April - June 2014, Volume 10, Issue 2

Onofriescu A, Bors A, Grigoriu R, Graur M, Onofriescu M, Vulpoi C

Role of Anti-mullerian Hormone in Predicting the Ovarian Response to Clomiphene Citrate Treatment in Obese Patients with Polycystic Ovary Syndrome

Acta Endo (Buc) 2014, 10 (2): 211-219
doi: 10.4183/aeb.2014.211

Background. Clomiphene citrate (CC) is a safe and widely available first-line ovulation induction drug in women with polycystic ovary syndrome (PCOS). Obesity may trigger the syndrome development in the presence of genetic predisposition or independent causal factor by inducing low insulin sensitivity. Objectives. The aim of this study was to compare the serum AMH levels in obese women with PCOS and obese women with ovulatory cycles, and to assess the role of AMH as a predictor of ovulation induction in obese patients with PCOS by CC as compared to follicle-stimulating hormone (FSH). Subjects and methods. Fifty-six obese infertile women with PCOS with a BMI greater than 30kg/m2 were compared with a control group of 30 obese women with normal ovulation. After ovulation induction treatment with CC, the PCOS group was further subdivided in responders and nonresponders. AMH level was assessed as an ovulation induction predictor using area under the curve (AUC) analysis, logistic regression and statistical correlation. Results. Serum AMH level was significantly higher in women with PCOS than in the controls. There were no significant differences in age, duration of infertility, weight, height, LH, and FSH, but significant differences in AMH level (p < 0.01), endometrial thickness (p < 0.01) and progesterone level (p < 0.01) between the patients responding and non-responding to treatment. Endometrial thickness (AUC = 0.932) and progesterone level (AUC = 0.732) were of predictive value for treatment response. A cut-off level of 1.92 ng/mL for AMH showed a good discriminative power for the positive response to treatment (AUC value = 0.819, p< 0.0001). Conclusion. AMH measurement could be useful in predicting ovarian response to clomiphene citrate therapy in obese anovulatory women with PCOS.

Keywords: polycystic ovary syndrome, polycystic ovary syndrome, clomiphene citrate, ovulation induction.

Correspondence: Alina Onofriescu MD, “Gr. T. Popa” University of Medicine and Pharmacy - Iasi Diabetes, Nutrition and Metabolic Diseases, Str. Universitatii nr. 16, Iasi, 700115, Romania, E-mail: alinaonofriescu@yahoo.com