Age as determinant of in vitro fertilization (IVF) outcome with extremely low anti- müllerian hormone (AMH)

Abstract

Though widely considered a contraindication to IVF, we reported robust pregnancy rates with AMH at < 0.1 (undetectable) to 0.4 ng/mL, though AMH = 1.05ng/mL separates lower and higher pregnancy chances (Fertil Steril 2010;94:2824-7). We here investigated if significance of AMH changes with age. Cohort study. We assessed 254 IVF cycle outcomes with AMH < 0.4 ng/mL in 128 women: Patient age 40.8 ± 4.1 (SD) years; follicle stimulating hormone (FSH) 15.7 ± 11.1 mIU/mL; AMH 0.2 ± 0.1 ng/mL. All women with diminished ovarian reserve are prior to IVF supplemented with dehydroepiandrosterone (DHEA, 25 mg p. o. TID) for at least 6 weeks. Ovarian stimulation involved microdose agonist, daily FSH (450-600 IU) and human menopausal gonadotropin (hMG, 150 IU). Ovulation was triggered with human chorionic gonadotropin (10,000 IU). Twenty clinical pregnancies were recorded (7.9% per cycle start [95% CI 4.9%-11.9%]; 15.6% cumulative [9.8%-23.1%]); resulting in 13 live births in 12 women (11 singletons and a pair of twins); eight miscarried. Eight deliveries occurred after first (6.3% per cycle start), 4 after subsequent IVF cycles (3.2%). 70 women ≤ 42 years presented with 16 clinical pregnancies that resulted in 10 deliveries (14.3%), while 58 patients above age 42 presented with four clinical pregnancies that resulted in two deliveries (3.4%), representing a significantly reduced pregnancy chance and delivery rate versus age ≤ 42 years (P=0.013; P=0.036). These data confirm our prior publications suggesting surprisingly robust pregnancy chances, even at undetectable to extremely low AMH levels. They, however, significantly decline above age 42. Since patients were supplemented with DHEA, here reported outcomes may not be universally applicable. Even extremely low AMH can, however, no longer be considered an absolute contraindication for IVF.