الفهرس 
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Abstract
Antimullerian hormone (AMH), also known as mullerian inhibiting substance (MIS), is a dimeric glycoprotein member of the transforming growth factor-â family. AMH is secreted by granulosa cells within preantral and early antral follicles, <4 mm in diameter. Its secretion decreases as the antral follicles begin to grow, and stops when the follicles are larger 8 mm in diameter, or when atresia occurs.
Several reports suggest that AMH might be a better predictor of ovarian responses to controlled ovarian hyperstimulation (COS) than traditional parameters such as age, FSH, estradiol (E 2) and inhibin B (INH-B).
Previous studies have found associations between AMHs (including serum AMH and follicle fluid AMH), fertilization rate, blastocyst development, embryo quality, pregnancy outcome and live birth rate (LBR).
So our study aimed at investigating the predictive value of anti-Mullerian hormone (AMH) in serum and follicular fluid for assessment of ovarian reserve.
Also, We aimed to investigate the predictive value of serum and follicular fluid anti-Mullerian hormone (AMH) on fertilization rate (FR), implantation rate, blastocyst development, embryo quality, chemical pregnancy, clinical pregnancy and ongoing pregnancy after ICSI.
Also, It’s predictive value for incidence of ovarian hyperstimulation syndrome.
Subjects and Methods:
This observational study was conducted in El-Minia infertility center during the period from March, 2018 to March, 2020 after being approved by the ethical Committee of Obstetrics and Gynaecology department Faculty of Medicine, El-Minia University. The study population included 50 women who had their trial of intracytoplasmic sperm injection (ICSI) treatment.
Inclusion criteria:
• The women were 20-40 years of age.
• All patients were indicated for ICSI.
• The body mass indexes (BMI between 18 and 30 kg/m2).
• Day 3 serum FSH levels <12 IU/L.
• The women with no previous history of ovarian surgery.
Exclusion criteria:
• Women with a history of ovarian surgery.
• Old age (> 40 years).
• Previous history of poor ovarian response.
• History of OHSS.
• Women with history of any known systemic or endocrine disorder as diabetes mellitus,hypothyroidism and hyperprolactinemia.
All patients were subjected to the following on the first 3 days of the cycle prior to the start of induction program:
Full history taking.
Systematic clinical examination to assess the general condition, body mass index (BMI) and local pelvic physical findings.
Routine labs as CBC, liver & kidney functions to exclude general disease as a contraindication for induction or pregnancy.
Blood sample was obtained for assessment of basal serum levels of FSH , AMH and E2 on day 3 of the cycle.
The induction protocol was the long luteal phase agonist protocol
The level of AMH in Follicular Fluid was measured. In the day of ovum pick-up (dOPU), under transvaginal ultrasound guidance, fluid from three to five dominant follicles was gently and thoroughly aspirated.
The results of the current study showed that:
• Follicular AMH had strong positive correlations with serum AMH which is statistically significant (p< 0.001).
• Follicular and serum AMH had negative correlations with age and positive correlations with BMI which is statistically significant (p< 0.001).
• The serum and follicular AMH had positive correlations with the number of oocytes retrieved which is statistically significant (p< 0.001).
• The serum and follicular AMH had strong positive correlation with the blastocyst development and the quality of oocytes retrieved which is statistically significant (p< 0.001).
• The serum and follicular AMH had positive correlations with fertilization rate which is statistically significant (p< 0.001).
• The serum and follicular AMH had strong positive correlations with the ovarian reserve which is statistically significant (p< 0.001).
• The serum and follicular AMH had positive correlations with incidence of chemical pregnancy which is statistically significant (p< 0.001).
• The serum and follicular AMH had intermediate positive correlations with incidence of OHSS which is statistically significant (p< 0.011).
• Statistically significant optimal cutoff point of fAMH for prediction of good ovarian reserve which was >1.9 ng/ml with high sensitivity (96.55%) and high specificity (90%) (P value <0.001).
• Statistically significant optimal cutoff point of fAMH for prediction of incidence of chemical pregnancy which was >4.8 ng/ml with high sensitivity (100%) and low specificity (57.14%) (P value <0.008).
• statistically significant optimal cutoff point of fAMH for prediction of incidence of OHSS which was >10 ng/ml with low sensitivity (57.14%) and high specificity (87.5%) (P value <0.001).
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Conclusion:
Serum AMH level is an appropriate reflection of its follicular fluid level. Higher level of AMH in the follicular fluid revealed a better quality of the obtained oocytes. Follicular fluid AMH level can be a positive predictor of ART success cycles.
SO, we concluded that serum and follicular fluid AMH is an adequate predictor for ovarian reserve, clinical pregnancy after ICSI and incidence of OHSS.