Moustafa K Eissa
Cyberjaya University College of Medical Sciences, Malaysia
Title: Anti mullerian hormone in polycystic ovarian syndrome patients
Biography
Biography: Moustafa K Eissa
Abstract
PCOS is a multi-factorial complex characterized by chronic anovulation, polycystic ovaries and biochemical and clinical manifestation of hyperandrogenism. AMH is secreted exclusively by granulosa cells of primary, pre-antral and small antral follicles. The level of serum AMH correlates with the number of small follicles, ovarian reserve. It is known that AMH is elevated in PCOS patients probably because of the large numbers of small follicles. This high level may lead to desensitization of the primordial follicles to FSH. This may lead to poor response of ovaries to stimulation by gonadotropins. This increase of serum AMH is implicated in the pathogenesis of PCOS. It desensitizes the small antral follicles to secreted FSH, so prevent growth and selection with failure of dominance. Also it inhibits aromatization resulting in reduction of secretion of E2. This low E2 may cause further failure of follicle selection.This serum level of AMH can be used as indicator of good or bad response to ovarian stimulation in induced and assisted reproduction cycles. Some researchers reported a negative correlation between serum level of AMH and fertilization and pregnancy rates in PCOS patients. Others reported opposite findings. This led us to investigate the predictive value of circulating AMH in PCOS patients undergoing ovarian stimulation with gonadotropins. We found that circulating AMH was negatively correlated with ovarian response to gonadotropins stimulation and a high cancellation rate. This extends to other lines of stimulation as Laparoscopic ovarian drilling (LOD) and clomiphene citrate stimulation. This is opposite to non PCOS patients where response to ovarian stimulation positively correlates with the level of AMH. This may suggest that there is an optimum level of AMH for optimum response. So, pre-treatment estimation of serum AMH may be a valuable predictor of the possible response and the suitable dose of stimulation.