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Hum. Reprod. Advance Access published online on July 25, 2008
Human Reproduction, doi:10.1093/humrep/den282
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Effect of pituitary desensitization on the early growing follicular cohort estimated using anti-Mullerian hormone

K. Jayaprakasan1, B.K. Campbell, J.F. Hopkisson, J.S. Clewes, I.R. Johnson and N.J. Raine-Fenning

Nottingham University Research and Treatment Unit in Reproduction (NURTURE), Academic Division of Reproductive Medicine and Surgery, School of Human Development, Queen's Medical Centre, University of Nottingham, Nottingham, Nottinghamshire NG7 2UH, UK

1 Correspondence address. Tel: +44-115-82-30700; Fax: +44-115-82-30651; E-mail: k.jayaprakasan{at}nottingham.ac.uk or jayaprakasan{at}hotmail.co.uk

BACKGROUND: This study evaluated the effect of pituitary desensitization on the early growing follicle population through assessment of serum anti-Mullerian hormone (AMH) concentration. Other markers of ovarian reserve, basal follicular stimulating hormone (FSH), luteinizing hormone (LH), estradiol, inhibin-B and three-dimensional ultrasound ovarian parameters were also assessed for comparison.

METHODS: One hundred and two subjects aged <40 years with FSH levels <12 IU/l underwent venepuncture and transvaginal ultrasound in the early follicular phase of the menstrual cycle and after 14 days of down-regulation using gonadotrophin releasing hormone (GnRH) agonists. Serum levels of AMH and other markers of ovarian reserve measured during the early follicular phase were compared with those measured following down-regulation.

RESULTS: While AMH levels increased significantly by ~32% (P < 0.01), there was a significant decline of ~40–50% (P < 0.01) in the levels of inhibin-B, FSH, LH and estradiol. Down-regulation treatment was also associated with a decrease (P < 0.01) in mean ovarian volume and in ovarian blood flow, but no difference was seen in the antral follicle count.

CONCLUSIONS: Pituitary desensitization results in a significant increase in AMH levels, which implies that either the secretion of AMH by early growing follicles is enhanced or that the size of this follicle cohort is increased. The number of antral follicles visualized on ultrasound in the early follicular phase and at down-regulation appears unchanged, suggesting that any effect is restricted to the smaller selectable follicles. Our results may explain the enhanced ovarian response to conventional controlled ovarian stimulation and higher pregnancy rates when pretreatment with GnRH-agonists is employed.

Key words: in vitro fertilization/antral follicle count/three-dimensional power Doppler ultrasound/ovarian reserve/down-regulation

Submitted on May 1, 2008; resubmitted on June 17, 2008; accepted on June 24, 2008.


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