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

Document Type : Original Article


1 Shahid Akbar-Abadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran

2 Department of Obstetrics and Gynaecology, Shahid Akbar-Abadi Hospital, Iran University of Medical Sciences, Tehran, Iran

3 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

4 Shahid Akbar-Abadi Hospital IVF Centre, Iran University of Medical Sciences, Tehran, Iran

5 Metabolic Diseases Research Centre, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran


Background: The objective of this study was to investigate serum levels of anti-Müllerian hormone (AMH) in
normal-ovulatory infertile women with polycystic ovarian morphology (PCOM) and their association with ovarian

Materials and Methods: This prospective cohort study was carried out on 100 infertile women with PCOM who
were 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) cycle
and the ovarian hyper-response was evaluated by retrieved oocyte numbers, ooestradiol levels on the triggering
day, and the incidence of ovarian hyper-stimulation syndrome (OHSS) clinical signs and symptoms. Logistic regression
and the area under the curve (AUC) were used to estimate the effects of AMH and the accuracy of the test.

Results: Receiver operating characteristic (ROC) curve analysis showed that AMH could significantly predict ovarian
hyper-response in PCOM patients (AUC=0.73). The estimated threshold value was 4.95 ng/ml, with a specificity
of 74.58% (95% confidence interval [CI]: 50.85, 93.22) and sensitivity of 73.17% (95% CI: 48.78, 92.68). Logistic
regression results showed a significant interaction between AMH and body mass index (BMI, P=0.008), which indicated
that BMI had a moderation effect.

Conclusion: Individualized stimulation protocols for patients with isolated PCOM and AMH greater than 4.95 ng/ml
may significantly reduce the chances of developing OHSS. However, the AMH cut-off values to predict ovarian hyperresponse
differ for different BMI categories among PCOM patients; thus, it becomes a more precise predictive marker
with increasing BMI.


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