服用避孕藥一段時間後，AMH與FSH數值會下降

服用避孕藥一段時間後，基礎AMH與FSH數值會下降
AMH由卵子顆粒細胞granulosa cell製造

http://humrep.oxfordjournals.org/content/22/12/3192.full

Serum anti-müllerian hormone levels and follicular cohort characteristics after pituitary suppression in the late luteal phase with oral contraceptive pills

1. E. Arbo1, 
2. D.V. Vetori, 
3. M.F. Jimenez, 
4. F.M. Freitas, 
5. N. Lemos and
6. J.S. Cunha-Filho

+Author Affiliations

1. Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul Serviço de Ginecologia e Obstetrícia Rua Ramiro Barcelos, 2350, Sala 1126 Porto Alegre, RS 90035-003, Brazil

1. 1Correspondence address. Tel: +55-51-2101-8117; E-mail: elisarbo@bol.com.br

• Received March 12, 2007.
• Revision received June 2, 2007.
• Accepted July 11, 2007.

 

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Abstract

BACKGROUND Anti-mullerian hormone (AMH) is a marker of ovarian function and reserve and reflects the number and size of antral follicles. The objective of this study was to evaluate the effect of FSH suppression on AMH levels, during the late luteal phase of human menstrual cycle, with the use of oral contraceptives pills (OCP).

METHODS Twenty normovulatory infertile women were included in the study. On the third day of a spontaneous menstrual cycle, the patients were submitted to a transvaginal ultrasound examination and blood sample collection. From the 20th day of this menstrual cycle, the patients took daily OCP, containing 0.030 mg of ethinyl-estradiol plus 0.15 mg of desogestrel. On the third day of the following cycle, the measurements were repeated.

RESULTS After OCP use, the levels of FSH and estradiol were significantly reduced (P < 0.001). The number of antral follicles measured on both occasions did not differ, although after OCP use, the follicles presented significantly lower diameters (mean 4.4 + 1.7 mm before OCP versus 3.5 + 1.2 mm after OCP P < 0.001). The levels of AMH were significantly reduced after pituitary suppression, with a median (inter-quartile range) of 3.02 ng/mL (1.21–6.39) before OCP and 2.22 ng/mL (0.9–3.11) after OCP, P = 0.04.

CONCLUSIONS The short administration of OCP in late luteal phase caused suppression of FSH secretion during the cycle transition, leading to a more homogeneous follicular cohort. The lower AMH levels observed, although simultaneous with FSH suppression, were probably not a direct effect of the reduced FSH levels, but were more likely a consequence of the lower production by the arrested follicular cohort.

Figure 1:

Per follicle levels of AMH (AMH/number of follicles) at the third day of a spontaneous menstrual cycle and after inter-cycle FSH inhibition with the use of luteal OCP. Central horizontal lines indicate the median; additional horizontal lines represent the 10th, 25th, 75th and the 90th centiles

Figure 2:

Individual AMH (A), FSH (B) and estradiol serum levels (C) before (1) and after (2) use of OCP in the late luteal phase to pituitary down-regulation

Table I.

Hormonal and follicular measures in a spontaneous menstrual cycle and after intercycle FSH inhibition with the use of OCP in the late luteal phase.

	Third day of a spontaneous cycle	Third day of a cycle after OCP use in luteal phase	P	Δ%
FSH (um/mL)	5.47 (4.81–9.24)	1.99 (0.97–2.33)	0.001	−68.29
Estradiol (pg/mL)	36.17 (26.81–47.6)	8.98 (6.04–16.1)	0.001	−69.09
AMH (ng/mL)	3.02 (1.21–6.4)	2.22 (0.9–3.11)	0.04	−15.44
Number of antral follicles	15.8 ± 4.7	16.6 ± 3.6	0.44	11.60
Number of antral follicles with 2–4 mm	7.9 ± 4.3	12.8 ± 4.7	0.001	63.62
Mean follicular diameter (mm)	4.4 ± 1.7	3.5 ± 1.2	<0.001	−20.44

• Data are displayed as median (inter-quartile range) or mean ± SD. Δ% represents the mean percentual variation after late luteal phase OCP administration.