavlja pouzdan biomarker pričuve jajnika. Prednost u odnosu na druge markere ovarijske rezerve mu je visoka reproducibilnost zbog male varijacije između i unutar menstrualnih ciklusa. Odličan je prediktor kvantitativnog odgovora jajnika na kontroliranu ovarijsku stimulaciju (COS) u liječenju metodama pomognute oplodnje (MPO). Predviđa mogućnost slabog odgovora jajnika, ali i rizika razvoja ovarijskog hiperstimulacijskog sindroma (OHSS). Glavna klinička primjena mu je optimizacija odgovora jajnika u COS-u i smanjenje rizika nastanka OHSS, odabirom prikladnih stimulacijskih protokola i doze gonadotropina. Iako odlično procjenjuje prinos oocita , AMH se smatra slabim prediktorom stopa kliničkih trudnoća kao i stopa živorođene djece. Dokazi o mogućnosti predviđanja kvalitete oocite, kvalitete embrija te stope gubitka trudnoće su ograničeni. Ipak, zamijećena je korelacija AMH mjerenog u folikularnoj tekućini s nekim kvalitativnim ishodima liječenja MPO-om. Također, AMH bi mogao biti i i indirektni prediktor nastupa preuranjene menopauze u rizičnih pacijentica. Sve veći klinički značaj ovog hormona pridonio je razvoju brojnih imunoeseja za određivanje njegove koncentracije. Do sada je usporedba vrijednosti AMH mjerenih različitim imunoesejima predstavljala problem zbog velikih varijacija u rezultatima, ali rješenje nude novi automatizirani imunoeseji. Serumski AMH danas je zlatni standard u određivanju ovarijske rezerve. U budućnosti je važno dodatno istražiti korisnost AMH u individualizaciji stimulacijskih protokola i razviti točne prediktivne modele. Također je važno raditi na uspostavi međunarodnog standarda u njegovom mjerenju te istražiti dodatne čimbenike koji utječu na serumsku koncentraciju AMH kako bi se poboljšalo tumačenje vrijednosti ovog hormona u kliničkoj primjeni.

Abstract (english)

Anti-Müllerian hormone (AMH) is produced by the granulosa cells of the growing follicles in the ovary. Serum AMH highly correlates with the antral follicle count (AFC) and represents a reliable biomarker of ovarian reserve (OR). The advantage of AMH over other markers of the ovarian reserve lies in its high reproducibility due to the small variations in concentration between and within menstrual cycles. It is an excellent predictor of quantitative ovarian response to controlled ovarian stimulation (COS) protocols used in assisted reproductive technology (ART). AMH predicts the possibility of poor ovarian response, as well as the risk of ovarian hyperstimulation syndrome. Its main clinical application is to optimize ovarian response in COS and reduce hyperstimulation risks by aiding the selection of appropriate stimulation protocols and gonadotropin doses. Although it is a great predictor of oocyte yield, AMH has a weak predictive utility regarding clinical pregnancy and live birth rates. There is also limited evidence of predicting oocyte quality, embryo quality and miscarriage rates. However, a correlation of follicular fluid AMH with some qualitative ART outcomes has been observed. AMH could also be an indirect predictor of premature menopause onset in patients at risk. The growing importance of this hormone in clinical practice contributed to the development of numerous AMH immunoassays. So far, the comparison of AMH values measured by different immunoassays has been a problem due to large variations in results. However, a solution is offered with new automated immunoassays being developed. AMH is the marker of choice in assessing ovarian reserve. In the future, its utility in the individualization of stimulation protocols could be further explored and more accurate prediction models could be developed. It is important to work on establishing an international AMH measuring standard and investigate additional factors influencing its serum concentration in order to improve the interpretation of AMH values in clinical application.

• Keywords: anti-Müllerov hormon; metode pomognute oplodnje; in vitro oplodnja
• Keywords (english): anti-Müllerian hormone; assisted reproductive technology; in vitro fertilization
• Language: croatian
• URN:NBN: urn:nbn:hr:105:108319
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-02-24 10:35:37