Assessment of Serum Anti-mullerian Hormone Level, Antral Follicle Count and Age as Indicators of Ovarian Reserve Response in Women Diagnosed with Infertility in Abia State, South Eastern Nigeria

Main Article Content

Ebirien-Agana S. Bartimaeus
Chukwuma E. J. Obi
Felix O. Igwe
Edna O. Nwachuku

Abstract

Aim: This study aimed at assessing serum anti-mullerian hormone level, antral follicle count and age as indicators of ovarian reserve response in women diagnosed with infertilility.

Methodology: Subjects comprised of 200 females: 150 subjects and 50 controls, aged < 20  and up to 49 years, stratified into age < 20 years (control), age 20-29 years  (group 1), age 30-39 years (group 2) and age 40-49 years (group 3). About 5 ml of blood sample for AMH determination was collected on day 2-3 of spontaneous menstrual cycle from all groups and control and serum anti-mullerian hormone analyzed using enzyme linked immunosorbent assay. Baseline transvaginal ultrasound scanning was carried out on the subjects in experimental groups and control on day 2-3 of un-stimulated menstrual cycle for the measurement of antral follicle count, using the 2-dimensional plane.

Results: The means±SEM of serum anti-mullerian hormone by experimental groups was 1602.44 ± 54.42 pg/ml for control, 848.06±23.04 pg/ml for group 1, 26.74±1.28 pg/ml for group 2, while group 3 is 10.37±1.26 pg/ml. The means were significantly different (P<0.0001). The mean±SEM of AFC by experimental groups was control; 7.82±0.14, group 1; 5.46±0.18, 1.78±0.10 for group 2, and 0.70±0.08 for group 3. The means of antral follicle count by experimental groups showed significant difference (p<0.0001). Results showed that anti-mullerian hormone level and antral follicle count decreased significantly (p<0.05) as the age of the subjects increases. Subjects in the control and experimental group 1 showed 100% high anti-mullerian hormone level indicating 100% potential of good ovarian response. The antral follicle count result also indicate that 100% and 75% of the control group and experimental group 1 respectively show good ovarian reserve. The ovarian response and reserve in the subjects decreased substantially as the age of the subjects increased. Positive correlations were also observed between the AMH and AFC across the ages of the population studied.

Conclusion: The study reveals that good ovarian response and reserve in the population is related to the age of the subjects.

Keywords:
Antimullerian hormone, antral follicle count, infertility, age, pregnancy.

Article Details

How to Cite
S. Bartimaeus, E.-A., E. J. Obi, C., O. Igwe, F., & O. Nwachuku, E. (2020). Assessment of Serum Anti-mullerian Hormone Level, Antral Follicle Count and Age as Indicators of Ovarian Reserve Response in Women Diagnosed with Infertility in Abia State, South Eastern Nigeria. Journal of Advances in Medicine and Medical Research, 31(12), 1-11. https://doi.org/10.9734/jammr/2019/v31i1230338
Section
Original Research Article

References

National Guideline Clearinghouse Fertility: Assessment and Treatment for People with Fertility Problems; 2013.
Available:http;//www.rcog.org.uk/womens-health/clinical-guidance/fertility-assessment-and-treatment-people-fertility-problems
(2010; Accessed May, 14)

Menuba IE, Ugwu EO, Obi SN, Lawani LO, Onwuka CI. Clinical management and therapeutic outcome of infertile couples in southeast Nigeria. J Therap Clin Risk Manag. 2014;10:763-68.

Okonofua FE, Obi H. Specialized versus conventional treatment of infertility in Africa, time for a pragmatic approach. Afri J Reprod Health. 2009;13(1):9-15.

Ombelet W, Cooke I, Dyer S, Serour G. Devroey P. Infertility and the provision of infertility medical services in developing countries. Hum Reprod Update. 2008; 14(6):605-21.

Okohue JE, Onuh SO, Ikimalo JI. Comparism of IVF/ICSI outcome in patients with polcystic ovarian syndrome or tubal factor infertility. Niger J Clin Pract. 2013;16(2):207-10.

Omoaregba JO, James BO, Lawani AO, Morakinya O, Olotu OS. Psychosocial characteristics of female infertility in a tertiary health institution in Nigeria. Ann Afri Med. 2011;10(1):19-24.

van Balen F, Bos HM. The social and cultural consequences of being childless in poor-resource countries. F.V. and V Obst Gyn. 2009;1:106-121.

Dyer SJ, Abraham N, Mokoena NE, Lamard CJ, Van Der Spury ZM. Psychological distress among women suffering from couple infertility in South Africa: A quantitative assessment. Hum Reprod. 2005;20:1938-43.

Unuane D, Tournaye H, Velkeniers B, Poppe K. Endocrine disorders and female infertility. Best Pract Rev Clin Endocrin Metab. 2011;25(6):861-73.

Valvekar U, Lakshmi S, Kumar AN. Study of ovarian reserve parameters in infertile women of different age groups. Inter J Reprod Contracept Obst Gyn. 2016;5: 2116- 21.

La Marca A, Grisendi V, Griesinger G. How much does AMH really vary in normal women? Inter J Endocrin. 2013;1-8.
Article ID 959487.

Faddy MJ, Gosden RG. A mathematical model of follicle dynamics in the human ovary. Hum Reprod. 1995;10:770–75.

Check JH, Peymer M, Lurie D. Effect of age on pregnancy outcome without assisted reproductive technology in women with elevated early follicular phase serum follicle-stimulating hormone levels. Gyn Obst Invest. 1998;45:217–20.

Umeora OU, Ejikeme BN, Sunday-Adeoye I, Umeora MC. Sociocultural impediments to male factor infertility evaluation in rural Southeast Nigeria. J Obst Gyn. 2008; 28(3):323-36.

Park HJ, Lee GH, Gong DS, Yoon TK, Lee WS. The meaning of anti-Mullerian hormone levels in patients at a high risk of poor ovarian response. Clin Exp Reprod Med. 2016;43(3):139-45

Chang MY, Chiang CH, Hsieh TI, Soong YK, Hsu KH. Use of antral follicle count to predict the oucome of assisted reproductive technologies. Fertil Steril. 1998;69(3):505-510.

Faddy MJ, Gosden RG, Gougeon A, Richardson SJ, Nelson JF. Accelerated disappearance of ovarian follicles in mid-life: Implications for forecasting meno-pause. Hum Reprod. 1992;7(10):1342– 46.

Van Disseldorp J, Lambalk CB, Kwee J. Comparison of inter- and intra-cycle variability of anti-Mullerian hormone and antral follicle counts. Hum Reprod. 2010; 25:221-27.

Nelson SM, Messow MC, Wallace AM, Fleming R, Mc Connachie A. Nomogram for the decline in serum anti-mullerian hormone: A population study of 9,601 infertility patients. Fertil Steril. 2011;95: 736-41.

De Vet A, Laven JS, De Jong FH, Themmen AP, Fauser BC. Antimullerian hormone serum levels: A putative marker for ovarian aging. Fertil Steril. 2002;77(2): 357-362.

Barbakadze L, Kristesashvili J, Khonelidze N, Tsagareishvili G. The correlations of anti-mullerian hormone, follicle-stimulating hormone and antral follicle count in different age groups of infertile women. Inter J Fertil Steril. 2015;8(4):393-98.

Fleming R, Seifer DB, Frattarelli JL, Ruman J. Assessing ovarian response: Antral follicle count versus anti-Mullerian hormone. J Reprod Med Online. 2015;31: 486-96.

Bancsi LF, Broekmans FJ, Eijkemans MJ, De Jong FH, Habbema JD, Te Velde ER. Predictors of poor ovarian response in in vitro fertilization: A prospective study comparing basal markers of ovarian reserve. Fertil Steril. 2002;77:328-36.

American Society for Reproductive Medicine. Third-party reproduction (sperm, egg and embryo donation and surrogacy): A guide for patients.
(Accessed May 31, 2016)

Jamil, Z, Fatima SS, Ahmed K, Malik R. Anti mullerain hormone above and beyond conventional ovarian reserve markers. Disease Markers, Hindawi Publishing Corporation. 2016;1-9.

Islam Y, Aboulghar MM, AlEbrashy EA, Abdel-Aziz O. The value of different ovarian tests in the prediction of ovarian response in patients with unexplained infertility. Middle East Fertil Soc J. 2016; 21:69-74.

Nardo LG. Gelbaya TA, Wilkinson H, Roberts S.A, Yates A, Pemberton P. Circulating basal anti-mullerian hormone levels as predictor of ovarian response in women undergoing ovarian stimulation for In vitro fertilization. Fertil Steril. 2009;92: 1586-93.

Broer SL, Mol BW, Hendriks D, Broekmans FJ. The role of anti-mullerian hormone in prediction of outcome after IVF: Comparison with the antral follicle count. Fertil Steril. 2009;91:705-14.