The Relation between AMH Levels to the total Dose of HMG Given in Controlled Ovarian hyper Stimulation in In Vitro Fertilization (IVF)

Abstract

nti-Müllerian hormone (AMH) is a glycoprotein hormone, member of the transforming growth factor-ß (TGF-ß) superfamily, produced by the embryonic testis to induce the regression of the Müllerian ducts during male sex differentiation. Also in healthy ovaries expression of AMH is initiated in cuboidal granulosa cells of primary follicles as soon as primordial follicles are recruited from the dormant pool, and expression increases until the large preantral and small antral follicular stage. In the subsequent follicular stages, AMH expression diminishes and is absent during FSH dependent follicular growth. Furthermore, AMH is only expressed in healthy follicles, not in follicles undergoing atresia. Serum AMH measurements are used in many application in gynecological practice, as a measurement of the ‘ovarian reserve’ which encompasses both the quantity and quality of primordial follicles. Furthermore serum AMH levels more accurately reflect woman’s reproductive age than does chronological age, so AMH remained significant in predicting the age of menopause. It was also used to asses the ovarian reserve in patients undergoing numerous ovarian surgeries as well as patients who underwent chemotherapy. Serum AMH measurement in the prediction of quantitative and qualitative ovarian response in assisted reproductive technologies (ART) which means that AMH levels can predict normal responders, low responders and hyper-responders. AMH mayreflectnot only quantitative but also qualitative ovarian responsiveness. Indeed several authors have found a significant positive correlation between serum AMH levels versus oocyte and embryo morphology. It was also noted that the AMH levels in women did not reflect on the pregnancy rates. This study was held at the ART unitand a private clinic, Ain Shams University Maternity hospital on 251 patients ranging between the ages of 20-39 undergoing controlled ovarian hyperstimulation cycles for in vitro fertilization using GnRH-agonist long downregulation protocol. during which serum Antimullerian hormone sample was taken and analyzed. results showed that the median IQR for all age groups was 1.8 ng/ml. and were decreasing through out the age groups from 2.4 at the age group 20-29to -0.9 at the age of 35-39, while showing that the AMH showed statistical significance between poor and good responders, poor responders as defined by 3 or less growing follicles or the collection of less than four oocytes in response to an ovarian stimulation protocol of at least 150 IU FSH per day being at 0.8 ng/ml and good responders at 2.1 ng/ml. while it showed no statistical significance between