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Anti-Müllerian hormone levels could reveal ovulation response in women with obesity and PCOS
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CHICAGO — In obese women with polycystic ovary syndrome, an association between high anti-Müllerian hormone levels and decreased response to ovulation induction was discovered, according to research presented at the joint meeting of the International Congress of Endocrinology and the Endocrine Society.
Findings from a secondary analysis of the randomized clinical trial Pregnancy in Polycystic Ovary Syndrome conducted by Marcelle Ivonne Cedars, MD, of the University of California San Francisco, and colleagues, could carry treatment implications but requires further investigation.
“Increasing anti-Müllerian hormone (AMH) levels suggest a resistance to ovulation but no level could be identified as a cutoff,” Cedars said. “The factors that predict the ovulatory response are many, and AMH can be added to this list, but it does not appear to be strong enough to be used as a predictor alone.”
The investigators looked at 748 women (aged 18-40 years, mean BMI=35) with polycystic ovary syndrome (PCOS) as defined by Rotterdam Criteria who had AMH levels measured at baseline. Patients had at least one patent fallopian tube, normal uterine cavities and consenting sexual partners with at least 14 million/mL sperm concentration.
The researchers assigned couples to ovulation induction, with either letrozole or clomiphene citrate, and followed them for five treatment cycles to determine ovulation and incidences of pregnancy. They compared the geometric mean AMH levels of women who ovulated during the trial and those who did not, making adjustments for age, BMI, testosterone, insulin and Ferriman-Gallwey score. Logistic regression was used to determine the relationship between AMH and ovulation, with adjustments for the same factors.
In response to treatment, 619 women ovulated during the study. A lower mean AMH correlated with ovulation (geometric means 5.59 vs. 7.07; OR=0.56; 95% CI, 0.42-0.75). Results maintained significance with adjustments (P=.0001). Additional adjustments for antral follicle count (AFC), smoking and treatment did not affect results.
Negative associations were observed between age and BMI and AMH levels; absolute AMH levels still were relatively high (geometric mean 5.81). AMH positively correlated with testosterone but negatively with insulin levels. The fully adjusted AMH to AFC ratio was lower (0.14 vs. 0.17, P=.04) in women who ovulated compared with those who did not.
“AMH levels and AMH per follicle at baseline were significantly lower in women who ovulated compared to those who failed to ovulate, and were significantly lower in women who responded to the lowest doses,” Cedars said. “There were, however, no interactions between AMH levels and treatments, and no cut-off could be established beyond which ovulation did not occur.” — by Allegra Tiver
For More Information: Cedars MI. Abstract OR04-4. Presented at: The joint meeting of the International Congress of Endocrinology and the Endocrine Society; June 21-24, 2014; Chicago.
Disclosures: Cedars reports being an investigator for Ferring Pharmaceuticals.