Antral follicle count, anti‐mullerian hormone and inhibin B: predictors of ovarian response in assisted reproductive technology?

Muttukrishna, Shanthi; Mcgarrigle, H. H. G.; Wakim, Rami Antoine; Khadum, Iffat; Ranieri, Domenico Massimo; Serhal, Paul

doi:10.1111/j.1471-0528.2005.00670.x

Cited by 271 publications

(206 citation statements)

References 33 publications

(25 reference statements)

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“…In our study, estrodiol levels on the day of HCG administration and the number of retrieved oocytes showed a gradual increase from the low to high AMH group, but the total dose of gonadotrophins was significantly decreased. Our report is in agreement with previous studies indicating that serum AMH levels on day 3 of the stimulation cycle positively predict ovarian responsiveness to gonadotrophins [18,19]. But the result may seem paradoxical given that an inhibitory effect of AMH on FSH-stimulated aromatase mRNA expression has been shown in human granulosaluteal cell [20], suggesting the remarkably increased AMH may reduce follicle sensitivity to FSH and estradiol production.…”

Section: Discussionsupporting

confidence: 92%

Correlation of serum Anti-Müllerian hormone concentrations on day 3 of the in vitro fertilization stimulation cycle with assisted reproduction outcome in polycystic ovary syndrome patients

Wei

Gong

2012

J Assist Reprod Genet

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Purpose To investigate whether serum Anti-Müllerian hormone (AMH) on day 3 could predict controlled ovarian stimulation and reproductive outcomes in women with polycystic ovary syndrome. Methods A total of 164 PCOS patients undergoing their first IVF treatment cycle were prospectively included. Serum AMH levels on cycle day 3 was measured. The controlled ovarian stimulation and clinical outcomes for the study population were divided according to the <25th, 25 to 75th, or >75th percentile of serum day-3 AMH. Results Estradiol levels on hCG day and the number of retrieved oocytes significantly increased with increasing serum AMH levels, while total consumption of gonadotropin dose showed a significant decrease (P<0.05). Fertilization rate and the number of good quality embryos were comparable among the low, average and high groups (P>0.05). Embryo implantation rates in the high AMH group was significantly inferior to those with low and average AMH concentration (27 versus 48.8 and 50%, P<0.01). Clinical pregnancy rates was lower in the high AMH group than that of the low and average group (45.9 versus 65 and 66.7%, P00.09), but this difference was only close to statistical significance. In addition, ordinal regression analysis indicated that LH level was the only independent predictor of embryo implantation rates (P00.017). Conclusions In PCOS women, AMH levels on day 3 of the IVF stimulation cycle positively predict ovarian response to gonadotrophins. However, the women with high AMH levels had a significantly decreased IR, which may be due to remarkably increased LH concentrations.Keywords Anti-Müllerian hormone . Assisted reproduction . Polycystic ovary syndrome . Serum AMH Anti-Müllerian hormone (AMH), also known as Müllerian inhibiting substance (MIS), is producted specifically by granulose cells of early developing pre-antral and small antral follicles in the ovary, and declines with advancing age. AMH has therefore been proposed as a novel clinical marker of ovarian reserve [1]. Another major reason for the interest in AMH is the fact that serum AMH levels are increased significantly in women with polycystic ovary syndrome (PCOS) when compared with normoovulatory women [2,3].PCOS is the most frequent cause of anovulatory infertility and hyperandrogenism in young women [4]. Women with this syndrome are characterized by an excessive number of small antral follicles (2-3 fold that of normal ovaries) [5]. As an exclusively granulosa cell product, it was initially proposed that the rise in serum AMH in PCOS was a consequence of the increased small antral follicle number in these ovaries [6]. The Capsule In PCOS women, high AMH levels on day 3 of the IVF stimulation cycle predict high ovarian response to gonadotrophins, but low embryo implantation rates.

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Section: Discussionsupporting

confidence: 92%

Correlation of serum Anti-Müllerian hormone concentrations on day 3 of the in vitro fertilization stimulation cycle with assisted reproduction outcome in polycystic ovary syndrome patients

Wei

Gong

2012

J Assist Reprod Genet

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“…This large decline in AMH over a relatively short period of time was not accompanied by any significant change in antral follicle count, serum FSH or inhibin B levels, suggesting that AMH is the most sensitive maker of ovarian reserve [7]. Since then several reports have confirmed that serum AMH is the most sensitive predictor of ovarian response to COH compared to more traditional markers such as age, FSH, inhibin B, antral follicle count and ovary volume [8,9].…”

Section: Introductionmentioning

confidence: 80%

“…Firstly, serum AMH has been shown to be the most sensitive predictor of ovarian response to COH compared to serum FSH, inhibin B, oestradiol, antral follicle count and ovary volume [8,9]. Secondly, unlike serum FSH, inhibin B and oestradiol levels, serum AMH levels appear to be relatively stable throughout the menstrual cycle [29][30][31], making assessment of ovarian reserve possible at any stage of the cycle.…”

Section: Discussionmentioning

confidence: 99%

Increased gonadotrophin stimulation does not improve IVF outcomes in patients with predicted poor ovarian reserve

Lekamge

Lane

Gilchrist³

et al. 2008

J Assist Reprod Genet

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Purpose This retrospective study was carried out to evaluate whether increasing the starting dose of FSH stimulation above the standard dose of 150 IU/day in patients with low predicted ovarian reserve can improve IVF outcomes. Method A total of 122 women aged less than 36 years in their first cycle of IVF were identified as having likely low ovarian reserve based on a serum AMH measurement below 14 pmol/l. Thirty five women were administered the standard dose of 150 IU/day FSH, while the remaining 87 received a higher starting dose (200-300 IU/day FSH). There were no significant differences in age, BMI, antral follicle count, serum AMH, FSH or aetiology of infertility between the two dose groups.Results No significant improvement in oocyte and embryo yield or pregnancy rates was observed following an upward adjustment of FSH starting dose. While increasing the dose of FSH above 150 IU/day did not produce any adverse events such as OHSS, it did consume an extra 1,100 IU of FSH per IVF cycle. ConclusionThe upward FSH dose adjustment in anticipation of low ovarian reserve can not be advocated as it is both expensive and of no proven clinical value.

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“…As a result, various sensitivities and specificities of the screening tests are reported. Table 1 ( 15,16,21,22,[26][27][28] compares a selected summary of screening tests commonly used to evaluate for ovarian response in ART with reported sensitivities and specificities. (29), as the threshold considered to be normal is increased, there is improvement in specificity, but a corresponding reduction in sensitivity.…”

Section: Screening For Ovarian Insufficiencymentioning

confidence: 99%

A new approach to ovarian reserve testing

Sun

Stegmann

Henne

et al. 2008

Fertility and Sterility

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Objective-To critically examine ovarian reserve testing prior to assisted reproduction. Design-A PUBMED computer search to identify relevant literature. Setting-Multiple sites Interventions-Testing for ovarian reserve Main Outcome Measures-IVF and pregnancy outcomesResult(s)-The prevalence of ovarian insufficiency varies significantly for women aged 30-45 years. Generalization or averaging of threshold values across different aged women leads to very poor sensitivity, specificity, and positive predictive value for all tests of ovarian reserve. Because of the changing prevalence of ovarian insufficiency, there is no single, suitable threshold value for any screening test of ovarian reserve. Our analysis supports dividing impaired ovarian reserve into two groups: age-dependent ovarian aging (physiologic) and premature (non-physiologic) reductions in the oocyte pool. Interpretation of any screening test used requires that age is considered as a variable. To guide clinical interpretation of test results, we suggest using a nomogram of FSH values versus expected delivery rate-per-cycle-start with ART for a given age. Conclusions(s)-Proper interpretation of screening tests for ovarian insufficiency in couplesconsidering ART is important since the presence of impaired ovarian reserve is associated with a low likelihood of pregnancy. The condition of premature (non-physiologic) ovarian insufficiency warrants additional research. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. More than 100 years ago, population studies clearly documented a decrease in fertility with increasing age (1). In today's culture of widely available birth control and workforce equality, women often delay child-bearing to pursue a career. As a result, the childbearing age for women has been delayed from the 20's to the 30's and even into the early 40s (2). This societal shift has resulted in an increase in the number of women who are interested in fertility and have regular cycles, but who are subfertile due to a reduction in their oocyte (egg) supply. Recognition of the profound adverse effect of a reduction in oocyte supply on fertility led to the concept of ovarian reserve and the moniker of 'Diminished Ovarian Reserve' (DOR (5,13,14). NIH Public AccessThe pathophysiology associated with the age-related reduction in fertility (1) is a reduction in the oocyte pool accompanied by an increase in FSH due to reduced feedback from estrogen and inhibins (15). There are also reduced levels of hormones such as anti-Mullerian hormone (AMH) (16). Theoretically, in some women the reduction in the oocyte po...

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Antral follicle count, anti‐mullerian hormone and inhibin B: predictors of ovarian response in assisted reproductive technology?

Cited by 271 publications

References 33 publications

Correlation of serum Anti-Müllerian hormone concentrations on day 3 of the in vitro fertilization stimulation cycle with assisted reproduction outcome in polycystic ovary syndrome patients

Correlation of serum Anti-Müllerian hormone concentrations on day 3 of the in vitro fertilization stimulation cycle with assisted reproduction outcome in polycystic ovary syndrome patients

Increased gonadotrophin stimulation does not improve IVF outcomes in patients with predicted poor ovarian reserve

A new approach to ovarian reserve testing

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