Anti-Müllerian hormone and response to ovulation induction with clomiphene citrate in women with polycystic ovary syndrome

Mohamed S. Sweed, Osama S. El-Kady, Eman A. AbdElSalam, Mohammed M. Mostafa


Background: Anti-Müllerian hormone (AMH) is suggested as an important marker for women with polycystic ovary disease (PCOS). Several studies have found serum level of AMH correlate well to ovarian response to ovulation induction in women with PCOS. This study was conducted to assess the relationship between AMH in women with PCOS and response to ovulation induction with clomiphene citrate.

Methods: Prospective observational cohort study conducted at Ain-Shams university maternity hospital from February 2013 to February 2014. 100 women with PCOS were recruited from the infertility outpatient clinic. Serum AMH levels were measured by enzyme linked immunosorbent assay in the early follicular phase (days 3-5). Ovulation induction by clomiphene citrate was started on day 5 as 50 mg daily tablet for 5 days. Ovulation was documented by transvaginal ultrasonography and women who failed to ovulate till day 35 were considered anovulatory.

Results: 72 women ovulated within 12 to 33 days of the menstrual cycle, while 28 had undetectable ovulation till day 35. The median serum AMH level was significantly higher in women with failed ovulation [4.05 ng/mL (3.7 - 4.4)] than in ovulating women [2.7 ng/mL (1.9 - 3.1)] (p<0.001). Receiver-operating characteristic (ROC) curve analysis found the best cutoff value of AMH for prediction of successful ovulation ≤3.6 ng/mL (sensitivity = 97.2%, specificity = 82.1%).

Conclusions: Anti-Müllerian hormone is a very useful predictor of poor responders to clomiphene citrate among women with polycystic ovary disease.


Anti-Müllerian hormone, Anovulation, Clomiphene citrate, Polycystic ovary disease, Poor responders

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