AMHR2 Polymorphism in Blood and Granulosa Cells in Unexplained Infertility

Antimullerian Hormone Receptor 2 Polymorphism in Blood and Granulosa Cells in Unexplained Infertility

There are various known parameters for assessing ovarian reserve, including ovarian volume, antral follicle count, follicle stimulating hormone (FSH) and Inhibin B at the beginning of the menstrual cycle, as well as anti-Mullerian hormone (AMH). Anti-müllerian hormone is a dimeric glycoprotein and a member of the transforming growth factor β family that plays a role in the regulation of follicular development. AMH is produced by granulosa cells of the early developing follicles in the ovary, and continues to be expressed in the growing follicles until these follicles have reached a size of 4-6 mm and a differentiation state at which AMH becomes receptive for exogenous FSH, and may be selected for dominance.It exerts its biological effects through the receptor AMHR2, which is present on granulosa and theca cells. Considering the important role of the AMH signalling pathway in regulating FSH sensitivity in the ovary and follicular recruitment and selection, it is appropriate to consider that variation in the genes encoding key proteins in the pathway may influence ovarian response. The aim of this study is to investigate the effect of the distribution of single gene polymorphisms of the AMHR2 receptor gene A-482G/rs200255 in patients with unexplained infertility and to compare this distribution with the distribution in women without infertility.

Study Overview

• Status: Recruiting
• Conditions: Infertility, Female; IVF; AMH
• Intervention / Treatment: Genetic: AMHR2 polymorphism in blood; Genetic: AMHR2 polymorphism in granulosa cell

Detailed Description

This prospective, controlled cohort study was conducted at IVF Centre of Department of Obstetrics and Gynecology, Bezmialem University Hospital between October 2022 and April 2023. The study protocol was approved by the Ethical Committee of the Medical Faculty of Bezmialem University. Written informed consent was obtained from all patients. This trial was designed and reported according to the Consolidated Standards of Reporting Trials (CONSORT) guidelines.

The patients were divided into 3 groups. Group 1 (study group; unexplained infertilitiy, n=32), Group 2 ( first control group; healthy women with a history of at least one successful previous pregnancy, n=32), Group 3 ( second control group; infertile patients undergo IVF because of male or tubal factor, n=32). Inclusion criteria for the study were as follows: <40 years of age, normal serum levels of TSH and prolactin presence of both ovaries without any morphological abnormalities, normal ovulatory cycles (25-35 days), body mass index (BMI) ≤30, no previous history of poor response and no evidence of endocrine disease, such as polycystic ovary syndrome, hipo-hyper prolactinemia, no use of hormone therapy in the 6 months preceding the recruitment and commencing IVF treatment. Patients with moderate/severe endometriosis (stage III and IV), previous ovarian surgery or underwent chemo/radiotherapy excluded from the study.

At the first application, peripheral blood will be taken from the Study group, 1st Control and 2nd Control group to evaluate polymorphisms of the AMHR2-482A>G(rs200255) with PCR analysis. During IVF treatment at the day of ovum pick up; follicular fluid will be collected to isolate granulosa cell for polymorphisms of the AMHR2-482A>G(rs200255) with PCR analysis.

The total number of embryos, the number of embryos transferred, the number of frozen and viable embryos will be recorded. After the embryo transfer is performed in the study group and the 2nd control group, the pregnancy results will be recorded by checking the bhcg in the blood on the 10-12th day of the transfer.

• Study Type: Observational
• Enrollment (Anticipated): 96

Contacts and Locations

• Study Contact: Name: Pinar Ozcan, MD,PhD; Phone Number: +905414031625; Email: pinarozcan@hotmail.com

Study Locations

• Turkey
  • Istanbul, Turkey
    • Recruiting
    • Bezmialem Vakif University
    • Contact: Pinar Ozcan, MD, PhD; Phone Number: +905414031625; Email: drpinarozcan@hotmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 40 years (Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

Unexplained infertility group

Description

inclusion criteria

• unexplained infertility (study group)
• a healthy women with a history of at least one successful previous pregnancy resulting from spontaneous conception (first control group)
• infertility caused by male factor, tubal factor (second control group)
• <40 years of age
• normal serum levels of TSH and prolactin
• presence of both ovaries without any morphological abnormalities
• normal ovulatory cycles (25-35 days)
• body mass index (BMI) ≤30
• no previous history of poor response and no evidence of endocrine disease, such as polycystic ovary syndrome, hipo-hyper prolactinemia
• no use of hormone therapy in the 6 months preceding the recruitment
• undergoing IVF

exclusion criteria

• Patients with moderate/severe endometriosis (stage III and IV)
• previous ovarian surgery or underwent chemo/radiotherapy

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Study Group; Patients with Unexplained İnfertility	Genetic: AMHR2 polymorphism in blood; 1 tube of blood taken at the first application; Genetic: AMHR2 polymorphism in granulosa cell; Extraction of granulosa cell from the follicle fluid obtained during OPU
First Control Group; Healthy Multiparous Women	Genetic: AMHR2 polymorphism in blood; 1 tube of blood taken at the first application
Second Control Group; A: Patients with male infertility B: Patients with tubal factor	Genetic: AMHR2 polymorphism in blood; 1 tube of blood taken at the first application; Genetic: AMHR2 polymorphism in granulosa cell; Extraction of granulosa cell from the follicle fluid obtained during OPU

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Ovarian response	Number of oocytes, 5th day blast rate	average of 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Ongoing pregnancy rate	Pregnancies that continue until the 12th week of pregnancy	average of 9 months

Collaborators and Investigators

• Sponsor: Bezmialem Vakif University
• Investigators: Study Chair: Pinar Ozcan, MD, PhD, BEZMİALEM VAKIF ÜNİVERSİTESİ

Publications and helpful links

General Publications

• Yoshida Y, Yamashita Y, Saito N, Ono Y, Yamamoto H, Nakamura Y, Hayashi A, Terai Y, Ohmichi M. Analyzing the possible involvement of anti-Mullerian hormone and anti-Mullerian hormone receptor II single nucleotide polymorphism in infertility. J Assist Reprod Genet. 2014 Feb;31(2):163-8. doi: 10.1007/s10815-013-0134-7. Epub 2013 Nov 24.
• Peluso C, Fonseca FL, Gastaldo GG, Christofolini DM, Cordts EB, Barbosa CP, Bianco B. AMH and AMHR2 polymorphisms and AMH serum level can predict assisted reproduction outcomes: a cross-sectional study. Cell Physiol Biochem. 2015;35(4):1401-12. doi: 10.1159/000373961. Epub 2015 Mar 12.
• Cerra C, Newman WG, Tohlob D, Byers H, Horne G, Roberts SA, Mohiyiddeen L. AMH type II receptor and AMH gene polymorphisms are not associated with ovarian reserve, response, or outcomes in ovarian stimulation. J Assist Reprod Genet. 2016 Aug;33(8):1085-91. doi: 10.1007/s10815-016-0711-7. Epub 2016 May 3.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2022
• Primary Completion (Anticipated): December 1, 2023
• Study Completion (Anticipated): December 1, 2023

Study Registration Dates

• First Submitted: October 20, 2022
• First Submitted That Met QC Criteria: October 20, 2022
• First Posted (Actual): October 25, 2022

Study Record Updates

• Last Update Posted (Estimate): May 5, 2023
• Last Update Submitted That Met QC Criteria: May 3, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Keywords: unexplained infertility; anti-mullerian hormone receptor2 polymorphism
• Additional Relevant MeSH Terms: Infertility; Infertility, Female
• Other Study ID Numbers: 09.06.2022-E.65396

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No