High serum Antimullerian hormone levels are associated with lower live birth rates in women with polycystic ovarian syndrome undergoing assisted reproductive technology

Reshef Tal,Charles M Seifer,Moisey Khanimov,Oded Tal,David B Seifer

doi:10.1186/s12958-020-00581-4

Abstract

IntroductionAntimullerian hormone (AMH) strongly correlates with ovarian reserve and response to controlled ovarian stimulation. Emerging data suggests that serum AMH level may also predict ART outcomes. However, AMH is characteristically elevated in PCOS women and it is unknown whether it may predict live birth outcomes in this population.MethodsThis was a retrospective cohort study of 184 PCOS women (Rotterdam criteria) who underwent their first fresh IVF/ICSI cycle. Women were divided into 3 groups according to the <25th (low), 25 to 75th (average), or > 75th (high) percentile of serum AMH concentration. Cycle stimulation parameters and reproductive outcomes were compared between groups.ResultsWomen in the low serum AMH group were older than those in the average or high AMH (p < 0.05), and required greater gonadotropin dose for stimulation compared to the high AMH group (p < 0.05). Women with high AMH had greater testosterone level compared to women in the low or average AMH groups. No differences were noted between groups in terms of maximal E2, oocytes retrieved and fertilization rate. However, low serum AMH women had significantly greater live birth rates (p < 0.05) and showed a trend towards greater clinical pregnancy rates compared to women in the average and high AMH groups (p = 0.09). The significant association of AMH with live birth rate remained after adjusting for age, BMI, day of transfer and number of embryos transferred.ConclusionsIn PCOS women, elevated AMH concentrations are associated with hyperandrogenism and lower live birth rates.

Highlights

Antimullerian hormone (AMH) strongly correlates with ovarian reserve and response to controlled ovarian stimulation
The women’s demographics, cycle characteristics and clinical and laboratory data were extracted from electronic medical records and included the following parameters: age, body mass index (BMI), serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), AMH, total testosterone, dehydroepiandrosterone sulfate (DHEAS), 17-OH-progesterone, thyroid-stimulating hormone (TSH), and prolactin
AMH levels decreased with increasing age of women in our cohort, with women in the low AMH group being significantly older compared to the average and high AMH groups

Summary

Introduction

Antimullerian hormone (AMH) strongly correlates with ovarian reserve and response to controlled ovarian stimulation. Anti-Müllerian hormone (AMH), or Müllerian inhibiting substance (MIS), is a member of the transforming growth factor beta (TGF-β) superfamily. It is an established indicator of ovarian reserve and predictor of ovarian response in assisted reproductive technologies (ART) [1, 2]. In women with polycystic ovarian syndrome (PCOS) serum AMH is elevated, around 2 to 4-fold higher than normal, which is thought to be implicated in the pathogenesis of PCOS. Is follicular excess contributing to elevated AMH, but granulosa cells in women with PCOS have been shown to overproduce AMH [5]. Based on the evidence for the association of AMH with PCOS pathophysiology, it has been investigated whether serum AMH may be related to assisted reproductive outcomes in women with PCOS

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