Anti-mullerian hormone as a marker of ovrian reserve in females under prolonged hemodialysis

الملخص EN

Background : Chronic anovulation is a common problem in women with systemic diseases due to the loss of normal function of the hypothalamic-pituitary-ovarian axis.

Disturbances of ovarian function occur frequently in women with end-stage renal failure, leading to amenorrhea and infertility.

Pregnancy might rarely occur in chronic renal failure.

The aim of this study was to evaluate the anti-mulleins hormone (AMH) as a marker of ovarian reserve in females under prolonged hemodialysis in relation to other biomarkers.

Subjects And Methods : A total of 26 women with chronic end stage renal failure (under prolonged hemodialysis) were selected from Al-Haram Health Insurance Hemodialysis Units at Giza, Egypt and a control group of 13 women matched with same age were selected from International Islamic Center for Population Studies and Researches, ART Unit, Al-Azhar University during the period from June 2006-Feb 2008.

For all subjects, serum AMH levels were measured using enzyme-linked immunosorbent assay (ELISA).

In these two groups, number of natural follicles counts (AFC), and basal FSH, LH, prolactin, and estradiol (E2) levels were also measured. RESULTS : The mean value of serum prolactin was in the normal range and had no significant difference in both groups (P>0.05).

The mean value of serum cretonne in the study group was 9.05 + 1.67 mg / dl vs.

0.88 + 0.17 mg / dl in the control group hinting to a highly significant statistical difference (P<0.001).

The mean value of serum FSH in the study group was 11.47 ± 3.81 mlU / ml vs.

6.08 ± 1.35 mlU / ml in the control group with a highly significant statistical difference (P<0.001).

As regard basal serum LH, the mean value in the study group was 5.87 ± 2.13 mlU / ml vs.

4.67 ± 1.41 mlU / ml in the control group where the difference was significant (P<0.05).

The mean value of basal serum E2 was 31.04 ± 4.69 pg / ml in the study group and 54.92 ± 25.07pg / ml in the control group respectively with highly significant statistical difference (p<0.001).

The mean value of serum AMH was 1.43 ± 1.85 ng / ml in the study group vs.

0.69 ± 0.23 ng / ml in the control group where the difference was significant between the two groups (p<0.05).

AFC showed a mean value of 1.31 ± 0.74 in the study group vs.

9.15 ± 69 in the control group and the difference between the two groups was highly significant (p<0.001).

Serum AMH showed a significant positive correlation with serum FSH (r=0.658; p<0.001), serum LH (r=0.587; p<0.001) and serum prolactin (r=0.617; p<0.001).

There was also a significant negative correlation between serum 1; AMH and both serum E2 and AF C (r=-0.675 ; p<0.001 and r=-0.631; p<0.001 respectively) CONCLUSION: Each hormonal biomarker has its benefits.

There will always be a combination of markers used to get the best answer.

The best candidate for a single non I invasive biomarker for detecting ovarian reserve especially in prolonged hemodialysis patients and because it can be measured any time is AMH.