Geburtshilfe Frauenheilkd 2014; 74 - FV_03_09
DOI: 10.1055/s-0034-1388562

Predictive markers for the FSH sensitivity of polycystic ovaries

A Köninger 1, B Schmidt 2, L Koch 1, P Edimiris 1, S Kasimir-Bauer 1, T Strowitzki 3, R Kimmig 1
  • 1Universitätsklinikum Essen, Frauenklinik, Essen, Germany
  • 2Universitätsklinikum Essen, Institut für medizinische Informatik, Biometrie und Epidemiologie, Essen, Germany
  • 3Klinikum der Ruprecht-Karl-Univ. Heidelberg, Abt. Gynäkologische Endokrinologie und Fertilitätsstörungen, Heidelberg, Germany

Purpose: The aim of this study was to evaluate predictive markers of the ovarian sensitivity to recombinant FSH in patients with polycystic ovarian syndrome.

Methods: 48 chlomifenresistant PCOS patients aged 18 to 43 years were enrolled. Study participants received between one and six cycles of recombinant FSH therapy, using a step-up-protocol. FSH dosage for reaching a monofollicular development for ovulation induction was evaluated to investigate its association with Anti-Mullerian-Hormone (AMH), LH, FSH, LH/FSH-ratio, SHBG, androstendione, testosterone, free testosterone index, antral follicle count (AFC), ovarian volume, BMI and age.

Results: An interquartile range (IQR) increase of AMH was associated with a 51,4% (95% confidence interval [CI]: 24,7% – 79,0%; p = 0,0003) increase in mean FSH dosage per cycle in a crude regression model, corresponding to a 7,2% increase in mean FSH dosage per ng/ml AMH. Adjustment for BMI augmented the effect of AMH with a 58,3% (95% CI: 33,2% – 84,2%; p = 1,8 × 10-5) increase in FSH dosage per IQR AMH (corresponding to an 8,2% increase per ng/ml AMH) and a 46,2% (95% CI: 16,5% – 76,6%; p = 0,003) increase per IQR BMI (corresponding to a 3,7% increase per kg/m2). AMH was the only independent variable for which the effect on FSH dosage was statistically significant in the crude regression model as well as after adjustment for other promising predictors.

Conclusions: AMH appears to be an independent predictor of the needed FSH-dosage to achieve monofollicular development for ovulation induction in a study sample of clomiphene-resistant PCOS patients.