A prospective randomised controlled study of serum anti-mullerian hormone (AMH) as a predictive marker of ovarian hyperstimulation syndrome (OHSS) in IVF-ICSI cycles

Abstract

ObjectiveThe objective of this prospective randomised controlled study was to determine whether serum Anti Mullerian Hormone (AMH) level can predict ovarian hyperstimulation syndrome (OHSS) prior to the selection of controlled ovarian stimulation (COS) protocols.DesignA total of 380 IVF-ICSI cycles at our centre from 2007 to 2012 were prospectively studied. The patients in the study underwent a long GnRH-Agonist or an Antagonist protocol after randomisation using a computer generated list.Materials and MethodsBaseline hormone profile and AMH were determined on day-2. The ovarian response was monitored using transvaginal ultrasound on a daily basis until the day of hCG administration. Blood sampling for estradiol (E2) level was performed after five days of stimulation and on the day of hCG administration. Only patients with a moderate or severe degree of OHSS were considered as positive cases of OHSS.ResultsIn our study, 06% (23/380) of all patients developed moderate to severe OHSS. 04% (8/200) patients undergoing the Antagonist protocol and 8.3% (15/180) patients undergoing the long GnRH Agonist protocol developed OHSS. Only 34% (8/23) patients with OHSS had PCOS. We found that PCOS patients had high serum AMH levels. The mean serum AMH level for patients with OHSS in our study was 5.8 ng/ml. Thus, the basal serum AMH level appeared to be a more efficient predictor of OHSS than the patients Age, BMI and AFC.ConclusionHigh serum AMH levels can be utilised to predict ovarian hyperstimulation syndrome (OHSS) in IVF-ICSI cycles in a better way than than Age, BMI and AFC and mild stimulation protocols may be applied in such patients. This study indicates that a single AMH assay may be used to individualise treatment strategies for IVF-ICSI cycles. AMH levels may be used to adjust gonadotropin doses independently of AFC, Age and BMI. Based on this evidence, AMH may be a useful marker to predict OHSS for IVF-ICSI cycles, in addition to being an appropriate marker for ovarian reserve. ObjectiveThe objective of this prospective randomised controlled study was to determine whether serum Anti Mullerian Hormone (AMH) level can predict ovarian hyperstimulation syndrome (OHSS) prior to the selection of controlled ovarian stimulation (COS) protocols. The objective of this prospective randomised controlled study was to determine whether serum Anti Mullerian Hormone (AMH) level can predict ovarian hyperstimulation syndrome (OHSS) prior to the selection of controlled ovarian stimulation (COS) protocols. DesignA total of 380 IVF-ICSI cycles at our centre from 2007 to 2012 were prospectively studied. The patients in the study underwent a long GnRH-Agonist or an Antagonist protocol after randomisation using a computer generated list. A total of 380 IVF-ICSI cycles at our centre from 2007 to 2012 were prospectively studied. The patients in the study underwent a long GnRH-Agonist or an Antagonist protocol after randomisation using a computer generated list. Materials and MethodsBaseline hormone profile and AMH were determined on day-2. The ovarian response was monitored using transvaginal ultrasound on a daily basis until the day of hCG administration. Blood sampling for estradiol (E2) level was performed after five days of stimulation and on the day of hCG administration. Only patients with a moderate or severe degree of OHSS were considered as positive cases of OHSS. Baseline hormone profile and AMH were determined on day-2. The ovarian response was monitored using transvaginal ultrasound on a daily basis until the day of hCG administration. Blood sampling for estradiol (E2) level was performed after five days of stimulation and on the day of hCG administration. Only patients with a moderate or severe degree of OHSS were considered as positive cases of OHSS. ResultsIn our study, 06% (23/380) of all patients developed moderate to severe OHSS. 04% (8/200) patients undergoing the Antagonist protocol and 8.3% (15/180) patients undergoing the long GnRH Agonist protocol developed OHSS. Only 34% (8/23) patients with OHSS had PCOS. We found that PCOS patients had high serum AMH levels. The mean serum AMH level for patients with OHSS in our study was 5.8 ng/ml. Thus, the basal serum AMH level appeared to be a more efficient predictor of OHSS than the patients Age, BMI and AFC. In our study, 06% (23/380) of all patients developed moderate to severe OHSS. 04% (8/200) patients undergoing the Antagonist protocol and 8.3% (15/180) patients undergoing the long GnRH Agonist protocol developed OHSS. Only 34% (8/23) patients with OHSS had PCOS. We found that PCOS patients had high serum AMH levels. The mean serum AMH level for patients with OHSS in our study was 5.8 ng/ml. Thus, the basal serum AMH level appeared to be a more efficient predictor of OHSS than the patients Age, BMI and AFC. ConclusionHigh serum AMH levels can be utilised to predict ovarian hyperstimulation syndrome (OHSS) in IVF-ICSI cycles in a better way than than Age, BMI and AFC and mild stimulation protocols may be applied in such patients. This study indicates that a single AMH assay may be used to individualise treatment strategies for IVF-ICSI cycles. AMH levels may be used to adjust gonadotropin doses independently of AFC, Age and BMI. Based on this evidence, AMH may be a useful marker to predict OHSS for IVF-ICSI cycles, in addition to being an appropriate marker for ovarian reserve. High serum AMH levels can be utilised to predict ovarian hyperstimulation syndrome (OHSS) in IVF-ICSI cycles in a better way than than Age, BMI and AFC and mild stimulation protocols may be applied in such patients. This study indicates that a single AMH assay may be used to individualise treatment strategies for IVF-ICSI cycles. AMH levels may be used to adjust gonadotropin doses independently of AFC, Age and BMI. Based on this evidence, AMH may be a useful marker to predict OHSS for IVF-ICSI cycles, in addition to being an appropriate marker for ovarian reserve.