Antral follicle count versus serum anti-mullerian hormone for prediction of ovarian hypertimulation in patients with polycystic ovary syndrome treated with human menopausal gonadotropins

Abstract

The aim of this work was to compare the antral follicle count and the serum anti-Mullarian hormone concentration as predictors of ovarian hyperstimulation in patients with PCOS treated for ovulation induction with human menopausal gonadotrohins (HMG). Prospective study. A total of 33 anovulatory patients with PCOS (Rotterdam consensus) were studied. Antral follicle count (AFC) was measured on day 3 of a spontaneous or induced menstrual cycle. Day 3 serum levels of anti-Mullerian hormone (AMH) were also determined. A dose of 2 HMG ampoules (150 IU) was administered IM daily starting on day 5 of the cycle. Monitoring was effected by ultrasound and the dose was increased to 3 ampoules (225 IU) if the response was inadequate. HCG (5000 IU) was administered IM when the leading follicle reached 18 mm in diameter. Serum E2 was measured on the day of HCG administration and ovarian hyperstimulation was diagnosed if above 3000 pg/ml. The patient was seen 7 days later to determine the occurrence or otherwise of clinical OHSS. Eleven patients developed ovarian hyperstimulation (33.3%). The mean serum estradiol level (+/- SD) on the day of HCG was 5965.82 pg/ml (+/- 1591.99) pg/ml in the hyper-stimulated group compared to 2207.27 (+/- 859.32) in the normo-stimulated group (P< 0.0001). The mean (+/- SD) AFC was higher in the hyper-stimulated group (21.64 +/- 3.20 versus 14.32 +/- 3.81; P< 0.0002). Similarly, the mean (+/- SD) serum level of AMC was higher in the hyper-stimulated group (4.50+ /- 2.87 ng/ml versus 2.17 +/- 1.55; P< 0.005). Receiver operator characteristic curves showed that the day 3 AFC was a better predictor of ovarian hyperstimulation than day 3 level of AMH (area under the curve 0.926 versus 0.771). Seven patients developed clinical OHSS, three were treated with IV albumin and one required aspiration of ascetic fluid. Day 3 AFC is a better predictor of ovarian hyperstimulation than day 3 AMH level in PCOS patients treated with HMG.