Clinical Assessment And Outcome Evaluation Of AMH Levels In PCOS Patients With Assisted Reproductive Technology

Context: Anti-mullerian hormone(AMH)is a dimeric glycoprotein member of the TGF-(?) family.In women,AMH is derived primarily from preantral and early antral follicles and has been shown in recent years to accurately reflect the follicular pool.While the AMH level is utilized to assess the ovarian reserve in many scenarios,it has served most commonly to assess the likelihood of an adequate response during ovarian stimulation for assisted reproduction.Anti-mullerian hormone is expressed by granulosa cells of the ovary during the reproductive years and limits the formation of primary follicles by inhibiting excessive follicular recruitment by FSH.In this context,AMH is predictive of the number of oocytes retrieved,and increasingly is being utilized to guide selection of the stimulation protocol.Anti-Müllerian hormone(AMH)is an important regulator of folliculogenesis in the ovaries as AMH has an inhibitory role in the ovary,reducing both primordial follicle initiation and follicle sensitivity to FSH by inhibition of aromatase.It is for this reason that AMH is a focus of interest in polycystic ovary syndrome(PCOS).Antimullerian hormone(AMH)associates with ovarian reserve and response to controlled ovarian stimulation.Antimullerian hormone levels are higher in poly cystic ovarian syndrome PCOS patients and it has somes impacts on the physiology of the female reproductive system.Emerging data indicates that serum AMH levels may also presage ART outcomes.Objective: To determine the clinical assessment and outcome of AMH imbalance in poly cystic ovarian syndrome PCOS patients with assisted reproductive technology ART.Design: Retrospective cohort studyMethods: This was a retrospective cohort study and a total of 1550 in vitro fertilization(IVF)cycles performed from 01 January 2018 to 01 January 2020 in our center among them 185 poly cystic ovarian syndrome PCOS women(Rotterdam criteria)who underwent their first fresh IVF/ICSI cycle.Women were divided into 3 groups according to the<25th(low),25 to 75th(average),or > 75th(high)percentile of serum AMH concentration.Cycle stimulation parameters and reproductive outcomes were compared between groups.Results: In total 185 patients were distributed according to AMH levels and compared in-between average,low and high AMH groups.AMH Level Normal/average limit,3.32–8.27 n =92;Low limit < 3.32 n=47;High limit > 8.27 n =46.The fertilization rate from the average to high AMH ranges has increased from 64.2%,70.4% and 66.5%respectively.As well in implantation rate has increased in low AMH level and decrease in high AMH level.From average to high the rate was40.6%,47.1%,35.3%,accordingly.In case of clinical pregnancy rate also increased in the low group of AMH patients and decreased in decrease in high AMH level.All the above denominators were compared in orders in a series of analysis as,Low vs.High,Low vs.Average and Average vs.High.But there was no statistical difference noted.There was significant increase in live birth rate per embryo transfer(LBR)in PCOS women in the low AMH group(65.2%)compared to the average AMH(46.7%)and high AMH(43.5%)groups.In the group analysis of Live birth in Low vs.High,the p-value < 0.05;Low vs.Average,the p-value < 0.05;and Average vs.High,p-value was not significant.Total numbers of Miscarriage were tabled in three groups.In this part,2 early pregnancy loss [n46] in high AMH level and also 4 clinical loss in high AMH level [n46].About 95%,85% and 80% term delivery in average,low and high AMH group,respectively.On the other view the preterm delivery rate increase in high AMH level group.About 5%,15%,and 20% in association with normal/average,low and high AMH groups of PCOS patents.Conclusion: From our delegated analysis in distributed multi-group comparative study,it demonstrated that the elevated AMH concentration has strong impact in the ART outcomes.The elevated AHM levels may associate with an increased risk of lower live birth and preterm birth.So in terms of functional outcomes of ART,this AMH may consider as a multi-dimensional marker to predict the success of ART in PCOS women.