Correlation of Hypothalamic Hypogonadism and Serum AMH and ovarian responsiveness

 Relationships between gonadotrophins and AMH ? Is there any correlation-always??

A subgroup of Hypogonadotrophic-Hypogonadism (HH) may exhibit an ultrasound findings similar to polycystic ovaries and a high ovarian response to ovulation induction like  

PCOS.

Relationship between AMH

and endogenous gonadotrophins Gonadotrophin deficiency occurs in a spectrum of conditions with severe

life long absence of LH and FSH in hypogonadotrophic hypogonadism to

acquired suppression of gonadotropin releasing hormone (WHO Group 1

anovulatory infertility disorders). Hypothalamic Hypogonadism (HH) provides a model to explore the relationships between  gonadotrophins and AMH

Surprise 1: A subgroup of hypogonadotrophic patients demonstrated a  so-called multicystic ovaries. We know that Serum anti-Mullerian hormone (AMH) concentrations correlate with the number of pre-antral and small

antral follicles in the ovaries.

AMH is thought to play an important role in both ovarian primordial

follicle recruitment and selection of the dominant follicle

.

Surprise 2: -Studies have shown a positive correlation between AMH and LH concentrations with a negative correlation between AMH and FSH serum levels in a population of PCO patients.

 Surprise 3:-Whether AMH is driving the gonadotropins or visa-versa has not been established.

.

Unanswered Q : Is there any change of   AMH, levels in a group of patients with hypogonadotrophic-hypogonadism with very low levels of serum gonadotropin levels? If so how much ? .There are two distinct subgroups of patients with hypogonadotrophic hypogonadism,

distinguished by the AFC.

There were significant differences between these subgroups with regard to serum AMH levels and ovarian response to controlled ovarian hyperstimulation during IVF treatment. Some

hypogonadotrophic-hypogonadism who exhibit an ultrasound findings

similar to polycystic ovaries and a high ovarian response to ovulation

induction have indeed co-existent hypogonadotrophic-hypogonadism and PCOS.

While this may be true, further investigation is needed to determine the difference between these two groups of patients with the same

‘umbrella’ diagnosis.As was expected the AMH levels showed a positive correlation with the

number of ovarian antral follicles, which was in keeping with previously

published data. As all patients in this present study had very low levels of gonadotrophins, it gave an opportunity to further delineate the relationship between AMH

and endogenous gonadotrophins.

Previous studies have shown a significant correlation between AMH and LH (positive) and FSH (negative). All patients had low gonadotrophin levels but with wide ranging AMH levels, specifically in the second subgroup of patients with the higher AFC count in whom the conclusion must be that the small antral follicles are intrinsic producers of AMH and independent of gonadotrophin influence