gynecology and obstetrics medical project, gynecology journal, obstetrics, gynecologic oncology, reproductive medicine, gynecological endoscopy, ultrasonography, gynecology articles

Ginekologia i Poloznictwo
ISSN 1896-3315 e-ISSN 1898-0759

Effect of anti-mullerian hormone in patients with polycystic ovarian syndrome on pregnancy rate in ICSI cycle


Author(s): Ahmed Mohamed Abd El-Hay*, Mohammed Salah Elsayed Elsokkary and Bassem Aly Islam

Background: Polycystic ovarian syndrome (PCOS) is the most frequent cause of anovulatory infertility and hyperandrogenism in young women. Women with this syndrome are characterized by an excessive number of small antral follicles (2–3 fold that of normal ovaries). Anti-Müllerian hormone (AMH), a member of the transforming growth factor-beta superfamily, it is mainly secreted in human ovary by the granulosa cells of ovarian early developing follicles. AMH is secreted inside preantral and early antral follicles <4 mm in diameter in granulosa cells. Its secretion decreases when the antral follicles begin to grow and stops when the follicles are larger 8 mm in diameter, or when atresia occurs. AMH levels are shown to be age-dependent, it is rarely detectable in new born baby girls and it reaches peaks after puberty and steadily declines with age until menopause when serum concentration becomes undetectable.

Objective: To evaluate the AMH in prediction of clinically pregnancy rate in patients with polycystic ovarian syndrome (PCOS) undergoing ICSI cycle.

Patients and Methods: The participants of this study were 140 PCOS women who were candidates for ICSI aged 20-40 years old with primary infertility for at least for 2 years and normal uterine cavity. Women with known metabolic disorders, pelvic pathologies as hydro-salpinges, myoma, stage IV endometriosis, history of myomectomy, history of ovarian hyper stimulation, previous ICSI cycles and/or cancelled cycle were excluded from the study. All participants underwent full history taking, physical examination, basic infertility tests and TVUS. Antagonist protocol was used for stimulation of ovulation. Pregnancy test divided the studied patients into two groups, 58% negative and 41.4% positive.

Results: There was statistically significant negative correlation between AMH level and age of the patients and total dose of ovulation induction. Receiver operating characteristic curve (ROC) for AMH level showed that the best cut off point was found > 3.3 ng/ml with sensitivity of 70.69%, specificity of 59.76% and area under curve of 0.672. Univariate logistic regression analysis showed that the pregnancy results was associated with AMH >3.3ng/ml, oocyte no >17, E2 >2746 pg/ml, embryo no >7, M2 >5, post maturation >2, A grade >2 and C grade >3.  Also the multivariate logistic regression showed that the most important factors associated with positive pregnancy was found M 2 >5 with p-value <0.001 and OR (95.0% CI) of 9.322 (3.142-27.653) followed by AMH >3.3 with p-value=0.020 and OR (95% CI) of 2.964 (1.190-7.378).

Conclusion: From the results of the current study we can conclude that AMH had an important value in prediction of clinical pregnancy rate in patients with polycystic ovarian syndrome (PCOS) undergoing ICSI cycle. AMH level, oocytes number, E2 level, embryo number, M2 number, post maturation and grade A and C ICSI trial were higher in cases with positive pregnancy than negative pregnancy. AMH >3.3ng/ml, oocyte no >17, E2 >2746 pg/ml, embryo no >7, M2 >5, post maturation >2, A grade >2 and C grade >3 were associated with better clinical pregnancy rates. Poor AMH level led to higher doses of induction of ovulation