الفهرس 
Patients and MethodsOnly 14 pages are availabe for public view
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Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-aged women. It is characterized by androgen excess, chronic oligo and/or anovulation and polycystic ovaries (PCO) on ultrasound.
Anti-Müllerian hormone (AMH) is a dimeric glycoprotein, which is secreted exclusively by granulosa cells of primary, preantral and small antral follicles (4-6 mm). Its secretion gradually diminishes in the subsequent stages of follicle development and is practically undetectable in follicles larger than 8 mm.
Previous research has shown women with polycystic ovarian syndrome (PCOS) to have a two- to threefold increase in serum AMH concentration, which corresponds to the two- to threefold increase in the number of small (2- 5 mm) follicles seen in PCOS. This increase in AMH has been implicated in the pathogenesis of PCOS. It has been hypothesized that the high serum AMH levels in PCOS lower the follicle sensitivity to circulating FSH thus preventing follicle selection resulting in follicle arrest at the small antral phase with failure of dominance. AMH also inhibits aromatase activity resulting in reduction of follicle production of estradiol (E2). The resulting low levels of E2 may also contribute to the failure of follicle selection.
The aim of this study was to evaluate the impact of AMH levels in women with PCOS on the ovarian responsiveness in women receiving Clomiphene Citrate for induction of ovulation.
This prospective cohort study was conducted at Ain- Shams University Maternity Hospital including 40 women with PCOS recruited from the infertility clinic from the period of January 2018 to May 2018.
The studied women were subjected to full gynecological history laying stress on menstrual history and infertility, full examination laying stress on anthropometric measurements and body hair distribution and investigations including serum anti-Müllerian hormone.
In this study, 40 PCOS women received Clomiphene Citrate for induction of ovulation with a daily dose of 100 mg orally for 5 days starting from day 5-9 of the menstrual cycle. Blood samples were collected during the early follicular phase (days 3-5) to measure serum concentrations of AMH. The levels of AMH were compared between responders and non-responders.
In the current study, 20 of patients had successful ovulation in response to ovulation induction with Clomiphene Citrate while 20 of patients not ovulated till day 35 of menstrual cycle.
In this study, women who ovulated in response to Clomiphene Citrate had a highly significant (p < 0.01) lower serum AMH concentration compared to that of women with undetectable ovulation till day 35 Using receiver-operating characteristic (ROC) curve, AMH was found to be a useful predictor of successful ovulation during Clomiphene Citrate treatment (AUC, 0.96; P < 0.001). Using a cut-off level of 6.7ng/mL, AMH had a sensitivity of 90% and specificity of 100% in predicting successful ovulation. Women with serum AMH concentrations ≤ 4.4ng/mL achieved highly significant higher incidence of ovulation p<0.01 compared to those in women with higher serum AMH concentration.
In our study we found that AMH level was highly significant determinant of failure of ovulation after CC induction. On the other hand, age, BMI, type of infertility, number of previous pregnancies and abortions, and level of LH/FSH were found not to be a significant determinant of successful ovulation.
Thus, women with PCOS should be screened for AMH level before treatment as this could be a good predictor for success of ovulation.
Also, women with PCOS who have relatively high level of circulating AMH (> 6.71 ng/ml) seem to be resistant to low dose of CC we therefore recommend higher starting dose of CC combined with other lines of treatment in PCOS with relatively high dose serum AMH.