Antimullerian hormone as a predictor of ovarian hyperstimulation syndrome
Tarek Gelbaya, Hannah Wilkinson, Steve Roberts, Ian Laing & Luciano Nardo
Objectives: To evaluate the use of Antimüllerian hormone (AMH) measured on day 2 of spontaneous menstrual cycles in the prediction of ovarian hyperstimulation syndrome (OHSS).
Design: Prospective observational study.
Setting: IVF unit within a department of reproductive medicine and surgery.
Patients: Women undergoing their first cycle of controlled ovarian hyperstimulation (COH) for IVF/ICSI.
Material and methods: We measured serum AMH on day 2 of the menstrual cycle in 165 women within 3 months before they started COH. We followed all patients prospectively and divided them according to their ovarian response to gonadotrophin stimulation into two groups: high- and non-high responders. The two groups were then compared with regard to patients characteristics as well as day 2 AMH, FSH and antral follicle count (AFC). An approval was obtained from the local ethical research committee.
Main outcome measure(s): Prediction of OHSS.
Result(s): Out of the 165 women who underwent COH for IVF/ICSI, 16 (9.7%) were classified as high-responders and 149 as non-high responders. Of the 16 high-response women, 5 (3.0%) had their cycles cancelled and 11 (6.7%) had freeze-all. Serum AMH level was significantly higher in the high-responders compared with the non-high responders group (5.56 ng/ml±2.85 vs 2.83 ng/ml±2.06, OR 1.52, 95% CI 1.221.88, P<0.001). Using a cut-off level of ≥3.75, AMH has a sensitivity and specificity of 75% and 72.5% in prediction of OHSS.
Conclusion(s): Our results demonstrate that AMH has a significant ability to predict patients who are at risk of OHSS. AMH could be a part of diagnostic model to identify patients at risk of OHSS before they embark on COH. This is likely to have enormous benefits in reducing costs and the distress of in-cycle cancellation.