Author/Authors :
Salmassi، Ali نويسنده Department of Gynaecology and Obstetrics, Center of Reproductive Medicine, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany , , Mettler، Liselotte نويسنده Department of Gynaecology and Obstetrics, Center of Reproductive Medicine, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany , , Hedderich، Jurgen نويسنده Institute of Medical Informatics and Statistics, University of Kiel, Kiel, Germany , , Jonat، Walter نويسنده Department of Gynaecology and Obstetrics, Center of Reproductive Medicine, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany , , Deenadayal، Anupama نويسنده Department of Gynaecology and Obstetrics, Center of Reproductive Medicine, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany , , von Otte، Soeren نويسنده Department of Gynaecology and Obstetrics, Center of Reproductive Medicine, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany , , Eckmann-Scholz، Christel نويسنده Department of Gynaecology and Obstetrics, Center of Reproductive Medicine, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany , , Gerd Schmutzler، Andreas نويسنده Department of Gynaecology and Obstetrics, Center of Reproductive Medicine, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany ,
Abstract :
Background: Evaluation of anti-mullerian hormone (AMH) cut-off levels in assisted
reproductive technology (ART) as predictive factor for individualization of
stimulation protocols and to avoid ovarian hyperstimulation syndrome (OHSS).
Materials and Methods: In a retrospective study, 177 infertile patients were assessed
for AMH in serum and follicular fluid (FF) on the day of follicular puncture
(FP), between 2012 and 2013 in Kiel, Germany. AMH levels and pregnancy rates
were compared between low, moderate and high responders and cut-off levels of
low and high responders. AMH cut-off levels in pathological cases were evaluated
in analysis 1 (OHSS) and in analysis 2 [polycystic ovarian syndrome, (PCOS)] and
compared in analysis 3 to normal endocrinological parameters.
Results: AMH levels in FF were higher than in serum (P < 0.001). AMH levels in serum
and FF increased from low through moderate to high responders (P < 0.001). Pregnancy
rates were 14.7, 23.3 and 44.9% (P=0.009), respectively. AMH cut-off level for poor
responders was 0.61 ng/ml in serum with a pregnancy rate of 13.8 and 37.1% for below
and above of this level, respectively. For FF, it was 1.43 ng/ml. AMH levels in analysis
1 and 2 were significantly higher than in analysis 3 (P=0.001). AMH cut-off level for
OHSS was 1.5 ng/ml in serum with OHSS rates of 80.8 and 19.2 % for above and below
of the level, respectively. For FF, it was 2.7 ng/ml. PCOS patients had an AMH cut-off
level of 3.9 ng/ml in serum and 6.8 ng/ml in FF, resulting in a PCOS rate of 100% above
this level.
Conclusion: AMH levels can help to assess ovarian response potential and guide ovarian
stimulation while avoiding OHSS.
