ABSTRACT
Conclusions on the effect of metformin on circulating anti-Müllerian hormone (AMH) levels in women with polycystic ovary syndrome (PCOS) are ambiguous. We performed a secondary analysis of a randomized, double-blind, placebo-controlled cross-over trial. Fifty-six women with hyperandrogenemic PCOS were included. Each woman served as her own control receiving a daily dose of either 1700 mg metformin or placebo for 6 months. After a 3-month wash-out period they received the opposite treatment. The decrease in AMH from a median of 49.5 to 46.9 pmol/L after 6 months on metformin was overall not significant (p = 0.81), nor were changes in obese women (from 49.5 to 38.2 pmol/L; p = 0.53). Comparing individual metformin/placebo AMH values, a small absolute decrease of 9.3 pmol/L (p = 0.03) was observed in obese women after 6 months relative to baseline, suggesting a trend towards decreasing values after metformin treatment, mainly in obese women.
Subject(s)
Anti-Mullerian Hormone/blood , Hyperandrogenism/blood , Hypoglycemic Agents/therapeutic use , Metformin/therapeutic use , Obesity/blood , Polycystic Ovary Syndrome/blood , Adolescent , Adult , Body Mass Index , Cohort Studies , Cross-Over Studies , Double-Blind Method , Female , Humans , Hyperandrogenism/complications , Hyperandrogenism/drug therapy , Middle Aged , Obesity/complications , Polycystic Ovary Syndrome/complications , Polycystic Ovary Syndrome/drug therapy , Young AdultABSTRACT
Anti-Müllerian hormone (AMH) is produced by the growing follicles in the ovaries. The number of follicles in this pool is proportional to the number of primordial follicles in the resting pool (the "ovarian reserve"), thus AMH is believed to be a surrogate marker of the ovarian reserve. AMH is a useful adjunct in the evaluation of a woman's "reproductive age", being an important parameter in counselling for reproduction. AMH is also used in pretreatment evaluation of infertile patients guiding proper hormone stimulation. Furthermore, AMH can be used as a tumour marker for granulose cell tumours.
Subject(s)
Anti-Mullerian Hormone/blood , Ovarian Reserve/physiology , Anti-Mullerian Hormone/physiology , Biomarkers/blood , Biomarkers/metabolism , Biomarkers, Tumor/blood , Biomarkers, Tumor/metabolism , Female , Humans , MaleABSTRACT
OBJECTIVE: To determine the influence of type 1 diabetes mellitus (T1DM) on the first trimester serum markers of fetal aneuploidy; pregnancy-associated plasma protein-A (PAPP-A) and free beta subunit of human chorionic gonadotropin (free ß-hCG) and to evaluate the influence of glycemic control on these parameters in the pregnant diabetic women. DESIGN: Retrospective study. SETTING: Data were extracted from electronic obstetric and laboratory databases at two Danish University Hospitals. POPULATION: Based on 36 415 pregnancies without T1DM (non-T1DM) and 331 pregnancies with T1DM; ß-hCG and PAPP-A were obtained at 8+0 to 14+2 gestational weeks. METHODS: Medians for PAPP-A and free ß-hCG were generated and multiple of the normal gestation-specific median (MoM) values were calculated for each separate pregnancy. After adjustment for maternal weight, ethnicity and smoking status, MoM values were compared across the T1DM and non-T1DM groups, respectively. Additionally, the relationship between PAPP-A MoM and HgbA1C was examined in 348 T1DM pregnancies by Spearman's rank correlation. MAIN OUTCOME MEASURES. Difference in biochemical marker levels between T1DM and non-T1DM. RESULTS: PAPP-A was 0.86 MoM in T1DM pregnancies and 1.01 MoM in non-T1DM pregnancies, p < 0.0001. Conversely, free ß-hCG was not altered in T1DM pregnancies (T1DM 0.99 MoM, non-T1DM 0.98 MoM; p=0.14). There was a significant inverse correlation between HgbA1C and PAPP-A (rho=-0.12, p=0.02). CONCLUSIONS: In T1DM pregnancies, PAPP-A MoM values were lower than in non-T1DM pregnancies. This suggests that correction should be considered in first trimester biochemical screening for fetal aneuploidy in T1DM women.
Subject(s)
Aneuploidy , Chorionic Gonadotropin, beta Subunit, Human/blood , Chromosome Disorders/diagnosis , Diabetes Mellitus, Type 1/blood , Pregnancy in Diabetics/blood , Pregnancy-Associated Plasma Protein-A/metabolism , Prenatal Diagnosis , Adult , Biomarkers/blood , Case-Control Studies , Chromosome Disorders/blood , Female , Fetal Diseases/diagnosis , Glycated Hemoglobin/metabolism , Humans , Pregnancy , Retrospective StudiesABSTRACT
The objective was to examine the applicability of the two biochemical markers PAPP-A and free beta-hCG for fetal trisomy 21 (T21) in very early pregnancy: gestational weeks (GA) 6 and 7. Medians for the two markers were generated on 36,745 fetal T21 unaffected pregnancies from gestational weeks 6-14. Concentrations were converted to Multiples of the Medians (MoMs). Median MoM from T21 affected pregnancies were compared over three intervals of gestational age; the very early weeks 6 and 7, weeks 8-10 and weeks 11-14. Median MoM from 9 affected pregnancies with a very early blood sample had a PAPP-A median MoM of 0.269, compared to 0.392 in weeks 8-10 and 0.531 in weeks 11-14. On the contrary, free beta-hCG diverged from the median with increasing gestational age. Our data suggest that PAPP-A is a useful marker for very early testing in first trimester screening for fetal T21.
