title: The predictive value of circulating anti-Müllerian hormone in women with polycystic ovarian syndrome receiving clomiphene citrate: a prospective observational study.
abstract: BACKGROUND
  Elevated serum anti-Müllerian hormone (AMH) concentration in women with polycystic ovarian syndrome (PCOS) is known to lower sensitivity of ovarian follicles to circulating FSH. This effect may compromise the outcome of clomiphene citrate (CC) ovulation induction.
  
  
  OBJECTIVE
  The objective of the study was to investigate the impact of high circulating AMH on the outcome of CC ovulation induction in women with PCOS.
  
  
  METHODS
  This was a prospective cohort observational study.
  
  
  METHODS
  The study was conducted at the Fertility Unit, Derby, United Kingdom.
  
  
  METHODS
  Sixty anovulatory women with PCOS participated in the study.
  
  
  METHODS
  Serum AMH concentrations were measured on cycle day 2 during 187 CC cycles. These concentrations were compared between responders and nonresponders. The receiver-operating characteristic curve was used to evaluate the prognostic value of circulating AMH. The success rates of CC were compared between patients with high vs low AMH levels. The dose of CC required to achieve ovulation was correlated with serum AMH concentrations.
  
  
  METHODS
  Ovulation and pregnancy rates were measured.
  
  
  RESULTS
  Serum AMH concentrations were significantly (P < .001) lower in responders (achieving ovulation) vs nonresponders (mean ± SEM, 2.5 ± 0.1 vs 5.8 ± 0.7 ng/mL, respectively). Similarly, serum AMH concentrations were significantly (P = .046) lower in pregnant (3.0 ± 0.4 ng/mL) vs nonpregnant patients (4.4 ± 0.5 ng/mL). There was a significant (P = .02) gradient increase of serum AMH levels with the increasing dose of CC required to achieve ovulation. The receiver-operating characteristic curve showed AMH to be a useful predictor of no ovulation (area under the curve, 0.809; P < .001) with a useful cutoff level of 3.4 ng/mL. Ovulation and pregnancy rates were significantly higher (97%, P < .001, and 46%, P = .034) in patients with low AMH (<3.4 ng/mL) vs women with AMH 3.4 ng/mL or greater (48% and 19%).
  
  
  CONCLUSIONS
  PCOS women with high circulating AMH (≥ 3.4 ng/mL) seem to be resistant to CC and may require a higher starting dose.
authors: MSc, MD, MRCOG, AssociateUniversity of Nottingham, Department of Obstetrics and Gynaecology, Royal Derby Hospital, Uttoxeter Road, Derby, Derbyshire DE23 3XW, United Kingdom. saad.amer@nottingham.ac.uk.
authors: Ahmad
authors: A
authors: Mahran
authors: Ayman
authors: A
authors: Abdelmeged
authors: Ahmad Reda
authors: AR
authors: El-Adawy
authors: Moustafa K
authors: MK
authors: Eissa
authors: Robert W
authors: RW
authors: Shaw
authors: Saad A
authors: SA
authors: Amer
mesh_terms: D000328:Adult; D000858:Anovulation / Q000097:blood* / Q000188:drug therapy; D054304:Anti-Mullerian Hormone / Q000097:blood*; D002996:Clomiphene / Q000627:therapeutic use*; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D006801:Humans; D010062:Ovulation Induction; D011085:Polycystic Ovary Syndrome / Q000097:blood* / Q000188:drug therapy; D011237:Predictive Value of Tests; D011247:Pregnancy; D018873:Pregnancy Rate; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene; D054304:Anti-Mullerian Hormone