Correlation of serum Anti-Müllerian hormone concentrations on day 3 of the in vitro fertilization stimulation cycle with assisted reproduction outcome in polycystic ovary syndrome patients

Abstract

Purpose To investigate whether serum Anti-Müllerian hormone (AMH) on day 3 could predict controlled ovarian stimulation and reproductive outcomes in women with polycystic ovary syndrome. Methods A total of 164 PCOS patients undergoing their first IVF treatment cycle were prospectively included. Serum AMH levels on cycle day 3 was measured. The controlled ovarian stimulation and clinical outcomes for the study population were divided according to the <25th, 25 to 75th, or >75th percentile of serum day-3 AMH. Results Estradiol levels on hCG day and the number of retrieved oocytes significantly increased with increasing serum AMH levels, while total consumption of gonadotropin dose showed a significant decrease (P<0.05). Fertilization rate and the number of good quality embryos were comparable among the low, average and high groups (P>0.05). Embryo implantation rates in the high AMH group was significantly inferior to those with low and average AMH concentration (27 versus 48.8 and 50%, P<0.01). Clinical pregnancy rates was lower in the high AMH group than that of the low and average group (45.9 versus 65 and 66.7%, P00.09), but this difference was only close to statistical significance. In addition, ordinal regression analysis indicated that LH level was the only independent predictor of embryo implantation rates (P00.017). Conclusions In PCOS women, AMH levels on day 3 of the IVF stimulation cycle positively predict ovarian response to gonadotrophins. However, the women with high AMH levels had a significantly decreased IR, which may be due to remarkably increased LH concentrations.Keywords Anti-Müllerian hormone . Assisted reproduction . Polycystic ovary syndrome . Serum AMH Anti-Müllerian hormone (AMH), also known as Müllerian inhibiting substance (MIS), is producted specifically by granulose cells of early developing pre-antral and small antral follicles in the ovary, and declines with advancing age. AMH has therefore been proposed as a novel clinical marker of ovarian reserve [1]. Another major reason for the interest in AMH is the fact that serum AMH levels are increased significantly in women with polycystic ovary syndrome (PCOS) when compared with normoovulatory women [2,3].PCOS is the most frequent cause of anovulatory infertility and hyperandrogenism in young women [4]. Women with this syndrome are characterized by an excessive number of small antral follicles (2-3 fold that of normal ovaries) [5]. As an exclusively granulosa cell product, it was initially proposed that the rise in serum AMH in PCOS was a consequence of the increased small antral follicle number in these ovaries [6]. The Capsule In PCOS women, high AMH levels on day 3 of the IVF stimulation cycle predict high ovarian response to gonadotrophins, but low embryo implantation rates.

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

“…Notably, in the study by Kaya et al [16] there were significant age differences between the three AMH strata: Women in the high AMH (>75th percentile), average AMH (25th-75th percentile) and low AMH (<25th percentile) groups had mean age of 25.1, 29.2 and 34.1, respectively. This was in contrast to the study by Xi et al [17] as well as the current study in which all three AMH groups were of more comparable age, which may explain some of the observed differences. Another possible explanation is the presence of multiple PCOS phenotypes and variable AMH concentration categorizations across studies.…”

“…While the literature suggests an inverse relationship between BMI and AMH [22], there was little variation in BMI between the different AMH level groups in this study. In agreement with previous literature, a direct relationship was found between testosterone and AMH levels [11,17] with a significant increase in the high AMH group compared to the average and low AMH groups. Total testosterone was 35.3 ± 10.2, 39.2 ± 12.8, and 58.0 ± 18.7 ng/dl in the <25th, 25 to 75th, and > 75th percentile, respectively.…”

“…To our knowledge, this study is unique in that it demonstrates that higher serum AMH levels are associated with lower assisted reproduction LBR in women with PCOS. There have been several investigations into the association between AMH and ART outcomes in women with PCOS, but they did not include live birth rate as an outcome [11,16,17]. These studies reported conflicting results, some demonstrating a positive relationship between serum AMH levels and CPR [11,16], while others having found an inverse relationship between serum AMH levels and CPR [17].…”

“…In studies that have looked at these relationships in PCOS women, the results are conflicting. Although some studies have suggested a positive relationship [11,16], some others have suggested an inverse relationship [17] between AMH concentration and pregnancy rates. Other studies have gone further to look at these associations based on PCOS phenotypes [18][19][20], but no consensus has been reached.…”

Relation of antimullerian hormone with the clinical signs of hyperandrogenism and polycystic ovary morphology

“…After having investigated several different parameters of PCOS, correlation between AMH and ovarian morphology was the strongest one. The cause of the increased AMH production in PCOS is unknown; however, increase in AMH concentration is largely attributed to the increase in the production of AMH by each follicle and not just a consequence of an increased follicle number [14,15]. Consistent with our previous results, amenorrheic women with PCOS display elevated AMH compared to oligomenorrheic women with PCOS, indicating the association of AMH in the pathogenesis of PCOS-related anovulation [8,10].…”