RESUMO
Antimüllerian hormone (AMH) is a homodimeric glycoprotein secreted by granulosa cells from primary to large antral follicles, and it plays an important role in the regulation of early follicle growth. It is considered a reliable marker of ovarian reserve and a predictor of ovarian response to controlled stimulation. Polycystic ovary syndrome (PCOS) is an endocrine condition that affects women of reproductive age worldwide, and it is associated with high levels of AMH. PCOS patients may have worse maturation and fertilization rates compared to normo-ovulatory women. Some studies have demonstrated a positive correlation between AMH levels and qualitative aspects of assisted reproduction treatment; but it is not clear whether high levels of both serum and follicular fluid AMH in PCOS patients correlate with in vitro fertilization outcomes. We ran this scoping review of the literature to address this specific question. We comprehensively searched the databases PubMed and Cochrane Library until January 2023. We found that higher AMH levels are associated with higher oocyte yield, but PCOS patients tend to have fewer mature oocytes and impaired embryo quality and implantation rates. Pregnancy rates, however, are not affected by AMH levels or laboratorial outcomes. We also found that higher AMH levels are associated with worse PCOS features.
Assuntos
Hormônio Antimülleriano , Fertilização in vitro , Síndrome do Ovário Policístico , Humanos , Síndrome do Ovário Policístico/sangue , Hormônio Antimülleriano/sangue , Feminino , Fertilização in vitro/métodos , Gravidez , Infertilidade Feminina/terapia , Infertilidade Feminina/sangue , Líquido Folicular/metabolismo , Taxa de GravidezRESUMO
Introducción: El diagnóstico del síndrome de ovario poliquístico, por su gran diversidad fenotípica ha sido y es objeto de debate. Es en este contexto que en los últimos años se ha propuesto la medición de la hormona antimulleriana como un indicador más eficaz en la evaluación de la disfunción folicular. Objetivo: Compilar información sobre la hormona antimulleriana y su utilidad diagnóstica en el síndrome de ovario poliquístico. Métodos: Revisión bibliográfica de 57 artículos obtenidos de las bases de datos Google Académico, Medline y Pubmed. Conclusiones: La concentración intrafolicular de hormona antimulleriana es inversamente proporcional al tamaño del folículo ovárico y sus niveles séricos son proporcionales a la reserva de folículos en estadio preantral o antral pequeño. En mujeres con síndrome de ovario poliquístico se ha observado incremento de hormona antimulleriana que se cree juega un papel en la patogenia de las alteraciones de la foliculogénesis y la disfunción ovárica. Por ello, la determinación de hormona antimulleriana se ha empleado con fines diagnósticos, como indicador de reserva folicular o como predictor de la respuesta a los tratamientos. Sin embargo, las dificultades técnicas para la medición y la variabilidad poblacional e interindividual, han llevado a que su utilidad práctica para el diagnóstico del síndrome de ovario poliquístico no haya podido establecerse consistentemente(AU)
Introduction: The diagnosis of polycystic ovary syndrome, due to its great phenotypic diversity, has been and is the subject of debate. It is in this context that in recent years the measurement of anti-Müllerian hormone has been proposed as a more effective indicator in the evaluation of follicular dysfunction. Objective: Compile information on the antimullerian hormone and its diagnostic utility in polycystic ovary syndrome. Methods: Bibliographic review of 57 articles obtained from the Google Scholar, Medline and Pubmed databases. Conclusions: The intrafollicular concentration of anti-Müllerian hormone is inversely proportional to the size of the ovarian follicle and its serum levels are proportional to the reserve of follicles in the preantral or small antral stage. An increase in anti-Müllerian hormone has been observed in women with polycystic ovary syndrome, which is believed to play a role in the pathogenesis of abnormal folliculogenesis and ovarian dysfunction. For this reason, the determination of anti-Müllerian hormone has been used for diagnostic purposes, as an indicator of follicular reserve or as a predictor of response to treatment. However, the technical difficulties for the measurement and the population and inter-individual variability have meant that its practical utility for the diagnosis of polycystic ovary syndrome has not been consistently established(AU)
Assuntos
Humanos , Síndrome do Ovário Policístico/diagnóstico , Hormônio Antimülleriano , Literatura de Revisão como AssuntoRESUMO
Resumen Varón trans es aquella persona de sexo biológico femenino con identidad de género masculina que puede optar por recibir una terapia hormonal de reafirmación con testosterona. Hasta el momento, los efectos de este tratamiento sobre la reproducción son poco claros. Se evaluaron los niveles de hormona antimülleriana en varones trans durante el tratamiento con testosterona a corto plazo. Se realizó un estudio prospectivo en 16 individuos que cumplían los requisitos para ser incluidos. Se midieron los niveles de gonadotrofinas, estradiol, testosterona y hormona antimülleriana en fase folicular temprana, previo al inicio deltratamiento hormonal de reafirmación (basal), mediante un método quimioluminiscente, y luego de 6 a 12 meses de tratamiento se determinaron los niveles de testosterona y hormona antimülleriana (control). La mediana de edad fue 22.5 años. Se obtuvieron niveles de testosterona y hormona antimülleriana basales de 0.58 ng/ml y 2.89 ng/ml respectivamente, valores dentro del rango correspondiente a mujeres biológicas. Todos los individuos, al momento del control semestral o anual del tratamiento hormonal, lograron alcanzar niveles de testosterona dentro del rango de referencia poblacional masculino (3-9 ng/ml). Sin embargo, no se observaron diferencias significativas (p 0.7630) en los niveles de hormona antimülleriana basales y luego de 6 a 12 meses de iniciado el tratamiento con testosterona. Nuestro estudio reveló que, a pesar de la alta variabilidad biológica de la hormona antimülleriana, no se observaron cambios significativos en sus niveles durante el tratamiento hormonal de reafirmación en varones trans.
Abstract Trans man is a biological female person with male gender identity, who can choose to receive a gender-affirming hormone treatment with testosterone. So far, the effects of this treatment on reproduction are unclear. Anti-müllerian hormone levels were evaluated in trans men during short-term testosterone treatment. A prospective study was conducted on 16 individuals who met the requirements to be included. The levels of gonadotrophins, estradiol, testosterone and antimüllerian hormone in the early follicular phase were measured prior to the start of the hormonal firming treatment, by means of a chemiluminescent method. The testosterone and antimüllerian hormone levels were determinedafter 6 to 12 months of treatment. The median age was 22.5 years.Basal testos terone and antimüllerian hormone levels of 0.58 ng/ml and 2.89 ng/ml respectively were obtained, values within the range corresponding to biological women. By the time of the semi-annual or annual control of the hormonal firming treatment, all the individuals managed to reach testosterone levels within the reference range of the male population (3-9 ng/ml). However, no significant differences were observed in antimüllerian hormone levels(p0.7630) before and after 6 to 12 months of starting treatment with testosterone. Our study revealed that, despite the high biological variability of the antimüllerian hormone, no significant changes in its levels were observed during the firming hormone treatment in trans men.
RESUMO
Trans man is a biological female person with male gender identity, who can choose to receive a genderaffirming hormone treatment with testosterone. So far, the effects of this treatment on reproduction are unclear. Anti-müllerian hormone levels were evaluated in trans men during short-term testosterone treatment. A prospective study was conducted on 16 individuals who met the requirements to be included. The levels of gonadotrophins, estradiol, testosterone and antimüllerian hormone in the early follicular phase were measured prior to the start of the hormonal firming treatment, by means of a chemiluminescent method. The testosterone and antimüllerian hormone levels were determinedafter 6 to 12 months of treatment. The median age was 22.5 years.Basal testosterone and antimüllerian hormone levels of 0.58 ng/ml and 2.89 ng/ml respectively were obtained, values within the range corresponding to biological women. By the time of the semi-ünnual or annual control of the hormonal firming treatment, all the individuals managed to reach testosterone levels within the reference range of the male population (3-9 ng/ml). However, no significant differences were observed in antimüllerian hormone levels(p 0.7630) before and after 6 to 12 months of starting treatment with testosterone. Our study revealed that, despite the high biological variability of the antimüllerian hormone, no significant changes in its levels were observed during the firming hormone treatment in trans men.
Varón trans es aquella persona de sexo biológico femenino con identidad de género masculina que puede optar por recibir una terapia hormonal de reafirmación con testosterona. Hasta el momento, los efectos de este tratamiento sobre la reproducción son poco claros. Se evaluaron los niveles de hormona antimülleriana en varones trans durante el tratamiento con testosterona a corto plazo. Se realizó un estudio prospectivo en 16 individuos que cumplían los requisitos para ser incluidos. Se midieron los niveles de gonadotrofinas, estradiol, testosterona y hormona antimülleriana en fase folicular temprana, previo al inicio deltratamiento hormonal de reafirmación (basal), mediante un método quimioluminiscente, y luego de 6 a 12 meses de tratamiento se determinaron los niveles de testosterona y hormona antimülleriana (control). La mediana de edad fue 22.5 años. Se obtuvieron niveles de testosterona y hormona antimülleriana basales de 0.58 ng/ml y 2.89 ng/ml respectivamente, valores dentro del rango correspondiente a mujeres biológicas. Todos los individuos, al momento del control semestral o anual del tratamiento hormonal, lograron alcanzar niveles de testosterona dentro del rango de referencia poblacional masculino (3-9 ng/ml). Sin embargo, no se observaron diferencias significativas (p 0.7630) en los niveles de hormona antimülleriana basales y luego de 6 a 12 meses de iniciado el tratamiento con testosterona. Nuestro estudio reveló que, a pesar de la alta variabilidad biológica de la hormona antimülleriana, no se observaron cambios significativos en sus niveles durante el tratamiento hormonal de reafirmación en varones trans.
Assuntos
Terapia de Reposição Hormonal , Reserva Ovariana , Adulto , Hormônio Antimülleriano , Feminino , Humanos , Masculino , Estudos Prospectivos , Testosterona , Pessoas Transgênero , Adulto JovemRESUMO
Resumen Antecedentes: La hormona antimüllleriana (HAM) ha sido utilizada como marcador de reserva ovárica, lo cual ayuda a predecir el éxito. Se desconoce si valores de otros países son apicables a México. Objetivo: Determinar los valores de HAM en nuestra población para graficarlas acorde a grupos de edad y evaluar su comportamiento. Metodología: Estudio observacional, descriptivo, retrospectivo y transversal de pacientes del 2008 al 2018, con reporte de nivel de HAM excluyendo a pacientes con enfermedades que alteran su nivel, analizando por grupos de edad en un laboratorio. Resultados: 450 pacientes de 36.93 años, el rango del valor de la HAM fue desde 0.003 ng/ml hasta 9.4 ng/ml, con una media de 1.5, con una disminución anual a partir de los 40 años (0.1-0.3). Correlación de Spearman de -436 (p < 0.000) con una asociación leve entre la edad y el nivel de HAM, pero sí lineal (p < 0.000). Conclusiones: La HAM es útil y sirve para dar recomendaciones personalizadas, así como base de estudios epidemiológicos en pro de una medicina individualizada.
Abstract Background: Antimüllerian hormone (AMH) has been used as a marker of ovarian reserve, which helps predict success. It is unknown if values from other countries are applicable to Mexico. Objective: To determine the AMH values in our population to graph them according to age groups and evaluate their behavior. Methodology: Observational, descriptive, retrospective, and cross-sectional study of patients from 2008 to 2018, with a AMH level report excluding patients with diseases that alter their level, analyzing by age groups in a laboratory. Results: 450 patients of 36.93 years old, the range of the AMH value was from 0.003 ng/ml to 9.4 ng/ml, with a mean of 1.5, with an annual decrease from 40 years of age (0.1-0.3). Spearman's correlation of -436 (p < 0.000) with a slight association between age and AMH level, but it was linear (p < 0.000). Conclusions: AMH is useful and serves to give personalized recommendations, as well as basis of epidemiological studies in favor of an individualized medicine.
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OBJECTIVES: To find a pretreatment predictor for achieving a live birth. Assisted reproduction technology with IVF/ICSI is the ultimate chance for some couples to conceive a child. The expectations are high and it is important to give them a realistic perspective about the chances of achieving a live birth. METHODS: A retrospective cohort study of all IVF/ICSI cycles performed in our center between 2012 and 2016. We considered only those cycles with a live birth delivery after 24 weeks, or cycles with no surplus embryos left. The following data was evaluated: AMH; AFC; age; BMI; previous diagnosis; type of treatment; number of previous deliveries; ethnicity, smoking status. Univariate and multivariate analysis were used to examine the association of live birth with baseline patient characteristics. We determined the odds-ratio for all the statistically significant variables (p<0.05), in a multivariate model. The results are presented according to the predictors founded. RESULTS: 739 cycles were evaluated: 9.1% were canceled; 10.2% did not have oocytes; 15.6% did not have D2 embryos; 31.4% achieved a live birth. The univariate analysis revealed statistically significant differences regarding AMH, AFC and women's age between couples with and without a live birth (p<0.001), and the cause of infertility. We found no association with live births in other variables. These variables were categorized and used in a multivariate analysis. CONCLUSION: Age, AMH, AFC and cause, when sub-classified, are independently associated with the results of an IVF/ICSI treatment. These results enable couples to face real expectations in their particular scenario.
Assuntos
Coeficiente de Natalidade , Fertilização in vitro , Infertilidade/terapia , Nascido Vivo , Injeções de Esperma Intracitoplásmicas , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Folículo Ovariano , Indução da Ovulação/métodos , Paridade , Gravidez , Taxa de Gravidez , Prognóstico , Estudos Retrospectivos , Adulto JovemRESUMO
RESUMEN La insuficiencia ovárica prematura es la pérdida de la función ovárica antes de los 40 años de edad. Se caracteriza por hipogonadismo hipergonadotrófico y amenorrea u oligomenorrea. Su etiología es multifactorial, pudiendo deberse a causas iatrogénicas, genéticas, metabólicas, autoinmunes y ambientales; siendo de origen idiopático en el 90 % de los casos. Su incidencia es de 1 cada 100 mujeres menores de 40 años y 1 cada 1000 mujeres menores de 30 años. En la actualidad no existe un único marcador que se pueda utilizar para calcular la reserva ovárica; sin embargo, en los últimos años la hormona antimülleriana ha demostrado presentar algunas ventajas respecto a los biomarcadores clásicamente utilizados. Además, diversos estudios indican que existe una correlación positiva entre los niveles de esta hormona y el recuento de folículos antrales, que es, por el momento, el método más confiable para evaluar reserva ovárica debido a las actuales dificultades técnicas para la determinación de hormona antimülleriana.
ABSTRACT Premature ovarian insufficiency, the loss of ovarian function before the age of 40 years, is characterized by hipergonadotrofic hipogonadism and amenorrhea or oligomenorrhea. The etiology is multifactorial, and can be due to genetic, metabolic, autoimmune, environmental or iatrogenic causes, being idiopathic 90% of cases. Currently there is not a single marker that can be used for estimate ovarian reserve in this patients; however, in recent years antimüllerian hormone has proved to have some advantages over other classical biomarkers. Moreover, several studies indicate a positive correlation between antimüllerian hormone concentration and antral follicle count, considered nowadays the most reliable method for ovarian reserve estimation.
Assuntos
Humanos , Feminino , Insuficiência Ovariana Primária/diagnóstico , Insuficiência Ovariana Primária/etiologia , Biomarcadores , Hormônio Antimülleriano/fisiologia , Reserva OvarianaRESUMO
Resumen OBJETIVO: Evaluar los desenlaces en la recuperación de ovocitos y la tasa de embarazo en pacientes en protocolo de fertilización in vitro de acuerdo con las concentraciones de hormona antimülleriana y la edad de la mujer. MATERIALES Y MÉTODOS: Estudio restrospectivo, transversal, comparativo y observacional efectuado en pacientes en tratamiento de fertilización in vitro en un centro privado de reproducción asistida (enero 2013-enero 2018). La población se dividió en grupo 1 (concentraciones menores de 1 ng/mL de hormona antimülleriana) y grupo B (concentraciones mayores de 1 ng/mL de hormona antimülleriana) para determinar la asociación entre la edad y las concentraciones de hormona antimülleriana y la respuesta a la cantidad de ovocitos recuperados y tasa de embarazo; estos grupos se subdividieron por edades (≤ 29, 30-34, 35-39 y ≥ 40 años). RESULTADOS: Se estudiaron 282 pacientes de las que se eliminaron 35 por expediente incompleto; quedaron 247; 93 en el grupo 1 y 154 en el grupo 2. En el grupo 1 se recuperaron 4.61 vs 7.9 ovocitos (p < 0.001). En las pacientes menores de 29 años con concentraciones de hormona antimülleriana menores de 1 ng/mL la cantidad promedio de ovocitos recuperados fue mayor: 7.8 ovocitos versus los otros grupos de edad con menos de 1 ng/mL. La tasa de embarazo en las pacientes con concentraciones de hormona antimülleriana mayores de 1 ng/mL fue mayor en los grupos de edad menores de 29 años y de 30 a 34 años (p < 0.01). CONCLUSIONES: Independientemente de la edad, cuando las concentraciones de hormona antimülleriana son mayores de 1 ng/mL se logra recuperar mayor cantidad de ovocitos que en quienes tienen menos de esa concentración. Las pacientes menores de 35 años con concentraciones de hormona antimülleriana mayores de 1 ng/mL tienen mayor tasa de embarazo que las de menos de 1 ng/mL. Cuando la edad de la mujer es mayor de 35 años las concentraciones de hormona antimülleriana no influyen en las tasas de embarazo.
Abstract OBJECTIVE: To evaluate the outcomes in oocyte retrieval and the pregnancy rate in patients under in vitro fertilization protocol according to anti-Müllerian hormone concentrations and the age of the woman. MATERIALS AND METHODS: Retrospective, cross-sectional, comparative and observational study carried out in patients undergoing in vitro fertilization treatment in a private assisted reproduction center (January 2013- January 2018). The population was divided into group 1 (lower concentrations of 1 ng / mL of antimülleriana hormone) and group B (concentrations higher than 1 ng / mL of antimülleriana hormone) to determine the association between the age and the antimülleriana hormone concentrations and the answer to the amount of recovered oocytes and pregnancy rate; these groups were subdivided by age (≤ 29, 30-34, 35-39 and ≥ 40 years). RESULTS: We studied 282 patients, of which 35 were eliminated due to incomplete records; there were 247; 93 in group 1 and 154 in group 2. In group 1, 4.61 vs 7.9 oocytes were recovered (p <0.001). In patients younger than 29 years old with antimüllerian hormone concentrations lower than 1 ng / mL, the average number of oocytes retrieved was higher: 7.8 oocytes versus the other age groups with less than 1 ng / mL. The pregnancy rate in patients with antimüllerian hormone concentrations greater than 1 ng / mL was higher in the age groups under 29 years and 30 to 34 years (p <0.01). CONCLUSIONS: Regardless of age, when antimüllerian hormone concentrations are greater than 1 ng/mL, more oocytes are recovered than in those less than that concentration. Patients younger than 35 years old with antimüllerian hormone concentrations lower than 1 ng/mL have a higher pregnancy rate than those less than 1 ng/mL. When the age of the woman is over 35 years old, anti-Müllerian hormone concentrations do not influence pregnancy rates.
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OBJECTIVE: To investigate whether serum antimüllerian hormone (AMH) levels are independently related to miscarriage rates after in vitro fertilization-embryo transfer (IVF-ET). DESIGN: Cohort study. SETTING: University-affiliated IVF-ET center. PATIENT(S): A total of 1,060 patients who attained a clinical pregnancy after IVF-ET. INTERVENTIONS(S): Centralized serum AMH measurements were performed within the 12 months before IVF-ET. Binary logistic regression was used to verify whether serum AMH levels were associated with the occurrence of a miscarriage independently from confounding factors, such as age and intensity of ovarian response to controlled ovarian stimulation assessed by the number of oocytes retrieved. MAIN OUTCOME MEASURE(S): Miscarriage rates. RESULT(S): In patients displaying reduced serum AMH levels, miscarriage rates were significantly increased independently from age and the number of oocytes retrieved. CONCLUSION(S): The present data indicate that serum AMH levels are independently associated with the occurrence of a miscarriage after IVF-ET.
Assuntos
Aborto Espontâneo/sangue , Aborto Espontâneo/epidemiologia , Hormônio Antimülleriano/sangue , Transferência Embrionária/estatística & dados numéricos , Fertilização in vitro/estatística & dados numéricos , Infertilidade Feminina/sangue , Infertilidade Feminina/terapia , Adulto , Distribuição por Idade , Biomarcadores/sangue , Terapia Combinada/estatística & dados numéricos , Comorbidade , Feminino , França/epidemiologia , Humanos , Incidência , Gravidez , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Falha de Tratamento , Adulto JovemRESUMO
OBJECTIVE: To compare the efficacy and safety of follitropin delta, a new human recombinant FSH with individualized dosing based on serum antimüllerian hormone (AMH) and body weight, with conventional follitropin alfa dosing for ovarian stimulation in women undergoing IVF. DESIGN: Randomized, multicenter, assessor-blinded, noninferiority trial (ESTHER-1). SETTING: Reproductive medicine clinics. PATIENT(S): A total of 1,329 women (aged 18-40 years). INTERVENTION(S): Follitropin delta (AMH <15 pmol/L: 12 µg/d; AMH ≥15 pmol/L: 0.10-0.19 µg/kg/d; maximum 12 µg/d), or follitropin alfa (150 IU/d for 5 days, potential subsequent dose adjustments; maximum 450 IU/d). MAIN OUTCOMES MEASURE(S): Ongoing pregnancy and ongoing implantation rates; noninferiority margins -8.0%. RESULT(S): Ongoing pregnancy (30.7% vs. 31.6%; difference -0.9% [95% confidence interval (CI) -5.9% to 4.1%]), ongoing implantation (35.2% vs. 35.8%; -0.6% [95% CI -6.1% to 4.8%]), and live birth (29.8% vs. 30.7%; -0.9% [95% CI -5.8% to 4.0%]) rates were similar for individualized follitropin delta and conventional follitropin alfa. Individualized follitropin delta resulted in more women with target response (8-14 oocytes) (43.3% vs. 38.4%), fewer poor responses (fewer than four oocytes in patients with AMH <15 pmol/L) (11.8% vs. 17.9%), fewer excessive responses (≥15 or ≥20 oocytes in patients with AMH ≥15 pmol/L) (27.9% vs. 35.1% and 10.1% vs. 15.6%, respectively), and fewer measures taken to prevent ovarian hyperstimulation syndrome (2.3% vs. 4.5%), despite similar oocyte yield (10.0 ± 5.6 vs. 10.4 ± 6.5) and similar blastocyst numbers (3.3 ± 2.8 vs. 3.5 ± 3.2), and less gonadotropin use (90.0 ± 25.3 vs. 103.7 ± 33.6 µg). CONCLUSION(S): Optimizing ovarian response in IVF by individualized dosing according to pretreatment patient characteristics results in similar efficacy and improved safety compared with conventional ovarian stimulation. CLINICAL TRIAL REGISTRATION NUMBER: NCT01956110.
Assuntos
Fármacos para a Fertilidade Feminina/administração & dosagem , Fertilização in vitro , Hormônio Foliculoestimulante Humano/administração & dosagem , Infertilidade/terapia , Indução da Ovulação/métodos , Ovulação/efeitos dos fármacos , Adolescente , Adulto , Hormônio Antimülleriano/sangue , Biomarcadores/sangue , Peso Corporal/efeitos dos fármacos , Brasil , Canadá , Implantação do Embrião , Transferência Embrionária , Europa (Continente) , Feminino , Fertilidade/efeitos dos fármacos , Fármacos para a Fertilidade Feminina/efeitos adversos , Fertilização in vitro/efeitos adversos , Hormônio Foliculoestimulante Humano/efeitos adversos , Humanos , Infertilidade/diagnóstico , Infertilidade/fisiopatologia , Nascido Vivo , Síndrome de Hiperestimulação Ovariana/etiologia , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Indução da Ovulação/efeitos adversos , Gravidez , Taxa de Gravidez , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Resultado do Tratamento , Adulto JovemRESUMO
Se debate la posible utilidad, o no, de métodos convencionales de evaluación en la pareja infértil, así como la aplicación de marcadores de recientes marcadores de reserva ovárica. Los nuevos enfoques van dirigidos a la evaluación de tres parámetros fundamentales: la ovulación, el estado de las trompas y la capacidad fértil del semen. La determinación de progesterona en día 21 de ciclo, la histerosalpingografía y el seminograma, siguen vigentes como herramienta inicial. Sin embargo, tales parámetros fundamentales deben ser ampliados con el estudio de la reserva ovárica y valorar la integridad uterina. En este sentido, la determinación de la hormona antimülleriana (HAM) o el recuento de folículos antrales (RFA) mediante ecografía transvaginal son hoy avances imprescindibles.
This article debates about the practical use of conventional methods for the evaluation of the infertile couple, and also explores the clinical impact of recently described ovarian reserve markers. Infertile couple work up is based on the evaluation of three main parameters: ovulation, Fallopian tubes patency and sperm quality. Progesterone level on the 21st day of menses, hysterosalpingography, and spermiogram are the best initial tools for infertility evaluation. But also, the ovarian reserve and uterine integrity must be evaluated; for such aim, antral follicle count or determination of antimullerian hormone together with transvaginal ultrasound supposes a great step forward to the correct evaluation of the infertile couple.