COMPARISON OF ANTI-MULLERIAN HORMONE WITH BASAL FOLLICLE STIMULATING HORMONE LEVEL IN PREDICTING RESPONSE TO CONTROLLED OVARIAN HYPERSTIMULATION IN IN- VITRO FERTILIZATION CYCLES AT UNIVERSITY OF BENIN TEACHING HOSPITAL, BENIN CITY, NIGERIA
Background: Anti-Mullerian hormone is an emerging biochemical marker useful in evaluating infertile females before in vitro fertilization treatment independent of gonadotrophin and stable thought the menstrual cycle. The follicle stimulating hormone which is the most commonly used biochemical marker and presently used at the University of Benin Teaching hospital for this evaluation is characterized by its inter- cycle and inter-sample variation of results and difficulty with timing of measurement in women with irregular menses. However there is paucity of indigenous studies and insufficient scientific evidence to recommend anti-Mullerian hormone for evaluating women for assisted reproduction in our own setting.
Objectives: To ascertain if serum anti-Müllerian hormone is superior to basal follicle stimulating hormone in predicting response to controlled ovarian hyperstimulation in in- vitro fertilization cycles.
Study Design: A Cohort Study.
Methodology: The study was conducted at the Human Reproduction and Research Unit of the department of Obstetrics and Gynaecology of the University of Benin Teaching Hospital in Benin City. It was a prospective cohort study on 54 consecutive women selected for their first in vitro fertilization cycle during the study period. Their day 3 blood samples were analysed for anti-Mullerian hormone using the Ansh-lab ultra- sensitive AMH ELISA assay and follicle stimulating hormone was also analysed by the DRG ELISA assay in all selected women in the synchronized cycle preceding their stimulation having given informed consent. They went through the agonist or antagonist cycles, had ultrasound scan monitoring and oocyte maturation achieved using the human chorionic gonadotrophin or buserelin before oocyte retrieval under ultrasound scan guidance. The number of oocytes retrieved served as the primary outcome measure in this study. The women were categorized as poor responders if less than 4 oocytes were retrieved or normal responders if 4 or more oocytes were retrieved. The relevant information were obtained using the data extraction form and analyzed using the IBM SPSS version 20.0 software. Anti-Mullerian hormone and follicle stimulating hormone were compared using measures of diagnostic accuracy, area under the receiver operating characteristic curve and further compared while controlling for confounding clinical variables using the multivariate logistic regression model.
Results: From the 54 women analyzed, 59.2% were over 35 years of age, 75.9 were nulliparous, 55.6% had tertiary level of education and tubal factor was the indication for in vitro fertilization treatment in 51.9% of the cases. Although most of these women were of late reproductive age, 75.9% were either overweight or obese and 75.9% still had regular menstrual cycles. Overall, 24.1% of the women had poor ovarian response.
In this study, the mean AMH level for poor and normal responders was 2.10 ± 0.70 and 5.3 ± 2.50 while 7.70 ± 3.00 and 8.10 ± 2.80 was the mean FSH level for poor and normal responders respectively. The sensitivity, specificity, diagnostic accuracy and AUROC was 80.5%, 76.9%, 79.6% and 0.811 respectively for anti-Mullerian hormone and 46.2%, 41.5%, 42.6% and 0.535 respectively for basal follicle stimulating hormone. On further analysis using the multivariate logistic regression model, odd ratio and p value was 12.15 and 0.002 for anti-Mullerian hormone when compared with 0.75 and 0.692 for basal follicle stimulating hormone.
Conclusion: Findings from this study has reaffirmed serum anti-Mullerian hormone level as a better predictor of response to controlled ovarian hyperstimulation than basal follicle stimulating hormone levels in infertile females in preparation for in vitro fertilization treatment.