Anti-Mullerian hormone and antral follicle count for prediction of ovarian stimulation response in polycystic ovary syndrome

Objective: To evaluate the ability of a combination of multiple ovarian reserve markers to predict ovarian stimulation response in polycystic ovary syndrome (PCOS). Methods: On cycle Day 3 of 75 infertile patients with PCOS, serum follicle stimulating hormone (FSH), luteinizing hormone (LH), and anti-Mfillerian hormone (AMH) were measured, and antral follicle count (AFC) and ovarian volume (OV) were evaluated by transvaginal sonography (TVS). All patients underwent the same mild ovarian stimulation protocol using clomiphene citrate and highly purified FSH. Ovulation was monitored by TVS and confirmed by midluteal serum progesterone level. Results: AMH, AFC, and "ovulation index" (01, serum AMH (ng/ml) x bilateral AFC] were significantly lower in the ovulatory group (n=57, 76%) compared with the anovulatory group, whereas LH, FSH, LH/FSH ratio, and OV were not significantly different. Using receiver-operating characteristic curve analysis, the 01 at a cutoff value of "85" had a sensitivity of 73.7% and a specificity of 72.2% in the prediction of ovulation, with an area under the curve of 0.733. Patients with 01< 85 had significantly higher ovulation rate (p<0.001). Conclusion: The 01, combining both AMH and AFC, is a potentially useful predictor of the outcome of ovarian stimulation in PCOS.