Role of Anti-Mullerian Hormone (AMH) in ındicating the over reserve of IVF Patients

ABSTRACTRole of Anti-Mullerian Hormone (AMH) in Indicating the Over Reserve of IVF PatientsObjective: To find the level of effectiveness and reliability of AMH (anti-müllerian hormone) in indicating the over reserve of IVF patients in comparison with other reserve indicators used.Materials and Methods: Our study was prospectively planned in the Clinic of Obstetrics and Gynecology of Çukurova University, School of Medicine. 89 infertile couples with ages between 18 and 45 who applied to the Assisted Reproduction Treatment Center of our hospital between September of 2009 and July of 2010 were evaluated for the study. At time of application, histories of the patients were received and physical and pelvic examinations were carried out on them. Basal serum FSH, LH, E2, prolactin, sT3, sT4 and TSH levels of female patients were measured in the 3rd day of menstruation. In the same day, blood samples were collected for AMH and AMH values were measured by use of the Eliza method. Over volume and AFC (number of antral follicles) were determined through transvaginal ultrasound. In our study, all patients were subjected to long protocol with GnRH agonist. Oocyte collection was performed for patients who developed follicles larger than 18 mm and the level treatment success was determined based on the number of oocytes collected. Patients were divided into two groups depending on the number of oocytes collected. Oocyte numbers equal to or higher than 4 were included in the ?good response? group and oocyte numbers lower than 4 were included in the ?bad response? group. Afterwards, the results obtained were statistically compared with other parameters used for determination of over reserve. In addition, it was discussed if there is a relationship between AMH and pregnancy rate.Results: No significant difference was observed between the two groups in terms of average values of period of infertility (p: 0.867), body mass index (p: 0.819), LH (p: 0.779) and E2 levels (p: 0.487). On the other hand, two groups proved to display statistically significant dissimilarity in terms of age (p: 0.027), serum FSH (p: 0.036), MIF levels (p: 0.001), hCG day E2 levels (p: 0.001), number of antral follicles (p: 0.002), hCG day follicle numbers (p:0.001) and mature oocyte numbers (p: 0.001. When the cutoff value for MIF was taken to be 0,24 ng/ml, sensitivity and specifity were determined to be 82.1% and 72.7% respectively. Number of pregnancies were founded to be 24 (39.3%) in the group with MIF value higher than 0.24 ng/ml, and 3 (10.7%) in the other group. These two groups were determined to be statistically different (p=0.006). Number of live pregnancies were founded to be 17 (27.8%) in the group with MIF value higher than 0.24 ng/ml, and 2 (7.1%) in the other group. These two groups were determined not to be statistically different (p=0.075).Conclusion: It was seen that there is a strong relationship between serum AMH level and the over response of the patients. Besides, MIF levels were determined to be in relation with the success of providing chemical pregnancy. However, a relation between live births and MIF could not be established with this study.Keywords: IVF-ICSI-ET cycles, AMH/MIF, over reserve, pregancy