Predictive value of FSH, TSH, prolactin, ANTİ -müllerian hormone, number of antral follicles and thyroid auto-antibodies in determining the ovarian reserve

Several methods have been developed for estimating the functional or biological age of ovary. Ovarian reserve indicates the reproductive potential of women. Ovarian reserve also reflects the number of primordial follicles and oocyte quality. Though the reduction in ovarian reserve is associated with age, its onset may vary a lot. Ideal marker to be used in evaluation of the ovarian reserve should be cost-effective, easy to measure and minimal invasive.The predictive value of the ideal marker should be higher. Follicle stimulating hormone (FSH) and estradiol (E2) values observed on the 3rd day of menstruation are indirect markers that indicate ovarian reserve. In later ages, E2 doesn't have a correlation with pituitary FSH secretion. Thus, provocative tests such as clomiphene citrate challenge test and GnRH agonist stimulation test have been developed. Adequacy of these tests is affected from hormonal intake (GnRH agonists and antagonists, hormonal contraceptives), endogenous hormones and timing of the test. There are lots of studies for the evaluation of better markers of ovarian reserve. Some researchers report that inhibin-B is useful in estimating the ovarian response whereas others report that it isn't contributive at all. According to the consequences of quite important studies, anti- mullerian hormone (AMH) isn't affected by the day of cycle or hormonal changes. While designating this study, we aimed to develop a non-invasive method in predicting the ovarian reserve. Study involved a total of 88 patients, 44 being fertile and 44 infertile, who applied to the Akdeniz University, School of Medicine, Gynecology and Obstetrics Department between June 2011 and June 2012. This is a prospective study. We have obtained important data on the variants affecting ovarian reserve. AMH, antral follicle count (AFC), age, TSH, thyroid auto-antibodies were determined as the most significant factors. An inverse relationship has been found between AMH and FSH for the 88 patients involved in this study. A positive correlation has been determined between TSH and prolactin. A positive correlation has also been observed between anti-thyroid peroxidase antibody and anti-thyroglobulin antibody. Then we examined the patients as fertile and infertile. Age, AFC E2, AMH rates of the infertile and fertile patients involved were found similar, which was then attributed to the smallness of the sample. Higher prolactin and TSH Rb Ab levels were determined in infertile patients. In both groups, a positive correlation was observed between AFC and AMH whereas the correlation between FSH and AMH was negative. High FSH level was accompanied by AMH level which was proportional to it but inversely low. A positive correlation was determined also between age and FSH in the infertile group. A negative proportion was found also between age and AMH in the infertile group. Additionally, high levels of TSH in the infertile patients was accompanied by high levels of prolactin. These latter stated correlations weren't observed in fertile patients. Lastly, when thyroid auto-antibodies were taken as a single variant, lower AFC was found in the fertile group with high levels of thyroid auto-antibodies.This finding also supports the hypothesis that thyroid auto-antibodies damage the follicles. Results of the study have provided valuable knowledge regarding the variants that affect ovarian reserve. Due to the limitations of other tests and high accuracy ratio of AMH in determining the ovarian reserve and response, AMH level could have high diagnostic value to determine ovarian reserve when combined with FSH,age,AFC and TSH