Prediction of Ovarian Response by Antimullerian Hormone in Women with Polycystic Ovarian Syndrome: A Randomized Prospective Study

Abstract

033Anti-Müllerian hormone (AMH) is proved as an outstanding contributors to this disorder [4,5].AMH is synthesized specifically by granulose cells of developing ovarian preantral and small antral follicles. Circulating AMH levels in women with PCOS are 2-to 3-fold more compared to ovulatory women with normal ovaries [6,7], which denotes to the 2-to 3-fold rise in the count of small follicles detected in PCOS. The excessive AMH has been hypothesized to decrease follicle sensitivity to FSH induction and oestradiol production, so hindering follicle selection, resulting in follicular maturation arrest at the small antral phase with the failure to reach maturity.Gonadotropin induction is widely utilized for ovulation stimulation in clomiphene citrate resistant PCOS women [8]. Human menopausal gonadotropin (hMG) is prepared by extraction from postmenopausal women urine. Commercial preparations contain 75 units of FSH and 75 units LH (Pergonal, Serono and Humegon, Organon) [9]. The utilization of urofollitropin, a purified FSH free of LH activity, looks to be an advisable therapy, since there is a proof that pure FSH may significantly decrease persistently high LH levels, favorably change the intraovarian hormonal environment, and IntroductionPolycystic ovary syndrome (PCOS) is the most frequent endocrine abnormality in women of reproductive age, with a prevalence of nearly 5-10 %. PCOS is the main reason of an ovulatory infertility [1]. The recent reports demonstrate that ovarian dysfunction results from ovarian follicle disorders in PCOS women are 2-folds [2,3]. First, early follicular development is excessive, so women with PCOS are characterized by an increase number of developing small antral follicles (2-to 3-folds that of normal ovaries). Secondly, the selection of the dominant follicle from the excessive pool of selectable follicles does not occur. This second disorder in the process of folliculogenesis is named the follicular arrest (FA) and explains the ovulatory dysfunction of PCOS. Although the FA has not clearly explained, Research AbstractObjective: To assess the effect of high level of circulating antimullerian hormone on the outcome of gonadotrophin ovulation induction in women with polycystic ovarian syndrome. Patients and Methods:This was a prospective study performed at Ain Shams University Maternity Hospital, over a 3-year period, between Jan 2013 and Jan 2016, and included 300 women who were presented at the infertility clinic and scheduled for having gonadotrophin ovulation induction. Participant ages ranged from 18 to 35 years, the patients were divided into two equal groups; group I (N=150) included women with PCOS having antimullerian hormone < 7.7 mg/dl and group II (N=150) which included women with PCOS with antimullerian hormone ≥ 7.7 mg/dl. The two groups underwent gonadotrophin stimulation of the ovary, serum AMH concentrations were measured on cycle day 3 before the commencement of gonadotrophins ovarian induction. Ovarian response and the biochemical and clinical pregnancy rates were a...