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ormnio anti-Mlleriano: cuidados nanterpretaco dos resultadosnti-Mllerian hormone: caution in interpreting the results concentraco srica de hormnio anti-Mlleriano (AMH),roduzido pelas clulas da granulosa dos folculos pr-antrais

antrais pequenos,1 no sofre influncia da secreco puls-il de gonadotrofinas e, portanto, apresenta pequena variaconter e intraciclos e em vigncia de uso de contraceptivosormonais, o que no acontece com outros testes hormo-ais, como o hormnio folculo estimulante (FSH) de terceiroia e a inibina B.2,3 Alguns clnicos esto to convenci-os da superioridade do AMH frente aos outros marcadoreslssicos de reserva ovariana que passaram a adotar esseeste como principal forma de avali-la, de prever a respostaolicular estimulaco da ovulaco e, mais corajosamente,orrelacion-lo com os desfechos e o prognstico de sucessoos tratamentos de reproduco assistida, sem levar emonsideraco as caractersticas da populaco de interesse.Muitos estudos e testes clnicos foram feitos com dife-

entes kits disponveis comercialmente desenvolvidos porois laboratrios: Diagnostics Systems Laboratories (DSL) emmunotech.4 Embora os resultados obtidos por esses kits seorrelacionem, suas curvas-padro no so paralelas, alm deo haver fator de converso universal aplicvel, o que tornaifcil a comparaco de resultados, principalmente nos valoresxtremos das curvas.5

Beckman Coulter, um grupo com vasta experincia noesenvolvimento e na venda de ensaios laboratoriais, adqui-iu os dois laboratrios e desenvolveu um novo kit para ensaioe AMH, o Beckman Coulter Generation II (Gen II). Parece, con-udo, que o problema ainda no est solucionado, pois o novoit apresentou valores mais baixos de AMH do que o esperado,lm de instabilidade durante o armazenamento. Isso fez comue a empresa reavaliasse o produto. Segundo a nova meto-ologia h necessidade de uso de um tampo aninico paraesolver o problema.6

Esses achados, relatados por diversos pesquisadores, suge-

em fortemente que a metodologia empregada para dosar oMH srico ainda inconsistente e, portanto, seus resultadosevem ser interpretados com cautela.4,7Dificuldades parte, o mtodo apresenta vantagens impor-tantes. Alm das j mencionadas no incio deste artigo, adosagem do AMH tem sua melhor indicaco no rastreamentoda reserva ovariana e no aconselhamento de mulheres comalto risco de apresentar diminuico da reserva ovariana, como,por exemplo, acima de 37 anos, seguimento aps ooforoplas-tia ou que apresentam FSH basal > 10 mUI/mL. De maneirageral, dosagens baixas de AMH (

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Documento descarregado de http://recli.elsevier.es el 16/03/2015. Cpia para uso pessoal, est totalmente proibida a transmisso deste documento por qualquer meio ou forma.2 r e p r o d c l i m

de discutir prognstico com as pacientes baseado nos valo-res desse teste. Tenha em mente que o mtodo de avaliacodo AMH pode variar entre os diversos laboratrios de anlisesclnicas, que ainda no foram estabelecidos valores de norma-lidade do teste para a populaco brasileira com os diferenteskits disponveis e, finalmente, que a melhor indicaco do teste para avaliaco dereserva ovariana em populaco especfica.

e f e r n c i a s

1. Weenen C, Laven JS, Von Bergh AR, Cranfield M, Groome NP,Visser JA, et al. Anti-Mllerian hormone expression pattern inthe human ovary: potential implications for initial and cyclicfollicle recruitment. Mol Hum Reprod. 2004;10:7783.

2. Li HW, Wong CY, Yeung WS, Ho PC, Ng EH. Serumanti-Mllerian hormone level is not altered in women usinghormonal contraceptives. Contraception. 2011;83:5825.

3. La Marca A, Stabile G, Artenisio AC, Volpe A. Serumanti-Mllerian hormone throughout the human menstrualcycle. Hum Reprod. 2006;21:31037.

4. Ledger WL. Measurement of anti-Mllerian hormone: not asstraightforward as it seems. Fertil Steril. 2014;101:339.

5. La Marca A, Sighinolfi G, Radi D, Argento C, Baraldi E,Artenisio AC, et al. Anti-Mllerian hormone (AMH) as a

predictive marker in assisted reproductive technology (ART).Hum Reprod Update. 2010;16:11330.

6. Freour T, Mirallie S, Bach-Ngohou K, Denis M, Barriere P,Masson D. Measurement of serum anti-Mllerian hormone by 1 4;2 9(1):12

Beckman Coulter Elisa and DSL Elisa: comparison andrelevance in assisted reproduction technology (ART). ClinChim Acta. 2007;375:1624.

7. Leader B, Hegde A, Baca Q, Stone K, Lannon B, Seifer DB, et al.High frequency of discordance between anti-Mllerianhormone and follicle-stimulating hormone levels in serumfrom estradiol-confirmed days 2 to 4 of the menstrual cyclefrom 5,354 women in U.S. fertility centers. Fertil Steril.2012;98:103742.

8. Muttukrishna S, McGarrigle H, Wakim R, Khadum I, RanieriDM, Serhal P. Antral follicle count, anti-Mllerian hormoneand inhibin B: predictors of ovarian response in assistedreproductive technology? BJOG. 2005;112:138490.

9. Silberstein T, MacLaughlin DT, Shai I, Trimarchi JR,Lambert-Messerlian G, Seifer DB, et al. Mullerian inhibitingsubstance levels at the time of HCG administration in IVFcycles predict both ovarian reserve and embryo morphology.Hum Reprod. 2006;21:15963.

0. Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. Asystematic review of tests predicting ovarian reserve and IVFoutcome. Hum Reprod Update. 2006;12:685718.

Leopoldo de Oliveira TsoEditor da Revista Reproduco & Climatrio

E-mail: leotso@uol.com.brhttp://dx.doi.org/10.1016/j.recli.2014.07.0041413-2087/ 2014 Sociedade Brasileira de ReproducoHumana. Publicado por Elsevier Editora Ltda. Todos os

direitos reservados.

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