Whatever its variability, AMH remains the most stable hormonal predictor

To the Editor:

Dr. Hadlow and colleagues argue that antimüllerian hormone (AMH) levels decrease in the luteal phase and that the hormone should be measured in the follicular phase, since this variability may lead to misprediction of ovarian response in IVF. This assumption was made on the basis of few, not frequent, blood samples performed on a very limited sample of women (1).

In the study, the intra-individual variability of AMH was found to be similar to that of FSH. This finding is really surprising and points out a critical revision of the results obtained. Both of the largest available studies to date (2, 3) reported that 89% of the variation in AMH was due to between-subjects variation, while only 11% was due to true individual fluctuations. AMH may exhibit some variability, but the important point is that the fluctuations are randomly distributed throughout the menstrual cycle (4), raising the possibility that a fixed day for its measurement, as proposed, would be useless. The suggested cyclic moifications of AMH in Dr. Hadlow’s study need to be confirmed in studies investigating hormonal variability through more frequent samples and across at least two menstrual cycles. A logical and agreeable hypothesis explaining why AMH should reduce in the luteal phase needed to be formulated by the authors. If AMH is produced by antral follicles, the number of which shows no significant reduction in the luteal phase, and since AMH seems to be only marginally influenced by gonadotropins, why should its concentration reduce in the second part of the cycle?

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Laparoscopic excision of endometriomas and ovarian reserve

To the Editor:

We read with great interest the article by Celik et al. (1) about the reduction of ovarian reserve in patients submitted to laparoscopic ovarian endometrioma excision. The topic of endometriosis and ovarian reserve is extremely interesting and has been extensively debated in the literature. Our group was the first to report a reduction of AMH levels in patients with endometriosis (2), and others have shown also a significant reduction of ovarian reserve after surgery in this group of patients (3). However, what caught our attention in this paper was the finding that after endometrioma excision, patients presented significantly lower levels of AMH while a significantly higher number of antral follicles was observed.

AMH and Repetitive Oocyte Donation

To the Editor:

The data that Bukulmez et al. present on increases in AMH with each oocyte donation cycle (Figure 2) is unexpected and provocative (1). The increase appeared to be most pronounced when donation cycles occurred in rapid succession, as demonstrated most convincingly in Group 6. The increase could be due to FSH stimulation of preantral and early antral follicles, the follicular stages that produce the most AMH (2).

The impact on ovarian reserve after laparoscopic ovarian cystectomy

To the Editor:

The importance of ovarian preservation in patients with infertility related endometriosis has long been debated (1). Endometriomas do impair fertility and studies have demonstrated improved IVF outcomes after ovarian cystectomy and treatment of endometriosis in matched controlled studies (2). The article by Tsolakidis et al. (1) deserves praise for several points and also raises some concern, as others may use this information as a guide in the treatment of their patients with endometriomas.

Ongoing pregnancy after hMG stimulation and timed intercourse in a 40-year-old woman with undetectable AMH levels

To the Editor:

We read with interest the reports of Fraisse et al. (2008) (1) and Tocci et al. (2009) (2) published in Fertility Sterility on a total of three cases of pregnancies despite undetectable serum anti-muellerian hormone (AMH) levels. Herein we report a similar case, which we would like to bring to the attention of our colleagues.

Is “restoration of ovarian function or ovarian reserve” possible after ovarian surgery?

We read the prospective study by Chang et al. (1) regarding the effect of ovarian surgery on ovarian reserve with great interest. The authors reported the impact of laparoscopic cystectomy on ovarian reserve in 20 ovarian cysts including endometrioma, mature teratoma and mucinous cystadenoma.

Serum antimüllerian hormone (AMH), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels in women with polycystic ovary syndrome (PCOS).

To the Editor:

We have read with great interest the study by Singer et al. (1) and we would like to comment on the relationship between anti-müllerian hormone (AMH), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels in polycystic ovary syndrome (PCOS).