title: Can AMH levels predict the need for increased medication during IVF/ICSI in PCOS women?
abstract: OBJECTIVE
  To investigate the ability of anti-Mullerian hormone (AMH) to predict the step up of human menopausal gonadotropins (HMG) dose in women with polycystic ovarian syndrome (PCOS) undergoing IVF/ICSI cycles.
  
  
  METHODS
  AMH was drawn before ovulation induction in 976 PCOS women scheduled for IVF/ICSI. After all cycles ended, a receiver operating characteristic (ROC) curve analysis was done to investigate the ability of AMH to predict step up of the HMG.
  
  
  RESULTS
  The area under the curve (AUC) was 0.820 95%CI (0.792-0.848), and a cutoff value of 4.6 ng/ml (sensitivity 74%, specificity 82%) for AMH was taken (p < 0.01). Cases were divided into two groups retrospectively; group (A) (AMH ≤4.6 ng/ml), and group (B) (AMH >4.6 ng/ml). No difference in the mean age (p = 0.147); BMI (p = 0.411), basal FSH (p = 0.221), and starting dose (p = 0.195); however, the dose at which the first response occurred was higher in group (B) (p < 0.01). The total dose and number of days were higher in group (B) (both p < 0.01) irrespective of the PCOS subtype or androgen levels. Severe OHSS was also higher in group (B) (p = 0.026).
  
  
  CONCLUSIONS
  PCOS with AMH >4.6 ng/ml are resistant to HMG stimulation, require dose step up during ART cycles, and are at higher risk for severe OHSS.
authors.affiliation: a Obstetrics and Gynecology department , Cairo University , Cairo , Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Kamel
authors.affiliation: a Obstetrics and Gynecology department , Cairo University , Cairo , Egypt.
authors.forename: Wafaa
authors.initials: W
authors.lastname: Ramadan
authors.affiliation: a Obstetrics and Gynecology department , Cairo University , Cairo , Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Hussein
authors.affiliation: a Obstetrics and Gynecology department , Cairo University , Cairo , Egypt.
authors.forename: Sherif
authors.initials: S
authors.lastname: Dahab
authors.affiliation: a Obstetrics and Gynecology department , Cairo University , Cairo , Egypt.
authors.forename: Moutaz M
authors.initials: MM
authors.lastname: Elsherbini
authors.affiliation: a Obstetrics and Gynecology department , Cairo University , Cairo , Egypt.
authors.forename: Yossra S
authors.initials: YS
authors.lastname: Lasheen
authors.affiliation: a Obstetrics and Gynecology department , Cairo University , Cairo , Egypt.
authors.forename: Fouad
authors.initials: F
authors.lastname: Abu-Hamila
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000097:blood* / Q000188:drug therapy / Q000209:etiology; D008596:Menotropins / Q000008:administration & dosage*; D010062:Ovulation Induction / Q000379:methods / Q000706:statistics & numerical data*; D011085:Polycystic Ovary Syndrome / Q000097:blood* / Q000150:complications; D020554:Sperm Injections, Intracytoplasmic; D055815:Young Adult
chemical_list: D008596:Menotropins; D054304:Anti-Mullerian Hormone
keywords: Anti-Mullerian hormone; intra-cytoplasmic sperm injection; ovarian response; polycystic ovarian syndrome; step-up dose