AMH能否被视为精液质量的有效标志？

Serum hormone evaluation is an integral part of the trinity of the workup for male factor fertility, the other two being a history and physical as well as semen analysis. With established reference points, these serum-level tests offer screening and indications of possible barriers to fertility. Moreover, it is crucial to have fully characterized hormonal reference ranges in the appropriate context. For instance, the distribution and positive predictive value of follicle-stimulating hormone levels in men with azoospermia have been shown to differ drastically from the previously proposed reference ranges often accompanying laboratory results . Despite falling within many laboratory “normal” reference ranges, follicle-stimulating hormone threshold levels >12.1 mIU/mL represent the upper 95th percentile of values.

血清激素评估是男性生育力评估三大检查项目之一，另两项则分别是病史和体格检查及精液分析。基于现有参考观点，这些血清水平检查是初步的筛查手段，并提供不育的可能原因。此外，在特定的情形中，具有充分的特征化的激素参考范围是至关重要的。例如，研究表明，由于不同实验室的检查结果不同，无精症男性的卵泡刺激素水平的分布和阳性预测值与先前建议的参考范围大相径庭。尽管仍在许多实验室的“正常”参考范围内，但FSH大于12.1 mIU/mL是阈值上限。

Antimüllerian hormone (AMH) is not a routinely investigated serum hormone in a clinical setting. In their manuscript, Holt et al.  set forth a prospective evaluation of the association between AMH levels and semen quality in men in the recruitment for the “First In Treating Male Infertility,” a double-blinded, placebo-controlled, single-center randomized clinical trial aimed to determine whether treatment with denosumab can improve semen quality in infertile men. The investigators report that a low serum AMH level is a marker of reduced sperm production and motility in infertile men, suggesting clinical relevance in the evaluation of male infertility.

抗苗勒氏激素（AMH）并非临床中常规检查项目。Holt等人进行了一项双盲、安慰剂对照、单中心随机临床试验，旨在确定使用地诺单抗治疗能否改善不育男性的精液质量。为此招募了“男性不育症初诊”患者，前瞻性地评估了这些患者AMH水平与精子质量的关系。研究显示，低血清AMH水平是精子生成减少和活力降低的标志物，在男性不育症评估中具有临床相关性。

Rarely do we see double-blinded, placebo-controlled studies in the sphere of male fertility. The larger collaborative study described invokes not just screening but possible intervention. Previous hormonal analyses, such as with 17-hydroxyprogesterone, have suggested nonconventional hormonal investigations as possible targets for stimulation therapy. Herein, the AMH level is currently discussed in a similar context.

在男性生育领域，我们很少看到双盲、安慰剂对照的研究。无论在筛查还是在可能的治疗干预方面都需要更大规模的协作研究。既往的激素分析，如17-羟基孕酮，已经提示了非传统的激素检查可能成为刺激治疗的靶点。本文中，对AMH水平的讨论与之有异曲同工之处。

Currently, no serum-level test remains a standalone test of fertility status. Overall, this study proposes an interesting premise with future applications. We are excited but will await the results of the larger collaborative study.

目前，没有一项血清水平检查能作为判断生育能力的独立指标。总而言之，这项研究提出了一个有趣的未来应用前景。我们对此感到激动，但仍很期待更大规模协作研究的结果。

参考文献：

Should we consider antimüllerian hormone a valid marker of semen quality?Campbell, Kevin J.Fertility and Sterility, Volume 122, Issue 2, 266