The Dynamics Of Anti-mullerian Hormone In Polycystic Ovarysyndrome During The Course Of Controlled Ovarian Stimulation And The Relationship Beween AMH And The Outcome Of IVF-ET

Objective: Research the dynamics of serum anti-Mullerian hormone(AMH) in polycystic ovary syndrome (PCOS) patients during the course ofcontrolled ovarian stimulation(COS); Analysis the relationship between serumAMH level in patients with PCOS and the dosage of gonadotropin (Gn) duringthe COS;Explore the relationship between AMH levels of serum and follicularfluid and the outcome of in vitro fertilization-embryo transfer (IVF-ET);Explore the predictive value of serum AMH level in the risk of ovarianhyperstimulation syndrome (OHSS).Method: We selected patients who accepted IVF/ICSI-ET treatment inthe Reproductive Center of Second Hospital of Hebei Medical Universityfrom December2012to October2013, all the patients have tubal dysfunctionand/or male dysfunction, including70cases of PCOS (experimentalgroup),and20non-PCOS patients (control group).Blood samples of all thepatients were collected on the third day of the Menstrual (Day3), the startingdate of exogenous gonadotropin (Gn day),the day of HCG injection (HCG day)respectively. On the oocyte retrieval day, follicular fluid was collected. Weanalyzed the levels of serum AMH in different time（Day3、Gn day and HCGday）, the level of basic FSH, the total dosage of Gn, the duration of COS,thenumber of transferrable embryo and the outcome of pregnancy. According tothe basic serum AMH, PCOS patients were divided into low, moderate andhigh groups. We compared the number of transferrable embryo, pregnancyrate,the occurrence of moderate and severe OHSS in the three groups. We explored the relationship between AMH levels of serum and follicular fluidand the occurrence of moderate and severe OHSS.Result: Compared with the control group, the levels of serum AMH onDay3、Gn day and HCG day are significantly higher in the PCOS group andthe follicular fluid AMH level is also significantly higher in the PCOS group(P <0.05). Serum AMH level on the Gn day is significantly higher comparedwith that of Day3in both the two groups, serum AMH level on the HCG dayis significantly lower than that of Day3in both the two groups (P <0.05). Thetotal Gn dose in PCOS group is higher than that in the control group, withstatistically significant difference (P <0.05).There is no statistical differencesin the duration of COS、 the number of transferrable embryo、the rate ofpregnancy and the occurrence of moderate and severe OHSS between thePCOS group and the control group(P>0.05). In the PCOS group, patients inhigh serum AMH require significantly higher dosage of Gn than the low AMHgroup and the moderate group, with statistically significant difference (P<0.05),but there is no statistical differences between the low AMH group andthe moderate AMH group (P>0.05).In the control group, serum and follicularfluid AMH levels were higher in the pregnant patients than the non-pregnantpatients,the difference was statistically significant (P <0.05).But in the PCOSgroup there is no statistical difference in serum and follicular fluid AMHlevels between the pregnant patients and the non-pregnant patients. In thePCOS group, there is no statistical difference in the serum and follicular fluidAMH levels between the moderate and severe OHSS patients and the non-moderate and severe OHSS patients.But in patients with moderate and severeOHSS, decline in serum AMH levels is higher than the non-moderate andsevere OHSS patients,the differences were statistically significant (P <0.05)Conclusion: Serum AMH level significantly changed during controlledovarian stimulation: Serum AMH level elevated after pituitarydown-regulation, then decreased after COS;Patients with higher AMHrequired greater amounts of Gn during controlled ovarian stimulation; AMHlevel of serum and follicular fluid can predict pregnancy outcome in patients with non-PCOS;The decreased level of serum AMH in PCOS patients can beused to predict the risk of moderate and severe OHSS.