Relationship between Anti-Müllerian Hormone level in women with polycystic ovary syndrome and response to ovulation induction with clomiphene citrate

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-aged women. It is characterized by androgen excess, chronic oligo and/or anovulation and polycystic ovaries (PCO) on ultrasound.

Anti-Müllerian hormone (AMH) is a dimeric glycoprotein, which is secreted exclusively by granulosa cells of primary, preantral and small antral follicles (4-6 mm). Its secretion gradually diminishes in the subsequent stages of follicle development and is practically undetectable in follicles larger than 8 mm.

Previous research has shown women with polycystic ovarian syndrome (PCOS) to have a two- to threefold increase in serum AMH concentration, which corresponds to the two- to threefold increase in the number of small (2-5 mm) follicles seen in PCOS. This increase in AMH has been implicated in the pathogenesis of PCOS. It has been hypothesized that the high serum AMH levels in PCOS lower the follicle sensitivity to circulating FSH thus preventing follicle selection resulting in follicle arrest at the small antral phase with failure of dominance. AMH also inhibits aromatase activity resulting in reduction of follicle production of estradiol (E2). The resulting low levels of E2 may also contribute to the failure of follicle selection.

The aim of this study was to evaluate the impact of AMH levels in women with PCOS on the ovarian responsiveness in women receiving Clomiphene Citrate for induction of ovulation.