Açıklanamayan İnfertilitesi Olan Hastalarda Serum Antimüllerian Hormon Seviyeleri ile Tedavi Cevabı ve Fertilite Sonuçları İlişkisi

Öz

Amaç: Açıklanamayan infertilite nedeniyle Klomifen Sitrat ile Ovulasyon İndüksiyonu ve İntrauterin İnseminasyon CC+IUI yapılan hastalarda serum Antimüllerian Hormon AMH değerleri ile tedavi sonuçları arasındaki ilişkiyi değerlendirmeyi amaçladık.Gereç ve Yöntemler: Açıklanamayan infertilite nedeniyle CC+ IUI tedavisi yapılan 60 hastanın sonuçları retrospektif olarak değerlendirildi. AMH değeri 3,15 ng/mL olan hastaların ve ß hCG değeri pozitif ya da negatif olan hastaların klinik ve laboratuvar özellikleri karşılaştırıldı. AMH seviyeleri ile başarılı ovaryan yanıt, gebelik testi pozitifliği, ovulasyon tetikleme günü serum Östradiol E2 düzeyi ve midluteal serum progesteron düzeyi arasındaki ilişkiyi değerlendirdik.Bulgular: Hastaların ortalama yaşı 30.5±4.7 yaş idi. Receiver Operating Characteristics ROC Analizinde, gebeliğin saptanması için AMH eşik değeri %53 sensitivite ve %34 spesifite ile 3.15 ng/mL olarak saptandı. AMH değeri >3,15 ng/mL olan ve

Anahtar Kelimeler

• Açıklanamayan infertilite, Antimüllerian Hormon, Gebelik öngörüsü, Klomifen sitrat, Ovulasyon indüksiyonu

The Relationship between Serum Antimullerian Hormone Levels and Treatment Response and Fertility Results in Patients with Unexplained Infertility

Abstract

Objective: We aimed to evaluate the relationship between serum Antimullerian Hormone AMH levels and treatment results in patients who underwent ovulation induction and intrauterine insemination CC + IUI with clomiphene citrate due to unexplained infertility.Material and Methods: The results of 60 patients who underwent CC + IUI treatment due to unexplained infertility were retrospectively evaluated. The clinical and laboratory characteristics of patients with positive or negative ß hCG values and patients with AMH 3.15 ng/mL levels were compared. We evaluated the association of AMH levels with a successful ovarian response, positive pregnancy test, ovulation triggering day serum estradiol E2 levels and mid-luteal serum progesterone levels.Results: The mean age of the patients was 30.5 ± 4.7 years. In the Receiver Operating Characteristics ROC analysis, the cut off value of AMH on detection of pregnancy was found 3.15 ng/mL with 53% sensitivity and 34% specificity. When we compared the patients with AMH levels 3.15 ng/mL, the mean age, duration of infertility, Body Mass Index BMI , Luteinizing Hormone LH , Thyroid Stimulating Hormone TSH , ovulation triggering day E2, mid-luteal progesterone levels, and ß hCG positivity were not significantly different between the two groups. In multiple logistic regression analysis, there was a significant relationship between mid-luteal progesterone levels and positive pregnancy test but there was no relationship between AMH and a positive pregnancy test.Conclusion: AMH is not a good marker of predicting pregnancy in patients with unexplained infertility treated with CC + IUI

Keywords

• Unexplained infertility, Antimullerian Hormone, Pregnancy prediction, Clomiphene citrate, Ovulation induction

References

1. Mosher WD, Pratt WF. Fecundity and infertility in the United States: Incidence and trends. Fertil Steril 1991; 56(2):192-3.
2. Guzick DS, Sullivan MW, Adamson GD, Cedars MI, Falk RJ, Peterson EP, Steinkampf MP. Efficacy of treatment for unexplained infertility. Fertil Steril 1998; 70(2):207-13.
3. Comhaire FH, World Health Organization. Task Force on the Diagnosis and Treatment of Infertility. Towards More Objectivity in Diagnosis and Management of Male- Infertility. International Journal of Andrology 1987; R3- 53.
4. Practice Committee of the American Society for Reproductive Medicine. Effectiveness and treatment for unexplained infertility. Fertil Steril 2006; 5 Suppl 1:111-4.
5. Almog B, Shehata F, Suissa S, Holzer H, Shalom-Paz E, La Marca A, Muttukrishna S, Blazar A, Hackett R, Nelson SM, Cunha-Filho JS, Eldar-Geva T, Margalioth EJ, Raine-Fenning N, Jayaprakasan K, McIlveen M, Wunder D, Freour T, Nardo LG, Balasch J, Peñarrubia J, Smeenk J, Gnoth C, Godehardt E, Lee TH, Lee MS, Levin I, Gamzu R, Tulandi T. Age-related normograms of serum antimullerian hormone levels in a population of infertile women: A multicenter study. Fertil Steril 2011; 95(7):2359-63.
6. Zheng H, Chen S, Du H, Ling J, Wu Y, Liu H, Liu J. Ovarian response prediction in controlled ovarian stimulation for IVF using anti-Müllerian hormone in Chinese women. Medicine (Baltimore) 2017; 96(13): 6495.
7. Zebitay AG, Cetin O, Verit FF, Keskin S, Sakar MN, Karahuseyinoglu S, Ilhan G, Sahmay S. The role of ovarian reserve markers in prediction of clinical pregnancy. J Obstet Gynaecol 2017; 37(4):492-7.
8. Ashrafi M, Hemat M, Arabipoor A, Salman Yazdi R, Bahman-Abadi A, Cheraghi R. Predictive values of anti- mullerian hormone, antral follicle count and ovarian response prediction index (ORPI) for assisted reproductive technology outcomes. J Obstet Gynaecol 2017; 37(1):82- 8.

9. Coskun B, Dilbaz B, Karadag B, Coskun B, Tohma YA, Dur R, Akkurt MO. The role of anti-Mullerian hormone in predicting the response to clomiphene citrate in unexplained infertility. Taiwan J Obstet Gynecol 2018; 57(5):713-7.
10. Casadei L, Manicuti C, Puca F, Madrigale A, Emidi E, Piccione E. Can anti-Müllerian hormone be predictive of spontaneous onset of pregnancy in women with unexplained infertility? J Obstet Gynaecol 2013; 33(8):857-61.
11. Nardo LG, Gelbaya TA, Wilkinson H, Roberts SA, Yates A, Pemberton P, Laing I. Circulating basal anti-Müllerian hormone levels as predictor of ovarian response in women undergoing ovarian stimulation for in vitro fertilization. Fertility and Sterility 2009; 92:1586-93.
12. Jayaprakasan K, Campbell B, Hopkisson J, Johnson I, Raine-Fenning N. A prospective, comparative analysis of anti-Müllerian hormone, inhibin-B, and three- dimensional ultrasound determinants of ovarian reserve in the prediction of poor response to controlled ovarian stimulation. Fertility and Sterility 2010; 93:855-64.
13. Hansen KR, He AL, Styer AK, Wild RA, Butts S, Engmann L, Diamond MP, Legro RS, Coutifaris C, Alvero R, Robinson RD, Casson P, Christman GM, Huang H, Santoro N, Eisenberg E, Zhang H; Eunice Kennedy Shriver National Institute of Child Health and Human Development Reproductive Medicine Network. Predictors of pregnancy and live-birth in couples with unexplained infertility after ovarian stimulation- intrauterine insemination. Fertil Steril 2016; 105(6):1575- 83.
14. Kini S, Li HW, Morrell D, Pickering S, Joo Thong KJ. Anti-mullerian hormone and cumulative pregnancy outcome in in-vitro fertilization. Journal of Assisted Reproduction and Genetics 2010; 27:449-56.
15. Ficicioğlu C, Kutlu T, Baglam E, Bakacak Z. Early follicular antimullerian hormone as an indicator of ovarian reserve. Fertility and Sterility 2006; 85:592-6.
16. Lee Y, Kim TH, Park JK, Eum JH, Lee HJ, Kim J, Lyu SW, Kim YS, Lee WS, Yoon TK. Predictive value of antral follicle count and serum anti-Müllerian hormone: Which is better for live birth prediction in patients aged over 40 with their first IVF treatment? Eur J Obstet Gynecol Reprod Biol 2018; 221:151-5.
17. Kamath MS, Bhave P, Aleyamma T, Nair R, Chandy A, Mangalaraj AM, Muthukumar K, George K. Predictive factors for pregnancy after intrauterine insemination: A prospective study of factors affecting outcome. J Hum Reprod Sci 2010; 3(3):129-34.
18. Costello MF, Emerson S, Lukic J, Sjoblom P, Garrett D, Hughes G, Steigrad S. Predictive value of midluteal progesterone concentration before luteal support in controlled ovarian hyperstimulation with intrauterine insemination. Aust N Z J Obstet Gynaecol 2004; 44(1): 51-6.
19. Hansen KR, Eisenberg E, Baker V, Hill MJ, Chen S, Talken S, Diamond MP, Legro RS, Coutifaris C, Alvero R, Robinson RD, Casson P, Christman GM, Santoro N, Zhang H, Wild RA, NICHD Reproductive Medicine Network. Midluteal progesterone: A marker of treatment outcomes in couples with unexplained infertility. J Clin Endocrinol Metab 2018; 103(7):2743-51.
20. Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update 2006; 12:685- 718.
21. Oner G, Ulug P, Elmali F. Ovarian reserve markers in unexplained infertility patients treated with clomiphene citrate during intrauterine insemination. Arch Med Sci 2015; 11(6):1250-4.