Anti-müllerian hormone (AMH) in normal ovarian reserve women undergoing in vitro fertilization

Abstract

OBJECTIVE: This study seeks to evaluate the clinical usefulness of serum anti-Müllerian hormone (AMH) levels in women with normal ovarian reserve by basal follicle-stimulating hormone levels (FSH), basal estradiol levels and basal antral follicle counts (AFC) as a tool to manage in vitro fertilization (IVF) cycles. DESIGN: A retrospective analysis of IVF cycles from a large private infertility practice. MATERIALS AND METHODS: Data from 194 IVF cycles were separated into three groups based on pre-cycle values: AMH <1 ng/ml, AMH 1-3 ng/ml, AMH > 3 ng/ml. Characteristics including age, basal FSH, basal estradiol, a random AFC. Outcome measures of gonadotropin amount used in the cycle, the number of oocytes retrieved, and clinical pregnancy rates were compared among the AMH groups. Cycles were excluded if FSH >10 mIU/ml, estradiol >80 pg/ml or AFC <10. Each continuous variable was analyzed by AMH group using ANOVA. Clinical pregnancy rate among each group was analyzed by Chi square. RESULTS: Women with AMH <1 ng/ml, 1-3 ng/ml, >3 ng/ml averaged 32.5, 31.4, and 28.8 years, respectively (p<0.01). AFC and basal estradiol did not differ (p>0.05). Although statistically significant (p<0.05), basal FSH levels were clinically similar for the three groups: 7.8 mIU/ml, 7.4 mIU/ml and 7.1 mIU/ml. However, the mean number of oocytes retrieved (11.9, 15.4, and 23.0; p<0.001) and the units of gonadotropin used during the IVF cycle (3740 IU, 2821 IU, 1931 IU) varied significantly (p<0.001) with the AMH group. Interestingly, the clinical pregnancy rate was 60-70% in all groups (p>0.05). CONCLUSION: This study suggests that AMH is useful for predicting the number of oocytes retrieved in women with normal ovarian reserve undergoing IVF cycles. Further studies are necessary to confirm whether gonadotropin dosing should be adjusted based on the basal AMH level.