Increased anti-Mullerian hormone and decreased FSH levels in follicular fluid obtained in women with polycystic ovaries at the time of follicle puncture for in vitro fertilization

Objective: To confirm the increased levels of anti-Mullerian hormone (AMH) in preovulatory follicles from patients with polycystic ovary syndrome (PCOS) and to study the role of other hormones involved in folliculogenesis in this increased secretion. Design: Prospective study. Setting: University hospital in France. Patient(s): Twenty-two patients with PCOS and 20 controls undergoing IVF. Intervention: On the day of oocyte retrieval, follicular fluid (FF) from one small follicle (8-13 mm) (SF) and one large follicle (16-23 mm) (LF) was collected in each patient. Main Outcome Measure(s): Per-follicle AMH, FSH, estradiol, androstenedione, hCG, and progesterone levels, and pregnancy rate. Result(s): In FF from both SF and LF of PCOS patients, AMH level was significantly increased, and FSH level was significantly decreased when compared with controls. Both hormone levels were negatively and significantly related in controls but not in PCOS. The AMH levels from SF and LF were significantly lower in patients who began a pregnancy. Conclusion(s): Our findings suggest that the granulosa cells from polycystic ovaries continue to produce elevated levels of AMH, possibly because of impaired access of FSH to follicles. Such an excess in FF AMH may have harmful consequences on oocyte quality and final maturation through unknown mechanisms. (Fertil Steril (R) 2010; 94: 198-204. (C) 2010 by American Society for Reproductive Medicine.)