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The AMH Test: A Reliable Predictor Of Ovarian Reserve – ADVERTORIAL

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AMH Tests

The Elecsys Anti-Müllerian Hormone from Roche is proving to be an accurate marker of female fertility

According to the WHO, fertility issues affect one in 10 couples, up to 80 million people globally, and this number is rising. Choosing whether to embark on the process of IVF is a huge decision for couples who are experiencing fertility problems and one that cannot be taken lightly. Ovarian reserve testing can help with the decision-making process as it determines how many eggs remain in the ovaries and therefore gives a good indication of whether a couple will have a successful conception.

The age of the woman has traditionally been a good indicator of egg quantity and quality, as egg numbers steadily decline from the time of puberty and this decline accelerates from around the age of 37.

FSH or follicle stimulating hormone testing has been a popular test for ovarian reserve for many years as FSH is instrumental in the production, growth and maturing of the follicles in the ovaries. Antral follicle count (AFC) testing with transvaginal sonography is also considered to be a good tool for determining the ovarian reserve.

However, a relatively new test called the antimüllerian hormone or AMH test is proving to be a particularly accurate marker of female fertility and reproductive lifespan.

The Elecsys® Anti-Müllerian Hormone (AMH) test from leading biotech company Roche was launched last year and has been shown to be a superior indicator of ovarian reserve compared to the FSH and oestradiol tests, the latter of which measures the amount of oestradiol, a form of the hormone oestrogen, in your blood.

Ovarian Reserve

HOW DOES IT WORK?

AMH is a hormone which is produced by the granulosa cells of the developing antral and preantral follicles (or egg sacks) in the ovaries. Its production is highest when the follicles are less than 4mm in diameter. As the follicles continue to grow, production decreases and then stops. Virtually no AMH is produced in follicles over 8mm. Since AMH is only produced in small ovarian follicles, blood levels of this hormone are used to measure the size of the pool of a woman’s growing follicles. In other words, AMH levels are thought to indicate a woman’s ovarian reserve. Therefore, testing blood levels of AMH before embarking on the IVF process is a useful indicator of ovarian reserve and potential response to IVF drugs. If AMH levels are within the normal range, the ovaries are likely to react more positively to stimulating medication and more eggs are likely to be retrieved. Having more eggs with IVF tends to result in a higher success rate.

THE BENEFITS OF THE ELECSYS AMH TEST

Prior to the launch of the Elecsys AMH test, the only tests – or assays – that were available were manual, plate-based enzyme linked immunosorbent assays (ELISAs). These have helped to increase understanding of the value of AMH measurement across a wide range of physiologic and clinical situations, but there are issues surrounding the lack of standardisation among those produced by different manufacturers as well as concerns about data reliability. The Elecsys AMH test is a sandwich assay based on electrochemiluminescence technology. This mean that the chemiluminescence reaction for the detection of the reaction complex is initiated by applying a voltage to the sample solution, resulting in a precisely controlled reaction. This technology can accommodate many immunoassay principles while providing superior performance.

“There is less chance of an error occurring because it is fully automated and there is limited intervention from staff. Another benefit is that a smaller sample volume is required.”

EXPERT OPINIONS

Arun Sankaralingam, Principal Clinical Scientist with the Automated Clinical Biochemistry Laboratory at St Thomas’ Hospital in London, carried out an evaluation of the Elecsys AMH test. She said: “The test is carried out prior to the IVF process and although it was not previously available on the NHS it is available now. If a patient is considering IVF treatment this test will be able to determine whether the outcome will be successful or not. The IVF clinician will then be able to advise the patient whether to go ahead or not based on the results. We already use the manual test in our laboratory, but this test is fully automated, meaning that it is very precise and there is less room for error. Not only is the test easy to use but it is also accurate and very reliable.

“As this is an automated test, the patient can get their results on the same day, whereas manual tests could take up to a week. It’s therefore much easier and more convenient for patients.”

Antral Follicle Count

Allison Gaskell, a biomedical scientist with Manchester Royal Hospital, added: “This assay has really simplified the whole process in our laboratory. Previously, with the manual assay, it took a long time to prepare the sample and then perform the assay, whereas now the sample is placed onto the analyser and we don’t see it again until the result comes through. The test is much more sensitive than the manual assay too. There is less chance of an error occurring because it is fully automated and there is limited intervention from staff. Another benefit is that a smaller sample volume is required. Previously, with the manual assay, we ran the tests in duplicate because there was a greater likelihood of errors occurring, but now we only need to run the test once.”

Damian Lally from the biochemistry lab at the National Maternity Hospital in Dublin recently carried out an evaluation of the Elecsys AMH test. He said: “To do this we compared the results from the new Roche test with an existing test. We also checked the accuracy and precision of the new test. This is the standard procedure for all new lab tests. As an added study we compared the AMH results to the AFC from 110 patients in our fertility clinic. We have shown there is a good correlation between AMH and AFC in our hospital (shown below).”

Lally added: “The antral follicle count by transvaginal sonography is considered to be the best tool for determining the ovarian reserve and represents the active cohort of growing antral and pre-antral ovarian follicles. However, AMH could be used as a surrogate marker for the AFC in ovarian reserve testing. Measuring AMH using an automated method has benefits in that it provides standardised results with minimum inter-operator and inter-laboratory variability, unlike AFC measurements which may be subjective, with many complications, a high inter-operator variability and within subject variability. The AFC by ultrasound also requires sophisticated ultrasound equipment and a trained ultrasonographer and can only be performed on day three of the menstrual cycle.” Future plans for the test include using it in combination with the new human recombinant follicle-stimulating hormone (human rFSH) treatment which is currently in development.

This combination, which will make possible individualised dosing of human rFSH based on a woman’s specific AMH level, may provide an improved option for couples seeking to conceive through IVF.

 

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NEWS: Get access to adult photos of the Cryos sperm donors

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Adult Cryos Sperm Donors Photos

Viewing adult photos of Cryos sperm donors is now a reality. Visit dk.cryosinternational.com today and get access to the new feature.

At Cryos it is now possible to access adult photos of sperm donors on our website, thus adding another dimension to your search for the perfect donor.

The unique chance to see both childhood and adult photos of your sperm donor, provides you with a more comprehensive idea of who your sperm donor is and moreover of the features of your future child. We hope that this extra dimension will upgrade your experience making your decision of a sperm donor easier.

The 5-6 adult photos are taken by a professional photographer and are a part of the donors extended profile where you also have access to childhood photos, an audio recording of the donor’s voice, a handwritten message, an emotional intelligence profile, and finally our staff impressions of the donor, amongst other exclusive features.

The adult photos require special access on our website. Visit our website and find out more and get access to this new feature now.

Please note that the person in the photos is a model and not a Cryos donor.
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Fertility And Sex: Why Her Orgasm Matters

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Why her orgasm matters

For many couples, trying to conceive can make sex feel less fun and more pressured. Instead of being an intimate and enjoyable experience, baby-making sex can start to seem like a finely choreographed routine. Often, the female orgasm is one of the first things to go, but the maleorgasm is not the only orgasm that matters when it comes to fertility.

Before I dive into discussing the potential benefits of the female orgasm for fertility, it’s important to note that reaching climax is not technically essential for conception. If you never, or rarely, achieve orgasm, don’t worry, you can still get pregnant! Around 1 in 10 women don’t experience orgasm, ever. What’s more, the exact nature of the female orgasm remains somewhat elusive. Some experience orgasm through clitoral stimulation, some through vaginal intercourse, some through both, and others through something else entirely, or not at all.

Even without reaching orgasm, sexual arousal is itself beneficial to fertility. Like an orgasm, arousal is, first and foremost, a good indication that sex is enjoyable. Sexual arousal and climax causes significant changes in your levels of neurotransmitters including noradrenaline, oxytocin, prolactin, dopamine, and serotonin. These ‘reward’ neurohormones help you bond to a sexual partner and make it more likely that you’ll have sex more often, thereby increasing your chances of conception.

Second, orgasm and arousal have a range of physiological effects that might aid conception, which I’ll discuss in a moment. And, third, sexual arousal and orgasms for everyone can help sperm-producing partners avoid feeling like they’re being used just for their sperm. In fact, some studies show that male partners who engage in cunnilingus prior to vaginal intercourse have greater sexual arousal and produce more semen!

HOW ORGASMS ENHANCE FERTILITY

The female orgasm can help relieve stress, and promote healthy circulation and balance in the body. Stress is a key cause of diminished libido and may also reduce the chances of conception by raising levels of the stress hormone cortisol. Conversely, good sex can help raise levels of oxytocin and the other neurohormones mentioned above. These help you to relax and bond to your partner.

Published in 1967, the author even went as far as suggesting that the increase in these hormones after orgasm help support conception by temporarily incapacitating you. Put simply, this ‘poleax’ effect means you’ll feel so relaxed that you’ll stay lying down, which may increase your chance of conceiving. Whether staying supine does make conception more likely is still under debate, but I’m all for promoting relaxation, so if this theory provides added motivation, go for it!

CERVICAL TENTING

There is some suggestion that orgasm affects the shape and function of the cervix. These effects, which may include cervical ‘tenting could enhance the likelihood of conception by promoting the movement of sperm into the uterus and beyond. If you are curious as to what your cervix looks like during different stages of your cycle, check out these photos.

THE ‘UP-SUCK’ THEORY

One of the main ways in which female orgasm has been linked to fertility is something called the ‘upsuck’ theory (or, sometimes, the ‘insuck’ theory). This theory proposes that the female orgasm causes uterine and vaginal contractions that actively draw semen up into the uterus and towards the fallopian tubes, thereby increasing the chances of an egg being fertilized.

Scientific evidence to support this theory is rather inconsistent, but there’s certainly no harm in trying! One proposed underlying mechanism of this theory is oxytocin-mediated uterine peristalsis, i.e. the same mechanism that causes uterine contractions during labour could be partially responsible for increasing the likelihood of conception. Indeed, some research has found higher pregnancy rates in women shown to experience this ‘insuck’ phenomenon.

SPERM RETENTION AND FERTILITY

More recently, one small study found that orgasm may increase sperm retention. This study involved women using a syringe to insert a sperm simulant (lube) prior to external stimulation to orgasm. As such, the study’s findings may be especially applicable to anyone undergoing artificial insemination (IUI).

The take-away: Chances are that if you orgasm 1 minute before or up to 45 minutes after insemination (whether artificial or otherwise), you will probably retain more sperm, which may increase your chance of conceiving.

IN CONCLUSION

To sum up, the female orgasm might enhance fertility in a variety of ways, but it isn’t essential to conception.

The take home message is that orgasm and sexual arousal itself have many benefits to fertility, partner relationships and stress relief. Don’t worry though, if you have a low libido, conception can still happen even in the absence of arousal and orgasm!

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What Is Polycystic Ovary Syndrome (PCOS)?

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Polycystic Ovary Syndrome

Polycystic Ovary Syndrome or PCOS is a hormonal imbalance that affects 5 to 10 percent of women of reproductive age across the world, and results in irregular or absent periods, acne, excess body hair and weight gain. It is also a major cause of infertility and yet is frequently misdiagnosed and often missed completely.

PCOS gets its name because under an ultrasound scan, the ovaries can look like a bunch of grapes, each one covered in what look like multiple cysts. In fact, these aren’t cysts at all, but are small, undeveloped follicles.

Symptoms

Not every woman with PCOS will get the same symptoms, but common signs to look out for include:

  • Few or no periods
  • Excess hair on the face or breasts or inside of the legs or around the nipples
  • Acne
  • Oily skin
  • Scalp hair thinning or loss (male pattern baldness)
  • Skin tags (known as acrochordons)
  • Skin discolouration (known as acanthosis nigricans) where the skin looks ‘dirty’ on the arms, around the neck and under the breasts
  • Mood swings
  • Depression
  • Lack of sex drive
  • Weight gain especially around the middle of the body
  • Difficulty in losing weight
  • Cravings and binges
  • Irregular or no ovulation
  • Difficulty in becoming pregnant
  • Recurrent miscarriages

PCOS creates a vicious cycle of hormone imbalances, which has huge knock-on effects throughout the rest of your body. With PCOS, the problem often starts with the ovaries, which are unable to produce the hormones they should, and in the correct proportions. But linked to this is the very common problem of insulin resistance. Women with PCOS very often have difficulties with blood sugar levels which can cause weight gain and the excess insulin can stimulate your ovaries to produce yet more testosterone. Half of all women with PCOS do not have any problems with their weight, yet they can still have higher insulin levels than normal.

How is Polycystic Ovary Syndrome diagnosed?

The most widely accepted criteria for the diagnosis of PCOS says that you should have two out of these three problems:

  • Infrequent or no ovulation
  • Signs (either physical appearance – hirsutism or acne – or blood tests) of high levels of male hormones
  • Polycystic ovaries as seen on an ultrasound scan

The Seven Nutritional Steps to beat Polycystic Ovary Syndrome

Good nutrition is the foundation of your health and you should never underestimate how powerful it can be. It is the fuel that provides you with the energy to live your life and it gives your body the nutrients it needs to produce your hormones in the correct balance. The better the supply of those nutrients, the more healthily your body will function.

The fundamental aim of my nutritional approach to PCOS is to target a number of areas simultaneously so that you get the maximum effect in the minimum amount of time.  

Here’s how:

  1. Switch to unrefined carbohydrates (eaten with protein) and never go more than 3 hours without food to keep your blood sugar levels balanced
  2. Eat oily fish and foods rich in Omega 3s to help your body to become more sensitive to insulin so it can overcome insulin resistance
  3. Cut out all dairy products for 3 months to bring levels of male hormones under control
  4. Eat more vegetables and pulses to which helps control male hormones
  5. Cut right back on or cut out alcohol for 12 weeks to allow your liver function to improve
  6. Cut down on caffeine to give your adrenal glands a rest
  7. Cut down on saturated fats and eliminate trans fats to help control the potentially damaging inflammatory processes PCOS causes in the body

PCOS Symptons

Best Supplements for PCOS

The use of certain vitamins and minerals can be extremely useful in helping to correct Polycystic Ovary Syndrome, along with a good diet.

Chromium

Chromium helps to encourage the formation of glucose tolerance factor (GTF), which is required to make insulin more efficient. A deficiency of chromium can lead to insulin resistance.  It also helps to control cravings and reduces hunger. Can help to reduce insulin resistance associated with PCOS

B vitamins

The B vitamins are very important in helping to control the symptoms of PCOS. Vitamin B2 helps to burn fat, sugar and protein into energy. B3 is a component of GTF which is released every time blood sugar rises, and vitamin B3 helps to keep the levels in balance. Vitamin B5 has been shown to help with weight loss and B6 is also important for maintaining hormone balance and, together with B2 and B3, is necessary for normal thyroid function.

Zinc

Zinc helps with PCOS as it plays a crucial role in the production of your reproductive hormones and also regulates your blood sugar.

Magnesium

Magnesium is an important mineral for dealing with PCOS because there is a strong link between magnesium levels and insulin resistance – the higher your magnesium levels the more sensitive you are likely to be to insulin.

Co-Enzyme Q10

Co-Q10 is a substance that your body produces in nearly every cell.  It helps to balance your blood sugar and lowering both glucose and insulin.

Alpha lipoic acid

This powerful antioxidant helps to regulate your blood sugar levels because it releases energy by burning glucose and it also helps to make you more insulin sensitive. It also has an effect on weight loss because if the glucose is being used for energy, your body releases less insulin and you then store less fat.   

Omega 3 fatty acids

Omega 3 fatty acids taken in supplement form have been found to reduce testosterone levels in women with Polycystic Ovary Syndrome.

Amino Acids

Certain amino acids can be very helpful for PCOS as they can improve your insulin sensitivity and also can have an effect on weight loss.

N-Acetyl cysteine

In women with PCOS this amino acid helps reduce insulin levels and makes your body more sensitive to insulin. Study using NAC in women who were clomiphene resistant and had ovarian drilling.  After ovarian drilling, the women given NAC compared to a placebo showed a significantly higher increase in both ovulation and pregnancy rates and lower incidence of miscarriage.

Arginine

Arginine can be helpful in reversing insulin resistance. In one study, a combination of both arginine and N-acetyl cysteine were given to women with Polycystic Ovary Syndrome.  The two amino acids help to improve blood sugar and insulin control and also increased the number of menstrual cycles and ovulation with one women becoming pregnant on the second month.

Carnitine

Carnitine helps your body break down fat to release energy and can help improve insulin sensitivity.

Tyrosine

Tyrosine is helpful for women with PCOS who are overweight as it helps to suppress the appetite and burn off fat.

Glutamine

This amino acid is useful for helping with sugar cravings as it can be converted to sugar for energy and so takes away the need to eat something sweet.  It also helps to build and maintain muscle which is important for fat burning.

Branched Chain Amino Acids (BCAAs)

BCAAs include three amino acids leucine, isoleucine and valine. They are important in PCOS because they help to balance blood sugar and having good levels of these BCAAs can have a beneficial effect on your body weight

Inositol

A study used inositol (2,000mg) in combination with NAC (600mg), a significant increase in ovulation rates.

Having a good diet, regular exercise, controlling stress and taking key nutrients will help in getting your hormones back in balance and reducing the negative symptoms associated with PCOS.

More information can be found on www.naturalhealthpractice.com

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