Yetkin Karasu, Berna Dilbaz, Berfu Demir, Serdar Dilbaz

Does Anti-Mullerian Hormone Level Change During recFSH Treatment?

The aim of this study to compare intracycle variability of Anti-Mullerian Hormone (AMH) in women with Polycystic Ovary Syndrome (PCOS) and normoresponder infertile patients during controlled ovarian hyper stimulation (COH) with follicle stimulating hormone (FSH). Infertile PCOS (n=30) patients were grouped into two and 15 patients were treated with long luteal gonodotropin releasing hormone analogue (GnRHa) and intracytoplasmic sperm injection (ICSI) and 15 PCOS patients were treated with COH-intrauterine insemination (IUI). Non-PCOS (n=30) patients were treated with COH-IUI. AMH was measured three times in all groups throughout the cycle (basal, mid-cycle, luteal). Intracycle variations of serum AMH levels in PCOS and non-PCOS patients underwent different amount of exogenous FSH treatment were compared. Pregnancy rates were also compared. AMH levels in the PCOS patients were 2-2.5 times higher than non-PCOS patients. Total gonodotropin dose used was higher in the PCOS patients (p<0.001). Intracycle AMH variability throughout the cycle wasn’t significant in PCOS patients but in non-PCOS patients declining AMH levels were observed (p=0.039). Our findings confirm that AMH levels were higher, remain steady and unaffected by high doses of FSH treatment in PCOS patients. On the other hand in non-PCOS patients there was a small decline in AMH levels with FSH. Clinical pregnancy rates were similar.

Anahtar Kelimeler:

Polycystic Ovary Syndrome, Anti-Mullerian Hormone, In Vitro Fertilization

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[1] Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab. 1998; 83(9): 3078. [2] Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89(6):2745. [3] Fallat ME, Siow Y, Marra M, Cook C, Carrillo A. Müllerian-inhibiting substance in follicular fluid and serum: a comparison of patients with tubal factor infertility, polycystic ovary syndrome, and endometriosis. Fertil Steril. 1997;67(5):962-5. [4] Somunkiran A, Yavuz T, Yucel O, Ozdemir I. Anti-Müllerian hormone levels during hormonal contraception in women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2007 Oct;134(2):196-201. [5] Streuli I, Fraisse T, Pillet C, Ibecheole V, Bischof P, de Ziegler D. Serum antimüllerian hormone levels remain stable throughout the menstrual cycle and after oral or vaginal administration of synthetic sex steroids. Fertil Steril. 2008;90(2):395-400. [6] Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004 Jan;19(1):41-7. [7] Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM, Haugen TB, Kruger T, Wang C, Mbizvo MT, Vogelsong KM. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010 May-Jun;16(3):231-45. [8] Cook CL, Siow Y, Brenner AG, Fallat ME. Relationship between serum müllerian-inhibiting substance and other reproductive hormones in untreated women with polycystic ovary syndrome and normal women. Fertil Steril. 2002 Jan;77(1):141-6. [9] Laven JS, Mulders AG, Visser JA, Themmen AP, De Jong FH, Fauser BC. Anti-Müllerian hormone serum concentrations in normoovulatory and anovulatory women of reproductive age. J Clin Endocrinol Metab. 2004 Jan;89(1):318-23. [10] Pigny P, Merlen E, Robert Y, Cortet-Rudelli C, Decanter C, Jonard S, Dewailly D. Elevated serum level of anti-mullerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest. J Clin Endocrinol Metab. 2003 Dec;88(12):5957-62. [11] La Marca A, Stabile G, Artenisio AC, Volpe A. Serum anti-Mullerian hormone throughout the human menstrual cycle. Hum Reprod. 2006 Dec;21(12):3103-7. [12] Wunder DM, Bersinger NA, Yared M, Kretschmer R, Birkhäuser MH. Statistically significant changes of antimüllerian hormone and inhibin levels during the physiologic menstrual cycle in reproductive age women. Fertil Steril. 2008 Apr;89(4):927-33. [13] Lie Fong S, Schipper I, de Jong FH, Themmen AP, Visser JA, Laven JS. Serum anti-Müllerian hormone and inhibin B concentrations are not useful predictors of ovarian response during ovulation induction treatment with recombinant follicle-stimulating hormone in women with polycystic ovary syndrome. Fertil Steril. 2011;96(2):459-63. [14] Hazout A, Bouchard P, Seifer DB, Aussage P, Junca AM, Cohen-Bacrie P. Serum antimüllerian hormone/müllerian-inhibiting substance appears to be a more discriminatory marker of assisted reproductive technology outcome than follicle-stimulating hormone, inhibin B, or estradiol. Fertil Steril. 2004;82(5):1323-9. [15] Wu CH, Chen YC, Wu HH, Yang JG, Chang YJ, Tsai HD. Serum anti-Müllerian hormone predicts ovarian response and cycle outcome in IVF patients. J Assist Reprod Genet. 2009;26(7):383-9. [16] Sahmay S, Demirayak G, Guralp O, Ocal P, Senturk LM, Oral E, Irez T. Serum anti-müllerian hormone, follicle stimulating hormone and antral follicle count measurement cannot predict pregnancy rates in IVF/ICSI cycles. J Assist Reprod Genet. 2012;29(7):589-95. [17] Tremellen K, Kolo M. Serum anti-Mullerian hormone is a useful measure of quantitative ovarian reserve but does not predict the chances of live-birth pregnancy. Aust N Z J Obstet Gynaecol. 2010;50(6):568-72. [18] Sahmay S, Guralp O, Aydogan B, Cepni I, Oral E, Irez T. Anti-Müllerian hormone and polycystic ovary syndrome: assessment of the clinical pregnancy rates in in vitro fertilization patients. Gynecol Endocrinol. 2013;29(5):440-3.