The role of anti-Müllerian hormone in predicting clomiphene citrate resistance in women with polycystic ovarian syndrome

Abstract

Clomiphene citrate (CC) is the agent of first choice in polycystic ovarian syndrome; however, anovulation problem does not resolve in a quarter of them. Thus, we investigated the value of anti-Müllerian hormone (AMH) in the prediction of ovarian response to CC in women with the polycystic ovarian syndrome (PCOS). This prospective cohort study included 90 anovulatory women with PCOS who were given 50 mg/d CC. The patients who ovulated occupied the group of responders and the patients who did not ovulate in three cycles included in the CC-resistant group. AMH levels of both groups were compared. p < .05 was considered statistically significant. Patients who ovulated had significantly lower serum AMH concentrations compared with the resistant group (p = .001). After analyzing the ROC curve, serum AMH concentration was found to be a useful predictor of CC resistance with the sensitivity of 66% and the specificity of 89%, when the threshold AMH concentration was >12.38 ng/ml in PCOS patients. In the present study, we revealed that the higher the AMH level the poorer the CC response would be in PCOS patients, therefore we recommend measuring the AMH levels of all PCOS patients before planning any ovulation induction treatment to achieve the desired success.

摘要

枸橼酸氯米芬(CC)是多囊卵巢综合征的首选药物, 但仍有四分之一的患者尚不能解决排卵障碍的问题。因此, 我们研究了抗苗勒管激素(AMH)在多囊卵巢综合征(PCOS)妇女卵巢对CC反应预测中的价值。此前瞻性队列研究纳入90例无排卵PCOS女性, 给予每天50mg的CC, 排卵组为应答组, 三周期未排卵组为CC耐药组。比较两组AMH水平。p < .05为有统计学意义。排卵患者血清AMH浓度明显低于耐药组(p= .001)。通过ROC曲线分析发现, 当PCOS患者的AMH阈值为>12.38 ng/ml时, 血清AMH浓度可作为CC耐药的有效预测指标, 敏感性为66%, 特异性为89%。在本研究中, 我们发现, AMH水平越高, PCOS患者CC反应越差, 因此我们建议在计划任何促排卵治疗前测量所有PCOS患者的AMH水平, 以达到预期的效果。

Keywords:

• Anti-Müllerian hormone
• clomiphene citrate
• infertility
• ovulation
• polycystic ovarian syndrome

Disclosure statement

No potential conflict of interest was reported by the authors.