title: Anti-Mullerian hormone as a predictor of ovarian reserve in ART protocols: the hidden role of thyroid autoimmunity.
abstract: BACKGROUND
  Protocols of controlled ovarian hyper-stimulation (COH) require, as a crucial step, the identification of reliable predictors of ovarian reserve. Anti-Mullerian hormone (AMH) is one of the most reliable predictors of ovarian reserve but other factors including autoimmune thyroid diseases (ATD) have been associated with reduced fertility and poor COH outcome. Aim of the present study was to evaluate the relationship between ATD and AMH, and their role on the outcome of COH.
  
  
  METHODS
  The study group included 288 sub-fertile euthyroid women aged less than 40 years attending a single center for Reproductive Medicine. Among them, 55 were ATD-positive and 233 ATD-negative. The serum levels of AMH, FSH, LH, estradiol (E2), and TSH were measured before COH. The ratio between serum E2 concentration on the day of oocytes pick-up and the total dose of administered recombinant FSH (r-FSH) (E2/r-FSH ratio) was calculated.
  
  
  RESULTS
  The serum levels of AMH were significantly related to E2/r-FSH ratio, total dose of r-FSH and number of M II oocytes, both in ATD-positive and ATD-negative women. Within the low stratum of AMH levels, the presence of ATD did not further affect the outcome of COH. When the serum levels of AMH were in the high stratum, the presence of ATD significantly affected the E2/rFSH ratio, the total dose of r-FSH and the number of M II oocytes.
  
  
  CONCLUSIONS
  The probability of a poor response to COH is high, and independent from ATD, in women with low AMH serum levels. In women with a good ovarian reserve, as assessed by high AMH serum levels, the presence of ATD impairs the outcome of COH.
authors.affiliation: Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia, via S.Maugeri 10, 27100, Pavia, Italy. flavia.magri@fsm.it.
authors.forename: Flavia
authors.initials: F
authors.lastname: Magri
authors.affiliation: Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia, via S.Maugeri 10, 27100, Pavia, Italy. lucia.schena01@ateneopv.it.
authors.forename: Lucia
authors.initials: L
authors.lastname: Schena
authors.affiliation: Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia, via S.Maugeri 10, 27100, Pavia, Italy. valentina.capelli00@gmail.com.
authors.forename: Valentina
authors.initials: V
authors.lastname: Capelli
authors.affiliation: Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia, via S.Maugeri 10, 27100, Pavia, Italy. margherita.gaiti@hotmail.it.
authors.forename: Margherita
authors.initials: M
authors.lastname: Gaiti
authors.affiliation: Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia, via S.Maugeri 10, 27100, Pavia, Italy. francesca.zerbini@hotmail.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Zerbini
authors.affiliation: Research Center for Reproductive Medicine, Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, University of Pavia, Pavia, Italy. emanuela_brambilla@yahoo.it.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Brambilla
authors.affiliation: Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia, via S.Maugeri 10, 27100, Pavia, Italy. mario.rotondi@fsm.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Rotondi
authors.affiliation: Department of Pediatrics, University of Pavia, IRCCS Policlinico S. Matteo, Pavia, Italy. M.DeAmici@smatteo.pv.it.
authors.forename: Mara
authors.initials: M
authors.lastname: De Amici
authors.affiliation: Research Center for Reproductive Medicine, Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, University of Pavia, Pavia, Italy. spinillo@smatteo.pv.it.
authors.forename: Arsenio
authors.initials: A
authors.lastname: Spinillo
authors.affiliation: Research Center for Reproductive Medicine, Unit of Obstetrics and Gynecology, IRCCS S. Matteo Foundation, University of Pavia, Pavia, Italy. renappi@tin.it.
authors.forename: Rossella E
authors.initials: RE
authors.lastname: Nappi
authors.affiliation: Unit of Internal Medicine and Endocrinology, IRCCS Foundation S. Maugeri, University of Pavia, via S.Maugeri 10, 27100, Pavia, Italy. luca.chiovato@fsm.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Chiovato
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D001327:Autoimmune Diseases / Q000097:blood* / Q000150:complications / Q000276:immunology; D015551:Autoimmunity / Q000276:immunology*; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007247:Infertility, Female / Q000097:blood* / Q000150:complications / Q000628:therapy; D007986:Luteinizing Hormone / Q000097:blood; D065851:Ovarian Reserve / Q000502:physiology*; D010062:Ovulation Induction / Q000379:methods*; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000276:immunology*; D013972:Thyrotropin / Q000097:blood
chemical_list: D004958:Estradiol; D054304:Anti-Mullerian Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D013972:Thyrotropin