April - June 2017, Volume 13, Issue 2

Hosseini E, Nikmard F, Aflatoonian B, Vesali S, Alenabi T, Aflatoonian A, Mehraein F, Aflatoonian R

Controlled Ovarian Stimulation in Endometriosis Patients Can Be Individualized by Anti-Mullerian Hormone Levels

Acta Endo (Buc) 2017, 13 (2): 195-202
doi: 10.4183/aeb.2017.195

Context. Anti-Mullerian hormone (AMH) assay is becoming the best indicator of successful IVF treatment response to fertility drugs and could be a useful marker of embryo implantation potential. Various protocols are being used for controlled ovarian stimulation (COS), but there is an uncertainty regarding the implementation of the best protocol for endometriosis patients and also little evidence is available concerning the clinical value of AMH levels in endometriosis. Objective. This study aimed to evaluate the prognostic value of serum AMH levels for pregnancy in COS using GnRH-agonist(GnRH-a) and GnRHantagonist( GnRH-ant) protocols in endometriosis patients. Design. This is a cross-sectional study between March 2012 and November 2015. Subjects and Methods. Data were collected from 249 COS cycles of endometriosis patients, including 129 cycles with GnRH-a and 120 cycles with GnRH-ant. Patients in each group were classified into three subgroups based on their serum AMH levels. The outcomes of ICSI program were evaluated. Results. The ROC curve analysis showed that embryo and oocyte counts and AMH were equally predictive for pregnancy, as demonstrated by a similar area under the curve (AUC) of 0.69, 0.66 and 0.64, respectively. The sensitivity and specificity for prediction of positive pregnancy were 70.91% and 67.01% for embryo counts, 70.91% and 67.53% for oocyte counts at the cutoff values of 5 and 7, respectively, and 83.64% and 52.58% for AMH levels at the cutoff values of 1.3ng/mL. Conclusions. This study demonstrates that AMH as a single test has substantial accuracy in the prediction of pregnancy using the GnRH antagonist protocol for patients with endometriosis. In other words, AMH assay prior to ovarian stimulation initiation guides the clinicians to choose the antagonist stimulation protocol for the patients with two extreme AMH levels. AMH levels can be used to individualize control ovarian stimulation in endometriosis patients.

Keywords: Anti-Mullerian hormone, Ovarian induction, Endometriosis, Gonadotropin releasing hormone

Correspondence: Fereshteh Mehraein MD, PhD, Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Hemmat highway, 1449614525, Tehran, Iran, E-mail: femehra@yahoo.com