Anti-Müllerian Hormone Predictive Levels to Determine The Likelihood of Ovarian Hyper-Response in Infertile Women with Polycystic Ovarian Morphology

The objective of this study was to investigate serum levels of anti-Müllerian hormone (AMH) innormal-ovulatory infertile women with polycystic ovarian morphology (PCOM) and their association with ovarianhyper-response. This prospective cohort study was carried out on 100 infertile women with PCOM whowere treated with an antagonist/agonist triggered stimulation protocol at Shahid Akbar-Abadi Hospital IVF Centre,Tehran, Iran. Serum AMH levels were measured before starting the assisted reproductive technology (ART) cycleand the ovarian hyper-response was evaluated by retrieved oocyte numbers, ooestradiol levels on the triggeringday, and the incidence of ovarian hyper-stimulation syndrome (OHSS) clinical signs and symptoms. Logistic regressionand the area under the curve (AUC) were used to estimate the effects of AMH and the accuracy of the test. Receiver operating characteristic (ROC) curve analysis showed that AMH could significantly predict ovarianhyper-response in PCOM patients (AUC=0.73). The estimated threshold value was 4.95 ng/ml, with a specificityof 74.58% (95% confidence interval [CI]: 50.85, 93.22) and sensitivity of 73.17% (95% CI: 48.78, 92.68). Logisticregression results showed a significant interaction between AMH and body mass index (BMI, P=0.008), which indicatedthat BMI had a moderation effect. Individualized stimulation protocols for patients with isolated PCOM and AMH greater than 4.95 ng/mlmay significantly reduce the chances of developing OHSS. However, the AMH cut-off values to predict ovarian hyperresponsediffer for different BMI categories among PCOM patients; thus, it becomes a more precise predictive markerwith increasing BMI.