Do baseline AMH levels in women with polycystic ovary syndrome predict ovulation rate and time to ovulation: a secondary analysis of PCOSAct trial?
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AbstractObjective: To assess the association of baseline AMH levels with ovulation, time to ovulation, and fertility outcomes in women with PCOS receiving clomiphene citrate (CC) and compare with placebo.
Design: Secondary analysis of the PCOSAct trial (NCT01573858).
Setting: 27 trial centers in mainland China.
Population or Sample: 1000 infertile women with PCOS receiving either CC or placebo.
Methods: Baseline serum AMH was measured and analyzed as continuous and categorical variable. Interaction between AMH and CC was tested. Predictive values of AMH for ovulation, time to ovulation and fertility outcomes were assessed.
Main outcomes measures: Ovulation and time to ovulation.
Results: 900 baseline AMH data were available for analysis. There were no significant interactions on ovulation and conception for AMH and CC treatment (P=0.782 and 0.419, respectively). Women in upper quartile of AMH >15.88 ng/mL had significant lower ovulation (OR 0.34, 95%CI 0.20-0.58) and conception rates (OR 0.65 95%CI 0.42-1.00) as compared to lower quartile. Associations of AMH with clinical pregnancy (OR 0.98, 95%CI 0.95-1.01) and live birth (OR 0.98, 95%CI 0.96-1.01) were not significant. Ovulation rate increased until baseline AMH levels ≥7.0 ng/mL in women administrated CC but decreased when AMH increased in women with placebo. When AMH <7.0 ng/mL, a AMH threshold at 4.11 ng/mL can predict ovulation in women receiving CC (AUC 0.64, 95% CI 0.42-0.86), with sensitivity 64% and specificity 62%, while the prediction value was poor for AMH ≥7.0 ng/mL (AUC 0.38, 95% CI 0.28-0.47). Median time to ovulation was 35 days in lower quartile for women with placebo, but significantly prolonged to 98 days in upper quartile. CC significantly shortened the time to ovulation up to 56 days.
Conclusions: Among women with PCOS, high baseline AMH levels were associated with a 20.1% lower chance of and 63 days longer to ovulation. AMH can predict ovulation only when baseline AMH level <7.0 ng/mL in women with PCOS undergoing ovulation induction with CC.
Keywords: Anti-Müllerian hormone, ovulation, time to ovulation, polycystic ovary syndrome
Acceptance Date30/03/2021
All Author(s) ListWu Q, Li J, Ng EHY, Liu JP, Ben Mol WJ, Wu XK, Wang CC, PCOSAct Study Group
Journal nameBJOG: An International Journal of Obstetrics and Gynaecology
Year2021
ISSN1470-0328
eISSN1471-0528
LanguagesEnglish-United Kingdom

Last updated on 2021-14-05 at 11:44