الفهرس 
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Abstract
Anti-Mullerian hormone (AMH) is a dimeric glycoprotein, which is secreted exclusively by granulosa cells of primary, preantral and small antral follicles (4-6 mm). Its secretion gradually diminishes in the subsequent stages of follicle development and is practically undetectable in follicles larger than 8 mm.
Previous research has shown women with polycystic ovanan syndrome (PCaS) to have a two- to threefold increase in serum AMH concentration, which corresponds to the two- to threefold increase in the number of small (2 - 5 mm) follicles seen in pcas. This increase in AMH has been implicated in the pathogenesis of pcas. It has been hypothesised that the high serum AMH levels in pcas lowers the follicle sensitivity to circulating FSH thus preventing follicle selection resulting in follicle arrest at the small antral phase with failure of dominance. AMH also inhibits aromatase activity resulting in reduction of follicle production of oestradiol (E2). The resulting low levels of E2 may also contribute to the failure of follicle selection.
The aim of this study was to evaluate the impact of high AMH levels in women with pcas on the ovarian responsiveness in women receiving clomiphene citrate (CC) or follicle stimulating hormone (FSH) for ovulation induction (aI) and in patients undergoing in-vitro fertilization (IVF).
In the first part of the study, 60 anovulatory women with pcas who received 187 cycles of CC ovulation induction were included. CC was given in the early follicular phase of the cycle (day 2 to 6) in incremental doses starting with 50mg/day up to a maximum of 150 mg/day. Blood samples were collected on initial cycle day two to measure baseline serum concentrations of AMH, gonadotrophins and androgens. Further day two blood samples were collected during all the cycles of CC treatment to measure serum AMH concentrations. The levels of AMH were compared between responders vs. non-responders. The success rates of CC treatment were compared between patients with high vs. low serum AMH concentrations.