Anti-Müllerian hormone dynamics during ovulation induction treatment with recombinant follicle-stimulating hormone in women with polycystic ovary syndrome.

INTRODUCTION Anti-Müllerian hormone (AMH) has been suggested as a predictor of ovarian response to ovulation induction and controlled ovarian hyperstimulation. MATERIAL AND METHODS Twenty-six women, wishing to become pregnant and who showed resistance to clomiphene citrate, were included in the study. All women received recombinant follicle-stimulating hormone (recFSH). RESULTS In the group of good responders, luteinising hormone (LH) and oestradiol levels were lower than in the group of non-responders. Free testosterone levels, free androgen index, and insulin resistance were higher in the group of non-responders. In the group of good responders, AMH levels decreased on successive days of ovarian stimulation and a greater slope of AMH levels was observed in patients with a higher number of increasing follicles. PCOS patients have low FSH and high AMH levels. It could be suggested that the serum AMH decrease preceded growth of many follicles, which is a consequence of the FSH stimulation. In anovulatory PCOS women, gently increasing the serum FSH level reduces the AMH excess, thus relieving the inhibition from the latter on aromatase expression by selectable follicles and allowing the emergence of growing follicles. Patients with severe hyperandrogenism, insulin resistance and high level of LH do not respond to stimulation. CONCLUSIONS The decrease of AMH levels in PCOS women after one week of ovarian stimulation is a practical, valuable indicator which could predict the patients with a high risk of ovarian hyperstimulation. Anovulating PCOS patients with severe hyperandrogenism, insulin resistance and hyperinsulinaemia should not be qualified for recFSH ovarian stimulation.