International Journal of Fertility and Sterility (Apr 2021)
Anti-Müllerian Hormone Predictive Levels to Determine The Likelihood of Ovarian Hyper-Response in Infertile Women with Polycystic Ovarian Morphology
Abstract
Background: The objective of this study was to investigate serum levels of anti-Müllerian hormone (AMH) innormal-ovulatory infertile women with polycystic ovarian morphology (PCOM) and their association with ovarianhyper-response.Materials and Methods: This prospective cohort study was carried out on 100 infertile women with PCOM whowere treated with an antagonist/agonist triggered stimulation protocol at Shahid Akbar-Abadi Hospital IVF Centre,Tehran, Iran. Serum AMH levels were measured before starting the assisted reproductive technology (ART) cycleand the ovarian hyper-response was evaluated by retrieved oocyte numbers, ooestradiol levels on the triggeringday, and the incidence of ovarian hyper-stimulation syndrome (OHSS) clinical signs and symptoms. Logistic regressionand the area under the curve (AUC) were used to estimate the effects of AMH and the accuracy of the test.Results: Receiver operating characteristic (ROC) curve analysis showed that AMH could significantly predict ovarianhyper-response in PCOM patients (AUC=0.73). The estimated threshold value was 4.95 ng/ml, with a specificityof 74.58% (95% confidence interval [CI]: 50.85, 93.22) and sensitivity of 73.17% (95% CI: 48.78, 92.68). Logisticregression results showed a significant interaction between AMH and body mass index (BMI, P=0.008), which indicatedthat BMI had a moderation effect.Conclusion: Individualized stimulation protocols for patients with isolated PCOM and AMH greater than 4.95 ng/mlmay significantly reduce the chances of developing OHSS. However, the AMH cut-off values to predict ovarian hyperresponsediffer for different BMI categories among PCOM patients; thus, it becomes a more precise predictive markerwith increasing BMI.
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