Anti-Müllerian Hormone and Ovarian Morphology in Women With Isolated Hypogonadotropic Hypogonadism/Kallmann Syndrome: Effects of Recombinant Human FSH

Abstract Context: Isolated hypogonadotropic hypogonadism (IHH), characterized by gonadotropin deficiency and absent puberty, is very rare in women. IHH prevents pubertal ovarian stimulation, but anti-Müllerian hormone (AMH) and antral follicle count (AFC) have not been studied. Objectives: (1) To co...

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Published in:The journal of clinical endocrinology and metabolism 2017-04, Vol.102 (4), p.1102-1111
Main Authors: Bry-Gauillard, Hélène, Larrat-Ledoux, Florence, Levaillant, Jean-Marc, Massin, Nathalie, Maione, Luigi, Beau, Isabelle, Binart, Nadine, Chanson, Philippe, Brailly-Tabard, Sylvie, Hall, Janet E., Young, Jacques
Format: Article
Language:English
Subjects:
17β-Estradiol
Adult
Anti-Mullerian Hormone - blood
Case-Control Studies
Female
Fertility
Follicle Stimulating Hormone, Human - pharmacology
Follicle Stimulating Hormone, Human - therapeutic use
Follicle-stimulating hormone
Follicles
Gonadotropins
Hormone Replacement Therapy
Human behavior
Humans
Hypogonadism
Hypogonadism - blood
Hypogonadism - drug therapy
Hypogonadism - pathology
Inhibin
Kallmann Syndrome - blood
Kallmann Syndrome - drug therapy
Kallmann Syndrome - pathology
Kallmann's syndrome
Luteinizing hormone
Luteinizing Hormone - pharmacology
Luteinizing Hormone - therapeutic use
Organ Size - drug effects
Ovary - drug effects
Ovary - pathology
Ovulation Induction - methods
Pituitary (anterior)
Puberty
Recombinant Proteins - pharmacology
Recombinant Proteins - therapeutic use
Sex hormones
Steroid hormones
Steroids
Stimulation
Young Adult
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Summary:Abstract Context: Isolated hypogonadotropic hypogonadism (IHH), characterized by gonadotropin deficiency and absent puberty, is very rare in women. IHH prevents pubertal ovarian stimulation, but anti-Müllerian hormone (AMH) and antral follicle count (AFC) have not been studied. Objectives: (1) To compare, in IHH vs controls, AMH, ovarian volume (OV), and AFC. (2) To compare, in IHH, ovarian responses to recombinant human follicle-stimulating hormone (rhFSH) and rhFSH plus recombinant human luteinizing hormone (rhLH). Subjects: Sixty-eight IHH women; 51 matched healthy women. Methods: Serum LH, FSH, sex steroids, inhibin B (InhB), AMH, and OV and AFC (sonography) were compared. Ovarian response during rhFSH administration was assessed in 12 IHH women with low AMH levels and low AFC and compared with hormonal changes observed in six additional IHH women receiving rhFSH plus rhLH. Results: InhB was lower in IHH than in controls. AMH levels were also significantly lower in the patients, but two-thirds had normal values. Mean OV and total, larger, and smaller AFCs were lower in IHH than in controls. Ovarian stimulation by rhFSH led to a significant increase in serum estradiol and InhB levels and in the number of larger antral follicles. AMH and smaller AFC increased early during rhFSH stimulation but then declined despite continued stimulation. rhFSH plus rhLH stimulation led to a significantly higher increase in estradiol levels but to similar changes in circulating InhB and AMH than with rhFSH alone. Conclusions: IHH women have both low AMH levels and low AFC. However, their decrease can be reversed by follicle-stimulating hormone. Serum AMH and AFC should not serve as prognostic markers of fertility in this population. We measured AMH and AFC in IHH/KS women and studied the effect of FSH. In IHH/KS, AMH and AFC were low, a decrease that can be reversed by FSH. They are not prognostic markers of fertility in IHH/KS.
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.2016-3799