Correlation of Serum Anti-Mullerian Hormone with Ovarian Follicle Output Rate in Infertile Females: A Clomiphene Citrate Challenge Test

Syeda Fatima; Qanbar Naqvi; Ambreen Tauseef; Mehwish Qamar; Qudsia U Khan; Tanzeela Akram; Muniza Saeed

doi:10.7759/cureus.8032

Correlation of Serum Anti-Mullerian Hormone with Ovarian Follicle Output Rate in Infertile Females: A Clomiphene Citrate Challenge Test

Cureus. 2020 May 8;12(5):e8032. doi: 10.7759/cureus.8032.

Authors

Syeda Fatima¹, Qanbar Naqvi², Ambreen Tauseef³, Mehwish Qamar¹, Qudsia U Khan³, Tanzeela Akram³, Muniza Saeed⁴

Affiliations

¹ Physiology, Islam Medical and Dental College, Sialkot, PAK.
² Anatomy, Islam Medical and Dental College, Sialkot, PAK.
³ Physiology, Combined Military Hospital Lahore Medical College and Institute of Dentistry, Lahore, PAK.
⁴ Physiology, Ameer Ud Din Medical College, Lahore, PAK.

Abstract

Background Failure to achieve a successful pregnancy after 12 months of unprotected intercourse is a pathology of the reproductive system known as infertility. Anti-Mullerian hormone (AMH) not only reflects the ovarian reserve but also is known to be a predictor of several assisted reproductive techniques, e.g., in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and clomiphene citrate challenge test. In this study, AMH levels are correlated with the follicular output rate after the clomiphene citrate challenge test. Objective The objective of this study is to correlate AMH with the follicular output rate (FORT) after the clomiphene citrate challenge test. Materials and methods This study included a total of 80 primary and secondary infertile females, divided into early (18-30) and late (31-45) reproductive age groups either currently under clomiphene citrate treatment or advised to start clomiphene treatment, culled from out-patient department and centers of assisted reproductive techniques. On the third day of the menstrual cycle, blood samples were taken to determine serum AMH levels by ELISA. Then on the fifth day of the menstrual cycle, antral follicular counts were calculated through transvaginal ultrasound and oral tablet clomiphene citrate was started, and on day 12 and then on day 5, transvaginal ultrasound was repeated to record the number and diameter of dominant follicles. Results The pre-ovulatory (mature) follicle count was divided by the antral follicle count ×100 for calculating the FORT, which showed a negative Spearman Rho correlation (p = 0.048) with AMH. P-value ≤ 0.05 was considered significant. Conclusion It is concluded that the most commonly administered drug, clomiphene citrate, may not be the treatment of choice for patients with high levels of AMH and may, in fact, interfere with the chances of achieving pregnancy. This study can provide guidelines to clinicians for patient counseling, given the results of the clomiphene citrate challenge test on the basis of AMH levels.

Keywords: anti-mullerian hormone; clomiphene citrate challenge test; fort; infertility.