Abstract
AimWe intended to establish the threshold of Anti-Mullerian Hormone (AMH) for detection of Ovarian Hyper-Stimulation Syndrome (OHSS) and poor response to treatment in Iranian infertile women.MethodsPre-stimulation menstrual cycle day-3 hormonal indices including basal AMH values were measured in 105 infertile women aged 32.5 ± 4.3 years. Patients underwent long GnRH agonist Controlled Ovarian Hyperstimulation (COH) in a referral infertility center (Tehran, Iran). The gonadotropin dose was determined based on the age and basal serum Follicular Stimulating Hormone (FSH) level. The IVF/ICSI cycles were followed and the clinical and sonographic data were recorded.ResultsSixteen cases developed OHSS. The prevalence of PCOS was higher in subjects with OHSS [62.5 % (38.8-86.2) vs. 17 % (9.2-24.9)]. The patients with OHSS had higher ovarian follicular count [23.7 (3.2) vs. 9.1 (0.5); p < 0.05], collected oocytes [13.5 (1.9) vs. 6.9 (0.5); p < 0.05] and AMH level [7.9 (0.7) vs. 3.6 (0.3); p < 0.05]. Basal AMH level and oocyte yields (but not age, BMI, and PCOS) correlated with occurrence of OHSS; and only the AMH levels were associated with poor ovarian response (oocytes yield ≤ 4). The optimal cutoff value for the prediction of OHSS was 6.95 ng/ml (area under the receiver operating characteristics curve: 0.86; CI: 0.78-0.95; sensitivity: 75 %; specificity: 84 %; odds ratio for occurrence of OHSS: 9 and p < 0.001). The optimal cut point to discriminate poor response (oocytes ≤4) was 1.65 ng/ml ( AUC : 0.8; CI: 0.69-0.91; sensitivity: 89 % specificity : 71 %; and OR = 23.8 and P value <0.001).ConclusionsIranian women with basal AMH level > 6.95 ng/ml are at high risk of developing OHSS and those with AMH level < 1.65 ng/ml are poor responders.
Highlights
Anti-Mullerian Hormone (AMH) is a granulosa cell derived hormone secreted from pre-antral and small antral follicles
Basal AMH level and oocyte yields correlated with occurrence of Ovarian Hyper-Stimulation Syndrome (OHSS); and only the AMH levels were associated with poor ovarian response
Iranian women with basal AMH level > 6.95 ng/ml are at high risk of developing OHSS and those with AMH level < 1.65 ng/ml are poor responders
Summary
Anti-Mullerian Hormone (AMH) is a granulosa cell derived hormone secreted from pre-antral and small antral follicles. AMH substantially inhibits the initiation of primordial follicle growth and contributes to normal folliculogenesis by enhancing the role of FSH in cyclic recruitment of follicles [1]. AMH can serve as a reliable ovarian reserve marker [2] independent of gonadotropins levels [3]. A helpful aspect of AMH, when used as an ovarian reserve marker, is that its serum levels remain relatively constant during normal menstrual cycles [4,5,6]. The reported variability during the menstrual cycles is not possibly clinically influential [7]. In 2002, Seifer et al underscored the association of AMH levels with ovarian response to Controlled Ovarian Hyperstimulation (COH) [8]. The recent metaanalysis by Broer et al highlighted 9 studies employing AMH to predict excessive responses during COH [9]. While the ability to predict excessive ovarian stimulation using basal AMH values is established, the optimal threshold of AMH to predict Ovarian Hyper-Stimulation Syndrome (OHSS) is controversial and subjected to this research
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