title: Optimal cutoff value of basal anti-mullerian hormone in iranian infertile women for prediction of ovarian hyper-stimulation syndrome and poor response to stimulation.
abstract: OBJECTIVE
  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 < 0.001). 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.
authors.affiliation: Vali-e-Asr Reproductive Health Research Center, Department of Obstetrics and Gynecology, Valiasr Hospital, Tehran University of Medical Sciences, 1419433141, Tehran, Iran. mmaghssa@yahoo.com.
authors.forename: Malek Mansour
authors.initials: MM
authors.lastname: Aghssa
authors.affiliation: Vali-e-Asr Reproductive Health Research Center, Department of Obstetrics and Gynecology, Valiasr Hospital, Tehran University of Medical Sciences, 1419433141, Tehran, Iran. azadehmehr@yahoo.com.
authors.forename: Azam Manshadi
authors.initials: AM
authors.lastname: Tarafdari
authors.affiliation: Vali-e-Asr Reproductive Health Research Center, Department of Obstetrics and Gynecology, Valiasr Hospital, Tehran University of Medical Sciences, 1419433141, Tehran, Iran. Meeshtehrani@yahoo.com.
authors.forename: Ensieh Shahrokh
authors.initials: ES
authors.lastname: Tehraninejad
authors.affiliation: Department of Obstetrics and Gynecology, Washington Hospital Center, Washington, DC, USA. mohezzati@hotmail.com.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ezzati
authors.affiliation: Vali-e-Asr Reproductive Health Research Center, Department of Obstetrics and Gynecology, Valiasr Hospital, Tehran University of Medical Sciences, 1419433141, Tehran, Iran. m_bagheri58@yahoo.com.
authors.forename: Maryam
authors.initials: M
authors.lastname: Bagheri
authors.affiliation: Vali-e-Asr Reproductive Health Research Center, Department of Obstetrics and Gynecology, Valiasr Hospital, Tehran University of Medical Sciences, 1419433141, Tehran, Iran. zahrapanahi57@yahoo.com.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Panahi
authors.affiliation: Saeed Medical Laboratories, Tehran, Iran. saeed@saeedlab.com.
authors.forename: Saeed
authors.initials: S
authors.lastname: Mahdavi
authors.affiliation: Department of Nuclear Medicine, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran. meabbasi@tums.ac.ir.
authors.forename: Mehrshad
authors.initials: M
authors.lastname: Abbasi
mesh_terms: D054304:Anti-Mullerian Hormone / Q000097:blood*; D005260:Female; D006801:Humans; D007492:Iran; D016015:Logistic Models; D016471:Ovarian Hyperstimulation Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D010053:Ovary / Q000187:drug effects*; D010062:Ovulation Induction; D015995:Prevalence; D012016:Reference Values
chemical_list: D054304:Anti-Mullerian Hormone