Evaluation of Anti-Mullerian Hormone (AMH) Cut-Off Levels in Serum and Follicular Fluid in Patients with and without Endocrinological Risk Factor in ART

Headnote

Keywords: AMH, Cut-offLevel, Poor Response, Pregnancy, OHSS, PCOS

Background: Assessment of AMH cut-offlevels in serum and in follicle fluid (FF) for patients with (group 2, n=34) and without (group1, n= 96) endocrinological risk factors, such as ovarian hyperstimulation syndrome (OHSS) and polycystic ovary syndrome (PCOS), is clinically useful in optimising the treatment protocol.

Materials and Methods: AMH was analysed in serum and FF of 130 infertile patients on the day of follicular puncture (FP). Cut-offlevels were evaluated for poor responders (n=21), with OHSS (n=19) and PCOS (n=15), by ELISA.

Results: In group 1 the AMH level in FF was higher than in serum (p<0.001). According to ROC-AUC, these results revealed for poor responders an AMH cut-offlevel of 0.61 ng/ml in serum and 1.44 ng/ml in FF, at a sensitivity of 82 % and a specificity of 77%. The pregnancy rate, at a cut-offlevel of < 0.61 ng/ml, was 12.2 % and at > 0.61 ng/ml, 41.5 %. Mean AMH levels in serum and in FF of patients with endocrinological risk factors were significantly higher than in normal patients in group 1 (p=0.001). OHSS patients revealed an AMH cut-offlevel in serum of 1.39 ng/ml and in FF of 2.38 ng/ml, at a sensitivity of 79% and a specificity of 74%. In patients with PCOS we found an AMH cut-offlevel of 4.0 ng/ml in serum and 6.7 ng/ml in FF, at a sensitivity of 92% and a specificity of 96%. We could optimise the treatment protocol according to the AMH cut-offlevel in serum of women undergoing ART.

Conclusion: AMH cut-offlevels are an important predictor of poor response and a useful diagnostic criterion for OHSS and PCOS patients. They could be a useful marker for the application of appropriate stimulation protocols and IVF outcome.