The effect of Laparoscopic Ovarian Drilling on Anti-Müllerian Hormone, LH/FSH ratio and inhibin B

Background: Where laparoscopic ovarian surgery is to be recommended, there may be a small associated risk of lower ovarian reserve or loss of ovarian function. Based on its activities, Anti-Müllerian hormone (AMH) has been proposed to be involved in the pathophysiology of polycystic ovary syndrome (PCOS). AMH has become a useful clinical marker of ovarian reserve (OR) and reproductive disease in women. Its clinical utility has been expanding in scope for use in monitoring ovarian reserve, response to in vitro fertilization protocols, and diagnosis of ovarian diseases such as primary ovarian insufficiency and polycystic ovary syndrome (PCOS).  Aim: Comparing AMH to other parameters of ovarian reserve (OR) in evaluating the effect of laparoscopic ovarian drilling (LOD) on OR in treatment of PCO.  Patients and Methods: It is a prospective comparative clinical trial study. Serum AMH along with other parameters of OR measurement (LH/FSH ratio and Inhibin B) were done before and after LOD in forty eight PCO women. This study was conducted in Ain Shams University Maternity Hospital. The patients were recruited from the gynecologic outpatient clinic of Ain-Shams University Hospital from January 2014 to December 2017 (about four years).  Results: Eight cases of our studied patients got pregnant within the first three months postoperative after LOD and six cases got pregnant after three months. The total number of cases that got pregnant was 14 out of 48 cases before excluding the 8 cases that got pregnant before 3 months (29.16⁒). The mean AMH level before the operation was 6.9 ± 1.4 ng/ml and 8.2 ± 1.4 ng/ml for the patients who got pregnant and those who did not get pregnant, respectively. While the mean AMH level after 3 months of the operation was 5.1 ± 1.1 ng/ml and 6.3 ± 1.4 ng/ml for the patients who got pregnant and those who did not get pregnant, respectively. The mean LH/FSH ratio before the operation was 2.04 ± 0.5 and 3.02 ± 0.6 for the patients who got pregnant and those who did not get pregnant, respectively. While the mean LH/FSH ratio after 3 months of the operation was 1.15 ± 0.2 and 1.93 ± 0.6 for the patients who got pregnant and those who did not get pregnant, respectively. The mean inhibin B level before the operation was 52.5 ± 2.2 pg/ml and 52.6 ± 3.9 pg/ml for the patients who got pregnant and those who did not get pregnant ,respectively. While the mean inhibin B level after 3 months of the operation was 48.3 ± 2.1 pg/ml and 49.1 ± 3.6 pg/ml for the patients who got pregnant and those who did not get pregnant, respectively.
Lower preoperative AMH levels and LH/FSH ratio and after 3 months postoperatively were associated with increased pregnancy rates in patients who conceived compared to those who did not conceive (p=0.004) and (p=0.002) preoperative versus (p=0.003) and (p=0.004) postoperative, respectively. On the other hand, preoperative and 3 month’s postoperative levels of Inhibin B had no effect on pregnancy rates (p=0.954) and (p=0.582).
Conclusion: Pregnancy rates were significantly related to the preoperative LH/FSH ratio and AMH levels when comparing the cases that got pregnant with the cases who did not conceive postoperatively in patients of polycystic ovary syndrome (PCOS), whereas preoperative Inhibin B level had no relation to pregnancy rates . Therefore, AMH measurement could be a useful tool in assessing and predicting the results of LOD on PCOS patients concerning the pregnancy results after the operation.