Hum. Reprod. Advance Access originally published online on July 29, 2009
Human Reproduction 2009 24(11):2760-2766; doi:10.1093/humrep/dep271
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The value of measuring anti-Müllerian hormone in women with anovulatory polycystic ovary syndrome undergoing laparoscopic ovarian diathermy
1 University of Nottingham, Derby City General Hospital, Derby, UK 2 Reproductive Medicine and Surgery Unit, University of Sheffield, Sheffield Teaching Hospitals, Sheffield, UK
3 Correspondence address. E-mail: saad.amer{at}nottingham.ac.uk; saadamer{at}hotmail.com
BACKGROUND: Anti-Müllerian hormone (AMH) has been implicated in the pathogenesis of polycystic ovary syndrome (PCOS). The aim of this study was to measure circulating AMH before laparoscopic ovarian diathermy (LOD) to evaluate its prognostic value for an ovulatory response and to investigate AMH changes after LOD to further explore the effects of LOD.
METHODS: This prospective study included anovulatory women with PCOS undergoing LOD (n = 29) or receiving clomiphene citrate (n = 18). Plasma AMH concentrations were measured before and 1 week after treatment. Further measurements of AMH were made at 3- and 6-month follow-up.
RESULTS: The pretreatment median (range) plasma AMH concentrations were 6.1 (1.0–21.0) and 5.7 (1.3–9.5) ng/ml in women having LOD and clomiphene citrate treatment, respectively. Women who ovulated after LOD (n = 24) had a significantly (P = 0.032) lower pre-operative AMH [5.6 (1.0–21.0) ng/ml] compared with the non-responders [9.0 (6.1–17.1) ng/ml]. Using receiver-operating characteristic curve analysis, AMH was found to be a useful predictor of no ovulation after LOD with area under the curve of 0.804 (P = 0.025). Using a cut-off of 7.7 ng/ml, AMH had a sensitivity of 78% and a specificity of 76% in the prediction of no ovulation after LOD. For all patients (n = 47, clomiphene citrate or LOD), plasma AMH 
7.7 ng/ml was associated with a reduced chance of ovulation after treatment (P = 0.004). Following LOD, the median AMH concentration significantly (P = 0.003) decreased to 4.7 (0.3–15.1) ng/ml and remained low at 3- and 6-month follow-up.
CONCLUSIONS: Pretreatment circulating AMH level seems to be a good predictor of the ovarian response to LOD.
Key words: polycystic ovary syndrome/laparoscopic ovarian diathermy/ovulation/anti-Müllerian hormone/clomiphene citrate
Submitted on November 13, 2008; resubmitted on April 17, 2009; accepted on May 28, 2009.
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