Optimal Cutoff Value of Basal Anti-Mullerian Hormone in Iranian Infertile Women for Prediction of Ovarian Hyper-Stimulation Syndrome and Poor Response to Stimulation Female Fertility Publisher Pubmed



Aghssa MM¹ ; Tarafdari AM¹ ; Tehraninejad ES¹ ; Ezzati M² ; Bagheri M¹ ; Panahi Z¹ ; Mahdavi S³ ; Abbasi M⁴ Show Affiliations
Source: Reproductive Health Published:2015

Abstract

Aim: We intended to establish the threshold of Anti-Mullerian Hormone (AMH) for detection of Ovarian Hyper-Stimulation Syndrome (OHSS) and poor response to treatment in Iranian infertile women. Methods: Pre-stimulation menstrual cycle day-3 hormonal indices including basal AMH values were measured in 105 infertile women aged 32.5∈±∈4.3 years. Patients underwent long GnRH agonist Controlled Ovarian Hyperstimulation (COH) in a referral infertility center (Tehran, Iran). The gonadotropin dose was determined based on the age and basal serum Follicular Stimulating Hormone (FSH) level. The IVF/ICSI cycles were followed and the clinical and sonographic data were recorded. Results: Sixteen cases developed OHSS. The prevalence of PCOS was higher in subjects with OHSS [62.5 % (38.8-86.2) vs. 17 % (9.2-24.9)]. The patients with OHSS had higher ovarian follicular count [23.7 (3.2) vs. 9.1 (0.5); p∈<∈0.05], collected oocytes [13.5 (1.9) vs. 6.9 (0.5); p∈<∈0.05] and AMH level [7.9 (0.7) vs. 3.6 (0.3); p∈<∈0.05]. Basal AMH level and oocyte yields (but not age, BMI, and PCOS) correlated with occurrence of OHSS; and only the AMH levels were associated with poor ovarian response (oocytes yield∈<4). The optimal cutoff value for the prediction of OHSS was 6.95 ng/ml (area under the receiver operating characteristics curve: 0.86; CI: 0.78-0.95; sensitivity: 75 %; specificity: 84 %; odds ratio for occurrence of OHSS: 9 and p∈;lt0.001). The optimal cut point to discriminate poor response (oocytes <;4) was 1.65 ng/ml (AUC: 0.8; CI: 0.69-0.91; sensitivity: 89 % specificity: 71 %; and OR∈=∈23.8 and P value <0.001). Conclusions: Iranian women with basal AMH level∈>∈6.95 ng/ml are at high risk of developing OHSS and those with AMH level∈<∈1.65 ng/ml are poor responders. © 2015 Aghssa et al.