Can anti-mullerian hormone (AMH) levels predict response to ovulation induction treatments in women with polycystic ovarian syndrome (PCOS)?

To assess whether AMH levels can predict response to ovulation induction (OI) regimens [clomiphene citrate (CC), letrozole (LTZ) or follicle-stimulating hormone (FSH)] among women with PCOS. Retrospective cohort study. 517 OI/Intrauterine insemination (IUI) cycles from 172 women with PCOS, that took place at a single academic center between 8/2013 and 12/2018, were analyzed. Ovarian response to OI regimen was the primary outcome. Statistical analysis: Parametric and non-parametric tests were used as appropriate to compare AMH levels between regimens. Predicted probabilities of response to treatment [adjusted for age and body mass index (BMI)] were determined using mixed effects linear regression modeling, controlling for the potential of multiple cycles per woman. The level of statistical significance was set at 0.05. CC, LTZ, and FSH were administered in 204, 108, and 205 cycles, respectively. Overall, cycles in which response was noted had significantly lower AMH levels (ng/ml) when compared to cycles with no response [mean (SD): 10.5 (6.8) vs 14.4 (7.7), respectively, p<0.05]. When taking into consideration the type of OI treatment, cycles characterized by response to either CC or LTZ, when compared to those with no response, had significantly lower AMH levels [mean (SD): 9.3 (7.4) vs. 13.9 (7.9) ng/mL, p<0.05; 11.4 (5.5) vs. 14.5 (6.3) ng/mL, p<0.05; for CC and LTZ respectively, for response vs. non-response]. On the contrary, no such trend was noted in FSH cycles. Overall, after adjusting for age and BMI, the probability of response to treatment decreased as the AMH levels increased, dropping from 0.99 (95%CI: 0.90-1.08) among women with AMH ≤10th percentile (3.1 ng/ml) to 0.86 (0.78-0.95) among those with AMH ≥ 90th percentile (20.0 ng/ml). A similar trend was noted in both CC and LTZ cycles, with the probability of response being: 0.86 (95%CI: 0.69-1.00) and 0.57 (95%CI: 0.33-0.81), for CC and LTZ respectively, for patients with AMH values ≥90th percentile (20ng/ml). On the contrary, in FSH induced cycles the probability of response to treatment did not follow a similar trend; even at the highest AMH values (≥90th percentile, 20ng/ml), the predicted response to treatment was 0.96 (95%CI: 0.90-1.00) in models adjusting for age and BMI. Among PCOS patients, higher serum AMH levels are associated with significantly lower probability of response to either CC or LTZ but not to FSH, even after adjusting for age and BMI.