Undetectable Serum Levels of Anti-Müllerian Hormone in Women with Ovarian Hyperstimulation Syndrome During In Vitro Fertilization and Successful Pregnancy Outcome: Case Report.

We report a unique case of undetectable serum levels of anti-müllerian hormone (AMH) in women with polycystic ovary syndrome (PCOS) who developed ovarian hyperstimulation syndrome (OHSS) during in vitro fertilization (IVF). A case is described of a 28-year-old woman with clinical symptoms of PCOS and AMH serum level below analytical sensitivity (<1.0 pmol/L). After undergoing controlled ovarian stimulation, the patient developed OHSS. After follicle aspiration, seven oocytes were recovered. Three of them were used for intracytoplasmic sperm injection (ICSI) and fertilized, but with unsuccessful pregnancy outcome. A successful pregnancy was achieved in the second IVF/ICSI cycle with six oocytes retrieved and three embryos transferred. At 39 weeks of gestation, the patient delivered a healthy baby weighing 3930 g and 50 cm long. In conclusion, although AMH is considered a useful tool in ovarian reserve assessment and in predicting response to controlled ovarian hyperstimulation, the case presented shows that AMH should not be used as an independent ovarian marker.

Serum levels of antimüllerian hormone in women with regular menstrual cycles.

Antimüllerian hormone (AMH) is produced by Sertolli cells of the testes and granulosa cells of the ovaries. Recent studies have indicated that AMH may be a novel measure of ovarian reserve. Also, earlier reports have presented minimal fluctuations ofAMH levels throughout the menstrual cycle. The aim of this preliminary study was to demonstrate the relation of serum AMH levels and age in women with regular menstrual cycles and normal hormonal regulation of ovarian function. The study included 35 women divided into two groups of women aged 30 or younger and those older than 30. Hormone concentrations were assessed by measurements of lutropin (LH), follitropin (FSH), estradiol (E2), testosterone (T), sex hormone binding globulin (SHBG) and AMH on cycle day 3-5 (follicular phase); and LH, FSH and E2 on cycle day 13-15 (ovulation). Progesterone level was determined on cycle day 19-23 (luteal phase). Median age differed significantly between the two groups of study subjects (P = 0.001). Study results confirmed regular ovarian response to physiological gonadotropin stimulation, which is the assumption for normo-ovulatory cycles. Some decrease in the mean serum AMH levels was recorded in women over 30 years of age, although the difference was not statistically significant (P = 0.0693). There was no statistically significant difference in serum AMH concentrations between follicular phase and ovulation in study women (P = 0.3124). Our preliminary results, although obtained in a limited number of women, support the diagnostic value of AMH as a reliable marker of ovarian reserve.