Serum anti-mullerian hormone and estradiol levels as predictors of ovarian hyperstimulation syndrome in assisted reproduction technology cycles

Lee, Tsung-Hsien; Liu, Chung Hsien; Huang, Chuin Chia; Wu, Yi; Shih, Yang Tse; Ho, Hong Nerng; Yang, Yu Shih; Lee, Maw Shang

doi:10.1093/humrep/dem254

Cited by 231 publications

(137 citation statements)

References 37 publications

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“…Firstly, recent studies have suggested that women with high levels of AMH are at considerably increased risk of developing OHSS [15,18,38,39]. A clinician may use this information to reduce the starting dose of FSH in such "high risk" patients, thereby reducing their chances of developing OHSS.…”

Section: Discussionmentioning

confidence: 99%

Increased gonadotrophin stimulation does not improve IVF outcomes in patients with predicted poor ovarian reserve

Lekamge

Lane

Gilchrist³

et al. 2008

J Assist Reprod Genet

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Purpose This retrospective study was carried out to evaluate whether increasing the starting dose of FSH stimulation above the standard dose of 150 IU/day in patients with low predicted ovarian reserve can improve IVF outcomes. Method A total of 122 women aged less than 36 years in their first cycle of IVF were identified as having likely low ovarian reserve based on a serum AMH measurement below 14 pmol/l. Thirty five women were administered the standard dose of 150 IU/day FSH, while the remaining 87 received a higher starting dose (200-300 IU/day FSH). There were no significant differences in age, BMI, antral follicle count, serum AMH, FSH or aetiology of infertility between the two dose groups.Results No significant improvement in oocyte and embryo yield or pregnancy rates was observed following an upward adjustment of FSH starting dose. While increasing the dose of FSH above 150 IU/day did not produce any adverse events such as OHSS, it did consume an extra 1,100 IU of FSH per IVF cycle. ConclusionThe upward FSH dose adjustment in anticipation of low ovarian reserve can not be advocated as it is both expensive and of no proven clinical value.

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Section: Discussionmentioning

confidence: 99%

Increased gonadotrophin stimulation does not improve IVF outcomes in patients with predicted poor ovarian reserve

Lekamge

Lane

Gilchrist³

et al. 2008

J Assist Reprod Genet

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show abstract

“…Two large randomized trials revealed that AMH is highly predictive of OHSS. A cut-off value of AMH levels ~ ≥3.5 ng/ml had high sensitivities and specificities 11,12 . Lee et al demonstrated that basal AMH and serum E2 on the day of trigger are reliable predictors of OHSS with AMH cut-off value of > 3.36 ng/mL, with sensitivity of 90.5% and specificity of 81.3%.…”

Section: Discussionmentioning

confidence: 99%

“…Other Studies investigated the value of low BMI (low body weight) in the prediction of OHSS with reported contradictory results. Currently BMI is not a useful marker for prediction of OHSS 11,30 . Similarly AFC while significant in the OHSS group, no cut-off value could be obtained (non-significant ROC analysis).…”

Section: Discussionmentioning

confidence: 99%

Using Anti-Müllerian Hormone and Serum Estradiol to Predict Ovarian Hyperstimulation Syndrome in Patients Using Antagonist Protocol During IVF/ICSI Cycles

2017

Evidence Based Women's Health Journal

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Objectives: To investigate the ability of Anti-Müllerian hormone (AMH) and estradiol (E2) to predict OHSS in women using the GnRH antagonist protocol while undergoing invitro-fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI). Study design: Retrospective analysis of women who had performed IVF/ICSI at assisted conception unit of Kasr Alainy university hospital over a period of 3 years. Patients and Methods: Basal serum AMH, estradiol (E2) level on the day of ovulation trigger and OHSS, among various other parameters were recorded and analyzed. Results: Thirty cases of OHSS (8.54%) were identified. There was no statistical difference in incidence of OHSS among age (p=0.976), FSH (p=0.286), LH (p=0.932), TSH (p=0.277), and prolactin (p=0.283), however, AMH (p=0.04), BMI (p=0.012), AFC (p< 0.001), and E2 before trigger (p<0.001) were significant. The overall clinical pregnancy rate was 27.35 % (n=96). The receiver operator analysis curve had a cut-off value of 4.45ng/ml (80%, sensitivity & 56% specificity). The area under the curve (AUC) was 0.661 with 95% confidence interval (CI) (0.548-0.775) (p=0.003). While for E2 the cut-off value was 4459 pg/ml with 76.7% sensitivity and 55.7% specificity), AUC 0.673 95% (CI) (0.554-0.791) (p=0.002). Combining both AMH ≥ 4.45ng/ml and E2 ≥4459 pg/ml had odds ratio 4.302 (95% CI) (1.795-10.304), relative risk (RR) 0.891 with 95%CI (0.832-0.954) (p<0.001). Conclusion: AMH and serum E2 before trigger are not highly accurate tests alone for the prediction of OHSS. When basal serum AMH was ≥4.45ng/ml and E2 ≥ 4459 pg/ml, the patient was at 4 fold increased risk of developing OHSS.

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“…However, using a similar approach, Nardo et al were unable to demonstrate any relationship between serum follicle-stimulating hormone, luteinizing hormone or testosterone and ovarian stromal volume in 23 infertile women with clomiphene citrate-resistant polycystic ovarian syndrome at the same stage of the menstrual cycle [24]. 3D imaging can calculate ovarian volumes more accurately than measurements based on 2D estimations [25], and facilitates detailed follicle counts; this should arguably mean that it becomes the ultrasound technique of choice for diagnosis in the future.…”

Section: Polycystic Ovarian Syndromementioning

confidence: 99%

3D Ultrasound in Gynecology and Reproductive Medicine

Coyne

Jayaprakasan

Raine‐Fenning

2008

Womens Health (Lond Engl)

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With advances occurring in medicine on a daily basis, it was only a matter of time before essential gynecological investigations, such as ultrasound, were modified. Many clinicians remain unconvinced by its reputed advantages and 3D ultrasound is not without disadvantages. These mainly relate to the cost implications and training requirements. 3D ultrasound imaging is still at a relatively early stage in terms of its role as a day-to-day imaging modality in gynecology and reproductive medicine. 3D imaging has several obvious benefits that relate to an improved spatial orientation and the demonstration of multiplanar views, of which the coronal plane is particularly useful. It offers a more objective and reproducible measurement of volume and vascularity of the region of interest, and an improved assessment of normal and pathological pelvic organs through further postprocessing modalities, including tomographic ultrasound imaging and various rendering modalities. It also has the benefit of offering reduced scanning time, the option of teleconsultation and storage of images for re-evaluation. However, other than its application in the assessment and differentiation of uterine anomalies, there is very little evidence demonstrating that 3D ultrasound results in a clinically relevant benefit or negates the need for further investigation. Future work should ensure that 3D ultrasound is compared with conventional imaging in randomized trials where the observer is blind to the outcome, only after which will we truly be able to evaluate its role in an evidence-based manner.With advances occurring in medicine on a daily basis, it was only a matter of time before essential gynecological investigations, such as ultrasound, were modified. 2D ultrasound has been one of the key modes of investigation for years, but recent developments have seen the introduction of 3D ultrasound. This review focuses on the current role of 3D imaging in the field of gynecology and reproductive medicine, and outlines how our practice may change in the future as a result. However, very few studies have truly compared conventional ultrasound with 3D ultrasound and the following article appraises the current evidence, which is often derived from observational studies.What is 3D ultrasound? Conventional (2D) ultrasound is the most widely available modality at present. 2D ultrasound essentially provides us with 2D images of 3D structures, which appear as real-time crosssectional slices through the organ/structures being examined. The views can, at times, be restricted owing to limited scan planes. By contrast, 3D ultrasound techniques rely upon the production of a composite of multiple 2D scan images. Computing software is then used to fill in the gaps or 'interpolate' between these images to produce a solid volume. The acquired 3D ultrasound volume can then be displayed collectively in a variety of imaging modalities. Several viewing modalities are available to maximize the display of the acquired 3D images. The render mode shows a single image repre...

show abstract

Serum anti-mullerian hormone and estradiol levels as predictors of ovarian hyperstimulation syndrome in assisted reproduction technology cycles

Abstract: The basal serum AMH level could be utilized effectively to predict OHSS and thus to direct the selection of mild COS protocols.

Cited by 231 publications

References 37 publications

Increased gonadotrophin stimulation does not improve IVF outcomes in patients with predicted poor ovarian reserve

Increased gonadotrophin stimulation does not improve IVF outcomes in patients with predicted poor ovarian reserve

Using Anti-Müllerian Hormone and Serum Estradiol to Predict Ovarian Hyperstimulation Syndrome in Patients Using Antagonist Protocol During IVF/ICSI Cycles

3D Ultrasound in Gynecology and Reproductive Medicine

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