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Optimal cutoff value of basal anti-mullerian hormone in iranian infertile women for prediction of ovarian hyper-stimulation syndrome and poor response to stimulation.

Aghssa MM, Tarafdari AM, Tehraninejad ES, Ezzati M, Bagheri M, Panahi Z, Mahdavi S, Abbasi M - Reprod Health (2015)

Bottom Line: The optimal cutoff value for the prediction of OHSS was 6.95 ng/ml (area under the receiver operating characteristics curve: 0.86; CI: 0.78-0.95; sensitivity: 75 %; specificity: 84 %; odds ratio for occurrence of OHSS: 9 and p < 0.001).The optimal cut point to discriminate poor response (oocytes ≤4) was 1.65 ng/ml ( AUC : 0.8; CI: 0.69-0.91; sensitivity: 89 % specificity : 71 %; and OR = 23.8 and P value <0.001).Iranian women with basal AMH level > 6.95 ng/ml are at high risk of developing OHSS and those with AMH level < 1.65 ng/ml are poor responders.

View Article: PubMed Central - PubMed

Affiliation: Vali-e-Asr Reproductive Health Research Center, Department of Obstetrics and Gynecology, Valiasr Hospital, Tehran University of Medical Sciences, 1419433141, Tehran, Iran. mmaghssa@yahoo.com.

ABSTRACT

Aim: We intended to establish the threshold of Anti-Mullerian Hormone (AMH) for detection of Ovarian Hyper-Stimulation Syndrome (OHSS) and poor response to treatment in Iranian infertile women.

Methods: Pre-stimulation menstrual cycle day-3 hormonal indices including basal AMH values were measured in 105 infertile women aged 32.5 ± 4.3 years. Patients underwent long GnRH agonist Controlled Ovarian Hyperstimulation (COH) in a referral infertility center (Tehran, Iran). The gonadotropin dose was determined based on the age and basal serum Follicular Stimulating Hormone (FSH) level. The IVF/ICSI cycles were followed and the clinical and sonographic data were recorded.

Results: Sixteen cases developed OHSS. The prevalence of PCOS was higher in subjects with OHSS [62.5 % (38.8-86.2) vs. 17 % (9.2-24.9)]. The patients with OHSS had higher ovarian follicular count [23.7 (3.2) vs. 9.1 (0.5); p < 0.05], collected oocytes [13.5 (1.9) vs. 6.9 (0.5); p < 0.05] and AMH level [7.9 (0.7) vs. 3.6 (0.3); p < 0.05]. Basal AMH level and oocyte yields (but not age, BMI, and PCOS) correlated with occurrence of OHSS; and only the AMH levels were associated with poor ovarian response (oocytes yield ≤ 4). The optimal cutoff value for the prediction of OHSS was 6.95 ng/ml (area under the receiver operating characteristics curve: 0.86; CI: 0.78-0.95; sensitivity: 75 %; specificity: 84 %; odds ratio for occurrence of OHSS: 9 and p < 0.001). The optimal cut point to discriminate poor response (oocytes ≤4) was 1.65 ng/ml ( AUC : 0.8; CI: 0.69-0.91; sensitivity: 89 % specificity : 71 %; and OR = 23.8 and P value <0.001).

Conclusions: Iranian women with basal AMH level > 6.95 ng/ml are at high risk of developing OHSS and those with AMH level < 1.65 ng/ml are poor responders.

No MeSH data available.


Related in: MedlinePlus

Sensitivity, specificity, Yuden index and distance to the optimal point on the ROC curve for the basal anti-mullerian hormone levels to predict ovarian hyper-stimulation syndrome (panel a) and poor response to the IVF cycle (panel b). Arrows indicate the most effective threshold value of AMH (6.95 and 1.65 ng/ml for ovarian hyper-stimulation syndrome and poor response to ovarian stimulation, respectively) corresponding to both maximum Youden index and shortest distance on the ROC curve
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Fig3: Sensitivity, specificity, Yuden index and distance to the optimal point on the ROC curve for the basal anti-mullerian hormone levels to predict ovarian hyper-stimulation syndrome (panel a) and poor response to the IVF cycle (panel b). Arrows indicate the most effective threshold value of AMH (6.95 and 1.65 ng/ml for ovarian hyper-stimulation syndrome and poor response to ovarian stimulation, respectively) corresponding to both maximum Youden index and shortest distance on the ROC curve

Mentions: AMH levels classified subjects with and without OHSS with an area under the ROC curve (AUC) of 0.86 (0.78-0.95; Fig. 2); the best AMH cutoff value to predict OHSS was 6.95 ng/ml (sensitivity: 75 %, specificity: 84 %, PLR: 4.7, NLR: 0.3; Fig. 3, panel a). Patients with AMH values higher than 6.95 ng/ml experienced a higher frequency of OHSS (5.1 % vs. 46.2 %; OR = 9, CI: 1.3-59.7, Chi2 P value < 0.001). In subjects without OHSS, those with AMH values over 6.95 (n = 14) compared to those with AMH levels below 6.95 received significantly smaller gonadotropine doses per day [157 (17) IU vs. 197 (46); p < 0.005] with higher collected oocytes [9.4 (1.0) vs. 6.4 (0.5); p < 0.05] and the equal follicle count [11.1 (0.7) vs. 8.7 (0.7); p < 0.067]. The cutoff value of AMH with the best prediction of poor response to controlled ovarian stimulation (oocytes ≤4) was 1.65 ng/ml with AUC of 0.8 (0.69-0.91) and sensitivity and specificity of 89 % and 71 %, respectively (Fig. 3, panel b). A poor response rate in those with an AMH value below and above the cut point (1.65) was 75 % and 13.7 %, respectively (OR = 23.8, CI: 6.0-94.1, Chi2 P value <0.001). The cut points for detection of OHSS and poor response were substantially the same after exclusion of subject with PCOS (data not shown).Fig. 2


Optimal cutoff value of basal anti-mullerian hormone in iranian infertile women for prediction of ovarian hyper-stimulation syndrome and poor response to stimulation.

Aghssa MM, Tarafdari AM, Tehraninejad ES, Ezzati M, Bagheri M, Panahi Z, Mahdavi S, Abbasi M - Reprod Health (2015)

Sensitivity, specificity, Yuden index and distance to the optimal point on the ROC curve for the basal anti-mullerian hormone levels to predict ovarian hyper-stimulation syndrome (panel a) and poor response to the IVF cycle (panel b). Arrows indicate the most effective threshold value of AMH (6.95 and 1.65 ng/ml for ovarian hyper-stimulation syndrome and poor response to ovarian stimulation, respectively) corresponding to both maximum Youden index and shortest distance on the ROC curve
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4565016&req=5

Fig3: Sensitivity, specificity, Yuden index and distance to the optimal point on the ROC curve for the basal anti-mullerian hormone levels to predict ovarian hyper-stimulation syndrome (panel a) and poor response to the IVF cycle (panel b). Arrows indicate the most effective threshold value of AMH (6.95 and 1.65 ng/ml for ovarian hyper-stimulation syndrome and poor response to ovarian stimulation, respectively) corresponding to both maximum Youden index and shortest distance on the ROC curve
Mentions: AMH levels classified subjects with and without OHSS with an area under the ROC curve (AUC) of 0.86 (0.78-0.95; Fig. 2); the best AMH cutoff value to predict OHSS was 6.95 ng/ml (sensitivity: 75 %, specificity: 84 %, PLR: 4.7, NLR: 0.3; Fig. 3, panel a). Patients with AMH values higher than 6.95 ng/ml experienced a higher frequency of OHSS (5.1 % vs. 46.2 %; OR = 9, CI: 1.3-59.7, Chi2 P value < 0.001). In subjects without OHSS, those with AMH values over 6.95 (n = 14) compared to those with AMH levels below 6.95 received significantly smaller gonadotropine doses per day [157 (17) IU vs. 197 (46); p < 0.005] with higher collected oocytes [9.4 (1.0) vs. 6.4 (0.5); p < 0.05] and the equal follicle count [11.1 (0.7) vs. 8.7 (0.7); p < 0.067]. The cutoff value of AMH with the best prediction of poor response to controlled ovarian stimulation (oocytes ≤4) was 1.65 ng/ml with AUC of 0.8 (0.69-0.91) and sensitivity and specificity of 89 % and 71 %, respectively (Fig. 3, panel b). A poor response rate in those with an AMH value below and above the cut point (1.65) was 75 % and 13.7 %, respectively (OR = 23.8, CI: 6.0-94.1, Chi2 P value <0.001). The cut points for detection of OHSS and poor response were substantially the same after exclusion of subject with PCOS (data not shown).Fig. 2

Bottom Line: The optimal cutoff value for the prediction of OHSS was 6.95 ng/ml (area under the receiver operating characteristics curve: 0.86; CI: 0.78-0.95; sensitivity: 75 %; specificity: 84 %; odds ratio for occurrence of OHSS: 9 and p < 0.001).The optimal cut point to discriminate poor response (oocytes ≤4) was 1.65 ng/ml ( AUC : 0.8; CI: 0.69-0.91; sensitivity: 89 % specificity : 71 %; and OR = 23.8 and P value <0.001).Iranian women with basal AMH level > 6.95 ng/ml are at high risk of developing OHSS and those with AMH level < 1.65 ng/ml are poor responders.

View Article: PubMed Central - PubMed

Affiliation: Vali-e-Asr Reproductive Health Research Center, Department of Obstetrics and Gynecology, Valiasr Hospital, Tehran University of Medical Sciences, 1419433141, Tehran, Iran. mmaghssa@yahoo.com.

ABSTRACT

Aim: We intended to establish the threshold of Anti-Mullerian Hormone (AMH) for detection of Ovarian Hyper-Stimulation Syndrome (OHSS) and poor response to treatment in Iranian infertile women.

Methods: Pre-stimulation menstrual cycle day-3 hormonal indices including basal AMH values were measured in 105 infertile women aged 32.5 ± 4.3 years. Patients underwent long GnRH agonist Controlled Ovarian Hyperstimulation (COH) in a referral infertility center (Tehran, Iran). The gonadotropin dose was determined based on the age and basal serum Follicular Stimulating Hormone (FSH) level. The IVF/ICSI cycles were followed and the clinical and sonographic data were recorded.

Results: Sixteen cases developed OHSS. The prevalence of PCOS was higher in subjects with OHSS [62.5 % (38.8-86.2) vs. 17 % (9.2-24.9)]. The patients with OHSS had higher ovarian follicular count [23.7 (3.2) vs. 9.1 (0.5); p < 0.05], collected oocytes [13.5 (1.9) vs. 6.9 (0.5); p < 0.05] and AMH level [7.9 (0.7) vs. 3.6 (0.3); p < 0.05]. Basal AMH level and oocyte yields (but not age, BMI, and PCOS) correlated with occurrence of OHSS; and only the AMH levels were associated with poor ovarian response (oocytes yield ≤ 4). The optimal cutoff value for the prediction of OHSS was 6.95 ng/ml (area under the receiver operating characteristics curve: 0.86; CI: 0.78-0.95; sensitivity: 75 %; specificity: 84 %; odds ratio for occurrence of OHSS: 9 and p < 0.001). The optimal cut point to discriminate poor response (oocytes ≤4) was 1.65 ng/ml ( AUC : 0.8; CI: 0.69-0.91; sensitivity: 89 % specificity : 71 %; and OR = 23.8 and P value <0.001).

Conclusions: Iranian women with basal AMH level > 6.95 ng/ml are at high risk of developing OHSS and those with AMH level < 1.65 ng/ml are poor responders.

No MeSH data available.


Related in: MedlinePlus