Anti-Müllerian hormone as a predictor of polycystic ovary syndrome treated with clomiphene citrate

Abstract

ObjectiveThis study aimed to determine the threshold of anti-Müllerian hormone (AMH) as predictor of follicular growth failure in polycystic ovary syndrome (PCOS) patients treated with clomiphene citrate (CC).MethodsFifty female subjects with PCOS were recruited and divided into two groups based on successful and unsuccessful follicular growth. Related variables such as age, infertility duration, cigarette smoking, use of Moslem hijab, sunlight exposure, fiber intake, body mass index, waist circumference, AMH level, 25-hydroxy vitamin D level, and growth of dominant follicles were obtained, assessed, and statistically analyzed.ResultsThe AMH levels of patients with successful follicular growth were significantly lower (p=0.001) than those with unsuccessful follicular growth (6.10±3.52 vs. 10.43±4.78 ng/mL). A higher volume of fiber intake was also observed in the successful follicular growth group compared to unsuccessful follicular growth group (p=0.001). Our study found the probability of successful follicle growth was a function of AMH level and the amount of fiber intake, expressed as Y=–2.35+(–0.312×AMH level)+(0.464×fiber intake) (area under the curve, 0.88; 95% confidence interval, 0.79–0.98; p<0.001).ConclusionThe optimal threshold of AMH level in predicting the failure of follicle growth in patients with PCOS treated with CC was 8.58 ng/mL.

Anti-Mullerian Hormone and Fertility Treatment Decisions in Polycystic Ovary Syndrome: A Literature Review

“…A high pre-treatment AMH merits initiating OI with higher doses of CC or LET than used in ovulatory women. [ 50 51 52 53 54 ] Alternatively, gonadotropins may be more effective in inducing ovulation in such women. In the context of IUI, very high levels of AMH >10 ng/ml may predict a poor response even with gonadotropins.…”

“…Another study using AMH Gen II assay found a level of 8.58 ng/ml to have 78% sensitivity and 67% specificity for the prediction of non-response to CC. [ 52 ] A small retrospective study further reported an AMH level of 9.78 as the discriminatory level beyond which cumulative ovulation rates were significantly lower. [ 53 ] Finally, in a large cohort study of women with PCOS using Gen II AMH assay, it was noted that women with higher AMH levels needed higher doses of CC or LET to achieve ovulation and the chances of ovulation reduced with increasing levels of AMH.…”

How to Choose the Optimal Starting Dose of Clomiphene Citrate (50 or 100 mg per Day) for a First Cycle of Ovulation Induction in Anovulatory PCOS Women?

“…The selected AMH cut-off was 86.7 pmol/L, but sensitivity and specificity were not satisfactory for clinical application (65.5% and 52%, respectively). The AMH thresholds proposed in the literature to predict total resistance to CC (150 mg/day dose) are highly variable (from 24.3 pmol/L to 88.4 pmol/L) with no satisfactory relative sensitivities and specificities [21,41,[46][47][48]. In addition, some authors found no significant difference in serum AMH levels between women ovulating on CC versus those resistant to treatment [49].…”

Anti-Mullerian Hormone Assessment in Assisted Reproductive Technique Outcome and Natural Conception

“…The AMH thresholds proposed in the literature to predict complete resistance to CC (150 mg/day dose) are highly variable (from 24.3 to 88.4 pmol/L or 3.4 to 12.4 ng/mL) with unsatisfactory sensitivities and specificities. [21][22][23][24][25][26] In addition, some authors found no significant difference in serum AMH levels between women ovulating on CC and those who were resistant to treatment. 27 The difference in the AMH test kits used in the different studies (which have different sensitivities) may explain these results.…”