Predictive Value Of AMH Hormone Concentration For Ovulation Induction In Patients With Polycystic Ovary Syndrome

Background:Polycystic ovary syndrome is a disease with heterogeneous indicators and symptoms.It is characterized by reproductive endocrine dysfunctions and Metabolic dysfunction,and it affects approximately 20 percent of women’s health worldwide.Its most important clinical feature is thinning ovulation or anovulation,which is by far the most common cause of anovulatory infertility,accounting for about 70% of infertility patients due to ovulation disorders.At present,the mechanism of follicular dysplasia in POCS is still unclear.,it could be noticed that follicles stopped growing.PCOS with anovulation and high androgen phenotype,the expression of serum AMH hormone is increased,which inevitably makes people notice the relationship between high AMH levels and chronic anovulation in PCOS.In recent years,AMH has become an important diagnostic marker in the pathophysiology of PCOS.AMH is highly expressed in antral follicles,which is related to the excessive follicles in patients with PCOS.AMH can also reflect the severity of PCOS symptoms.AMH plays an important role in early follicular recruitment,development,selection and maturation.High levels of AMH have been shown to inhibit follicular growth in PCOS.Whether AMH is associated with ovulation induction disorders still need to be determined.Moreover,AMH has the advantages of stable expression throughout the menstrual cycle and does not require a specific time to collected.Therefore,it has a significance to evaluate AMH as an index for predicting anovulation in PCOS patients.Objective:To investigate the effects of AMH hormone levels in infertile patients with polycystic ovary syndrome on the ovulation outcome after ovulation induction and its predictive value.Methods:From July 2018 to July 2019,108 patients with PCOS and infertility were selected for a total of 180 ovulation induction cycles.Serum AMH concentration,basic sex hormones and follicular numbers of bilateral ovary were measured on D2-4 of each menstrual cycle.Divided into ovulation group and ovulation disorder group according to ovulation outcome,compare the difference of biological indicators between the two groups;ALL patients were divided into four groups according to the interquartile range of AMH: Quartile A≤6.16 μg/L、Quartile B<6.16～≤8.88 μg/L、Quartile C<8.88～≤12.46 μg/L、Quartile D>12.46 μg/L,each quartile including 45 patients.Compare parameters and ovulation rate differences;The relationship of AMH and ovulation were compared by logistic regression analysis;and the value of AMH predicted anovulation outcome was calculated according to ROC curve.Results:1.107 women were observed among who ovulated.Their age,basic testosterone and serum AMH level were lower than anovulation group(P<0.05);2.Four groups according to the interquartile range of AMH,the difference of basic testosterone and basic antral follicles were statistically significant.The basic testosterone of quartile D(>12.46 μg/L)was higher than quartile A(≤6.16 μg/L),the basic antral follicles of quartile D was higher than quartile A and quartile B(P<0.05);3.Ovulation rate of quartile D(44.4%)was lower than quartile B(73.3%)(P<0.05);4.Multivariate logistic regression analysis suggested that increased of AMH levels was the risk factor of anovulatory response(OR=0.88,95%CI:0.78～0.98,P=0.017);5.The receiver-operating characteristic(ROC)curve was showed it will be a useful predictor of ovulation disorders when AMH>10 ng/m L,AUC is 0.63(95%CI:0.54～0.71,P=0.004),with a sensitivity of 54.8% and a specificity of 68.2%.Conclusions:1.High serum AMH level is associated with the risk of anovulation outcomes;2.AMH has a good predictive value and it could be used as a indicator of outcomes in PCOS after ovulation induction treatment.3.AMH> 10 μg/L can be used as a diagnostic threshold for clinical judgment of patients’ ovulation induction failure.