RELATIONSHIP BETWEEN AMH LEVEL AND OVARIAN RESPONSE TO CLOMIPHINE CITRATE IN WOMEN WITH POLYCYSTIC OVARIAN SYNDROME

Sheren Hussien*, Basel Mohammad and Rajaa Rajab

ABSTRACT

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder of uncertain origin and it is the
major cause of anovulatory infertility. The treatment of first choice for induction of ovulation is antiestrogen
therapy. Clomiphene citrate stimulates endogenous FSH secretion, leading to development of a dominant follicle
and ovulation in approximately 75% of patients. While the exact function of anti mullarian hormone (AMH) is yet
to be completely clarified, there is evidence that it counteracts the actions of FSH on aromatase activity and in the
development of an ovulatory follicle. Although serum AMH levels are used as a predictive marker of ovarian
response during IVF, there are conflicting reports of its predictive value for follicular recruitment in ovulation
induction with clomiphene citrate. Objective: This study aims to detection the predictive value of AMH for
ovarian response to Clomiphine Citrate in PCO patients. Methods: A prospective trial conducted 100 patients with
PCO syndrome, who have an indication for ovulation induction. After measurement of AMH value, they received
tablet clomiphene citrate 100 mg/day starting on 5th day of menstrual period, for five days. The association between
AMH and ovarian response to clomiphene citrate was studied. Results: The mean AMH value in responsive group
was (3.11±0.7), while it was (4.57±1.6) in the non-responsive group (p=0.0001). The cut-off value of AMH =4.1,
with sensitivity of 96.7% [87 - 99] and specificity of 87.1% [70 - 95]. 39 (60%) cases of regular menstrual period
group showed ovarian response to clomiphin citrate compared with 26 (40%)cases in irregular group. Ovarian
response was most common in normal weight group41(63.1%) followed by overweight group24(36.9%) with no
response noticed in the obesity group0 (0%). Conclusions: AMH may be predictive for resistance of ovulation
induction with clomiphin citrate.

Keywords: AMH, PCO, Clomiphene citrate.