Anti-Mullerian Hormone (AMH) as a Predictor of Ovarian Response to Clomiphene Citrate in Polycystic Ovarian Syndrome

Abstract

Background: Serum Anti-Mullerian hormone (AMH) levels in women with polycystic ovary syndrome (PCOS) are two- to threefold higher than in ovulatory women with normal ovaries, corresponding to the two- to threefold increase in the number of small follicles in PCOS. The increased AMH has been hypothesized to reduce follicle sensitivity to follicle stimulating hormone (FSH) and estradiol production, thus preventing follicle selection, resulting in follicular arrest at the small antral phase with failure of dominance. Objective: The study was undertaken to test the hypothesis that high AMH level is associated with poor response to ovulation induction in PCOS women. Methods: This was a cross-sectional comparative study of 50 infertile women with PCOS, grouped into those with AMH level <8 ng/mL and those with AMH level [Formula: see text] 8 ng/mL. All participants received an initial dose of 100 mg/day of clomiphene citrate from 2nd to 6th day of menstrual cycle. Ovarian response (follicle size) was assessed by transvaginal monitoring on 12th day of cycle. Results: A total of 50 women were recruited, of which 4 dropped out. Women with AMH [Formula: see text] 8 ng/mL comprised only 23.91% of the PCOS women. AMH and day 12 follicle size had a statistically significant association. Adjusting for other confounding variables in linear, logarithmic, and logistic analysis, serum AMH had significant negative relationship with follicle size (r = 0.511, p < 0.001). AMH was also positively correlated with serum LH, testosterone and negatively correlated with serum follicle stimulating hormone (FSH), serum TSH and BMI. Conclusion: We observed that higher AMH level women had poor response to ovulation induction compared to women with low AMH level.