Objective: This study aimed to determine the threshold of $anti-M{\ddot{u}}llerian$ hormone (AMH) as predictor of follicular growth failure in polycystic ovary syndrome (PCOS) patients treated with clomiphene citrate (CC). Methods: Fifty female subjects with PCOS were recruited and divide...
Objective: This study aimed to determine the threshold of $anti-M{\ddot{u}}llerian$ hormone (AMH) as predictor of follicular growth failure in polycystic ovary syndrome (PCOS) patients treated with clomiphene citrate (CC). Methods: Fifty female subjects with PCOS were recruited and divided into two groups based on successful and unsuccessful follicular growth. Related variables such as age, infertility duration, cigarette smoking, use of Moslem hijab, sunlight exposure, fiber intake, body mass index, waist circumference, AMH level, 25-hydroxy vitamin D level, and growth of dominant follicles were obtained, assessed, and statistically analyzed. Results: The AMH levels of patients with successful follicular growth were significantly lower (p= 0.001) than those with unsuccessful follicular growth ($6.10{\pm}3.52$ vs. $10.43{\pm}4.78ng/mL$). A higher volume of fiber intake was also observed in the successful follicular growth group compared to unsuccessful follicular growth group (p= 0.001). Our study found the probability of successful follicle growth was a function of AMH level and the amount of fiber intake, expressed as Y =-2.35+($-0.312{\times}AMH\;level$)+($0.464{\times}fiber\;intake$) (area under the curve, 0.88; 95% confidence interval, 0.79-0.98; p< 0.001). Conclusion: The optimal threshold of AMH level in predicting the failure of follicle growth in patients with PCOS treated with CC was 8.58 ng/mL.
Objective: This study aimed to determine the threshold of $anti-M{\ddot{u}}llerian$ hormone (AMH) as predictor of follicular growth failure in polycystic ovary syndrome (PCOS) patients treated with clomiphene citrate (CC). Methods: Fifty female subjects with PCOS were recruited and divided into two groups based on successful and unsuccessful follicular growth. Related variables such as age, infertility duration, cigarette smoking, use of Moslem hijab, sunlight exposure, fiber intake, body mass index, waist circumference, AMH level, 25-hydroxy vitamin D level, and growth of dominant follicles were obtained, assessed, and statistically analyzed. Results: The AMH levels of patients with successful follicular growth were significantly lower (p= 0.001) than those with unsuccessful follicular growth ($6.10{\pm}3.52$ vs. $10.43{\pm}4.78ng/mL$). A higher volume of fiber intake was also observed in the successful follicular growth group compared to unsuccessful follicular growth group (p= 0.001). Our study found the probability of successful follicle growth was a function of AMH level and the amount of fiber intake, expressed as Y =-2.35+($-0.312{\times}AMH\;level$)+($0.464{\times}fiber\;intake$) (area under the curve, 0.88; 95% confidence interval, 0.79-0.98; p< 0.001). Conclusion: The optimal threshold of AMH level in predicting the failure of follicle growth in patients with PCOS treated with CC was 8.58 ng/mL.
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문제 정의
However, calculating or estimating the daily amount of fiber intake in clinical settings would be complicated, and fiber intake would be unsuitable for predicting successful follicular growth. Therefore, it was considered as one component in the successful follicular growth probability table according to various AMH levels and as preliminary data for further studies. The patients’ symptoms like oligoovulation or anovulation could be related to high cortisol level, or also high production of TSH and insulin, even though the clinical signs did not include hypercortisolism, high TSH levels, or glucose intolerance.
This study aimed to determine the threshold of AMH level as the predictor of follicular growth failure in patients with PCOS treated with CC by using the ROC curve analysis. Based on the result of ROC curve, AMH level had a high AUC and a significant difference between groups (0.
This study determined a threshold AMH level as a predictor of follicular growth failure following CC treatment. Despite the high sensitivity and specificity of the AMH threshold level (i.
Additional studies to determine the most useful clinical value of the hormone level were needed. This study was conducted to define the threshold of the AMH level as a predictor of follicular growth failure in patients with PCOS treated with CC.
제안 방법
Based on the correlation test, eligible variables for the logistic regression test were BMI, waist circumference, AMH level, fiber intake, use of Moslem hijab, and cigarette exposure. Binary logistic regression test was performed to determine the probability of having successful follicular growth with CC treatment (Table 3), resulting in the following function (Formula 1):
Multivariate analysis was established using the binary logistic regression test. Bivariate analysis was done between follicular growth and each of the following variables: age, BMI, waist circumference, AMH level and 25-OH vitamin D level, and the amount of fiber intake. Only variables that showed significant correlation (p-value < 0.
Only variables that showed significant correlation (p-value < 0.25) with follicular growth were used for further multivariate analysis.
The 50 female subjects with PCOS enrolled this study were divided into two groups based on the assessment of follicular growth. Twenty-three subjects (46%) had successful follicular growth and 27 subjects (56%) had unsuccessful follicular growth.
The inclusion criteria were women < 40 years, who had been previously diagnosed with PCOS based on Rotterdam consensus criteria (two or three criteria: oligoovulation or anovulation, hyperandrogenemia, and sonographic appearance of polycystic ovaries), had been infertile, were willing to participate in this study, and had not consumed any medications (CC or metformin) within 3 months.
7 ng/mL with 78% sensitivity and 76% specificity. These studies had parallel results with ours, corroborating the role of AMH in predicting the failure of follicle growth. The somewhat different thresholds of AMH level among studies were presumably related to the variation of the AMH kits used in those studies.
Subjects were recruited using the consecutive sampling method. This study assessed several variables, which consisted of the age of patient, duration of infertility, cigarette smoking exposure, use of Moslem hijab, sun exposure, fiber intake, BMI, waist circumference, AMH level, 25-hydroxy (25-OH) vitamin D level, and follicular growth. BMI was classified based on the World Health Organization criteria for Asians, where BMI > 23.
This study was conducted in female subjects with PCOS receiving CC treatment (dose of 100 mg) and observed for successful or unsuccessful follicular growth. The successful follicular growth rate in subjects with CC treatment found in this study was 46% (Table 2), which is consistent with rates (40%–80%) reported in a previous study by Messinis and Milingos [14] .
대상 데이터
0 kg/m2 is overweight [13]. Anamnesis, physical examination, and transvaginal ultrasonography (TVU) were performed on the eligible study subjects. Venous blood samples were taken to measure serum levels of AMH (AMH Gen II ELISA; Beckman Coulter, Fullerton, CA, USA) and 25-OH vitamin D (chemiluminescent immunoassay method, Liaison 25 OH vitamin D total assay; DiaSorin, Stillwater, MN, USA).
This cross-sectional observational study was conducted in the Endocrinology and Gynecology Clinic in Cipto Mangunkusumo Hospital from June 2013 to April 2014. This study included 50 female subjects with PCOS who were infertile, willing to participate in this study, and had not been under either CC or metformin therapy within the previous 3 months. The Rotterdam consensus was used to exclude subjects without PCOS, although we did not check the level of cortisol, thyroid-stimulating hormone (TSH), and insulin in these patients.
데이터처리
Successful and unsuccessful follicular growth was compared according to the subjects’ respective AMH levels. These values were entered into a diagnostic test using statistical analysis and the receiver operating characteristic (ROC) curve. Dietary intake assessment using a 24-hour food recall method was taken by a designated trained interviewer to collect data concerning the amount of daily fiber intake.
이론/모형
05 was used. Multivariate analysis was established using the binary logistic regression test. Bivariate analysis was done between follicular growth and each of the following variables: age, BMI, waist circumference, AMH level and 25-OH vitamin D level, and the amount of fiber intake.
성능/효과
This study aimed to determine the threshold of AMH level as the predictor of follicular growth failure in patients with PCOS treated with CC by using the ROC curve analysis. Based on the result of ROC curve, AMH level had a high AUC and a significant difference between groups (0.75, p= 0.001), with 8.58 ng/mL as the threshold with 78% sensitivity and 67% specificity. This finding indicates that PCOS patients with AMH level of < 8.
In this study there were equivalent results to these previous studies, indicating a BMI difference of 24.74 kg/m2 in the successful follicular growth group and 26.76 kg/m2 in the unsuccessful follicular growth group, although the difference was statistically insignificant (p= 0.2).
The role of AMH in follicle development was confirmed in a study demonstrating that continuous low dose recombinant FSH administration significantly lowered the AMH level in follicles. A decline of AMH level interrupted the inhibition mechanism in the follicles; therefore they could develop as mature follicles [11].
Determination of threshold value was based on the sensitivity and specificity. The threshold of AMH level found in this study was 8.58 ng/mL, and it had a moderately high specificity (67%) and sensitivity (78%), although it only contributed 40% towards predicting failure of follicular growth according to Formula 1 (Table 4).
후속연구
Previous studies reported that AMH could also be useful in the prediction of ovarian response to CC in obese women with anovulation [12]. Additional studies to determine the most useful clinical value of the hormone level were needed. This study was conducted to define the threshold of the AMH level as a predictor of follicular growth failure in patients with PCOS treated with CC.
We did not check the level of cortisol, TSH, and insulin, which is a weakness of this study. Further studies are needed to assess those variables in a normal population as a comparison to our study, to validate the predictors found in this study, and to observe thoroughly the effects of fiber intake on the follicular growth in patients with PCOS with a larger prospective cohort or randomized controlled trial.
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