Can AMH levels predict the need for increased medication during IVF/ICSI in PCOS women?. (2nd January 2018)

• Record Type: Journal Article
• Authors: Kamel, Ahmed; Ramadan, Wafaa; Hussein, Ahmed M.; Dahab, Sherif; Elsherbini, Moutaz M.; Lasheen, Yossra S.; Abu-Hamila, Fouad
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 31:Number 1(2018)
• Page Start: 32
• Page End: 38
• Publication Date: 2018-01-02
• Subjects: Anti-Mullerian hormone -- intra-cytoplasmic sperm injection -- ovarian response -- step-up dose -- polycystic ovarian syndrome; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2016.1272567
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Purpose: To investigate the ability of anti-Mullerian hormone (AMH) to predict the step up of human menopausal gonadotropins (HMG) dose in women with polycystic ovarian syndrome (PCOS) undergoing IVF/ICSI cycles. Methods: AMH was drawn before ovulation induction in 976 PCOS women scheduled for IVF/ICSI. After all cycles ended, a receiver operating characteristic (ROC) curve analysis was done to investigate the ability of AMH to predict step up of the HMG. Results: The area under the curve (AUC) was 0.820 95%CI (0.792–0.848), and a cutoff value of 4.6 ng/ml (sensitivity 74%, specificity 82%) for AMH was taken ( p < 0.01). Cases were divided into two groups retrospectively; group (A) (AMH ≤4.6 ng/ml), and group (B) (AMH >4.6 ng/ml). No difference in the mean age ( p = 0.147); BMI ( p = 0.411), basal FSH ( p = 0.221), and starting dose ( p = 0.195); however, the dose at which the first response occurred was higher in group (B) ( p < 0.01). The total dose and number of days were higher in group (B) (both p < 0.01) irrespective of the PCOS subtype or androgen levels. Severe OHSS was also higher in group (B) ( p = 0.026). Conclusions: PCOS with AMH >4.6 ng/ml are resistant to HMG stimulation, require dose step up during ART cycles, and are at higher risk for severe OHSS.