Abstract
Objectives:Anti-mullerian hormone (AMH) is a marker of the activity of recruitable ovarian follicles. It is useful in the prediction of ovarian reserve. Women with polycystic ovarian syndrome (PCOS) have elevated circulating and intrafollicular AMH levels. Laparoscopic ovarian drilling (LOD) in patients with PCOS destroys ovarian androgen-producing tissue and reduces their peripheral conversion to estrogens. Identifying factors that determine the response of patients with PCOS to LOD will help in selecting the patients who would likely benefit from this treatment. AMH is one such marker that can predict the response to LOD. To evaluate the effect of LOD on serum AMH levels among PCOS responders and non-responders and the usefulness of AMH as a tool in predicting the response to LOD, and to whether there was loss of ovarian function after LOD.Materials and Methods:This is a prospective cohort study including 30 clomiphene-resistant women with anovulatory PCOS undergoing LOD. Statistical analysis was performed to evaluate the effect of LOD on serum levels of AMH on these women.Results:A significant fall in the levels of AMH was observed after LOD in both responders and non-responders (p<0.001). Women with AMH >8.3 ng/mL showed a significantly lower ovulation rate (33.3%). LOD was not associated with a risk of diminished ovarian reserve.Conclusion:LOD is an effective first-line treatment for women with PCOS who are clomiphene resistant. LOD has no negative effect on ovarian reserve. AMH is a useful marker in predicting the outcome of LOD.
Highlights
Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders of women in the reproductive age group, affecting about 4 to 12% of women worldwide[1]
There was no significant difference in luteinizing hormone (LH), LH:folliclestimulating hormone (FSH) between responders and non-responders both before and after Laparoscopic ovarian drilling (LOD) (Table 1 and 2)
As a result of LOD, significant reductions in levels of Anti-mullerian hormone (AMH) were observed in both responders and nonresponders, but the magnitude of change was significantly higher in responders (p
Summary
Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders of women in the reproductive age group, affecting about 4 to 12% of women worldwide[1]. It is characterized by a combination of hyperandrogenism (either clinical or biochemical), chronic anovulation and polycystic ovaries, and is frequently associated with insulin resistance and obesity. The consistency of serum levels of AMH throughout the menstrual cycle, with very little inter cycle variability, makes it an attractive marker of response to treatment With this background, we conducted a prospective cohort study to evaluate the effect of LOD on plasma levels of AMH in PCOS
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