Antimüllerian Hormone Levels Are Strongly Associated With Live-Birth Rates After Assisted Reproduction

Abstract

Context:Previous studies have suggested that antimü llerian hormone (AMH) levels are positively associated with in vitro fertilization (IVF) outcome through their relationship with oocyte yield and not by reflecting oocyte or embryo quality. Objective:The aim was to investigate whether AMH levels are associated with pregnancy and live-birth rates and whether the results may also reflect qualitative aspects of oocytes and embryos. Design:The study was a prospective cohort study between April 2008 and June 2011. Setting:The study was done at a university-affiliated private infertility center. Patients:The study cohort consisted of 892 consecutive women undergoing 1230 IVF-intracytoplasmic sperm injection cycles. Intervention(s):AMH levels, analyzed using the DSL ELISA kit, were statistically adjusted for repeated treatments and age and analyzed for associations with treatment outcome. Main Outcome Measures:Pregnancy rates, live-birth rates, and stimulation outcome parameters were measured.Results: AMH was log-normally distributed with a mean (SD) of 2.3 (2.5) ng/mL. Live-birth rates per started cycle (mean [95% confidence interval]) increased log-linearly from 10.7% [7.2-14.1] for AMH Ͻ 0.84 ng/mL (25th percentile) to 30.8% [25.7-36.0] for AMH Ͼ 2.94 ng/mL (75th percentile), P trend Ͻ .0001, being superior in women with polycystic ovaries. These findings were significant also after adjustments were made for age and oocyte yield. AMH was also associated with ovarian response variables and embryo scores. Conclusions:AMH is strongly associated with live-birth rates after IVF-intracytoplasmic sperm injection. AMH may therefore serve as a prognostic factor for the chance of a pregnancy and live birth. Treatment outcome was superior in patients with polycystic ovaries. The findings also indicate that AMH may partially comprise information about oocyte quality. (J Clin Endocrinol Metab 98: 1107-1114, 2013)

Live birth rates in the different combinations of the Bologna criteria poor ovarian responders: a validation study

“…The two markers are strongly related to the quantitative aspect of ovarian reserve; hence a low AMH and/or AFC are highly indicative of possible low number of growing follicles and oocyte following ovarian stimulation. Moreover, both low AMH and AFC have been associated to reduced pregnancy and live birth following IVF independent of age [35][36][37][38][39][40][41]. This may indicate some relationship between quantity and quality of oocytes, with a The present study because of its retrospective design has relevant limitations, including a biased selection of women recruited for the study.…”

IVF results in patients with very low serum AMH are significantly affected by chronological age

“…AMH is an established marker of OR, and previous work showed its value in predicting the ovarian response to COS [5,19]. More recently, the accuracy of AMH in predicting live birth was tested by independent groups: some data showed that AMH could be used as a prognostic factor [20][21][22], but its predictive value at low or very low concentrations was not clearly clarified. In fact, some authors reported acceptable results in terms of clinical pregnancies even in patients with very low AMH levels (0.1-0.35) whereas others suggested their exclusion from IVF treatment due to a very poor prognosis [12,13].…”

Fertility Preservation in Reproductive-Age Women Facing Gonadotoxic Treatments

“…For many years, basal follicle-stimulating hormone (fsh) has been the standard evaluation of ovarian reserve and a simple means to screen patients for diminished response and poor outcome with ivf 55 . Antimüllerian hormone (amh) is proving to be the most predictive for ovarian response to exogenous gonadotropins and for pregnancy outcome, and also the most versatile in such patients [56][57][58] . Antimül-lerian hormone is detectable at all ages and, unlike fsh, is stable throughout the menstrual cycle; it can therefore be assessed at the time of presentation.…”