Anti mullerian hormone (AMH) levels at the onset of IVF predict outcome better than patient age or prior FSH levels

Abstract

OBJECTIVE: To determine if AMH levels obtained at the time of IVF baseline or HCG trigger predict cycle outcome and to compare these results with those of age and prior day 3 FSH values. DESIGN: AMH levels were obtained using the Diagnostic Systems Laboratories ELISA. FSH was measured using the Immulite 2000 (Siemens). MATERIALS AND METHODS: 191 patients undergoing IVF were enrolled in the study following IRB approval. All underwent suppression prior to baseline with either leuprolide acetate (luteal downregulated cycles) or oral contraceptives (antagonist or microdose flare cycles). AMH levels were measured on cycle day 2 or 3 at the time of baseline ultrasound and again on the day of HCG administration. Patient demographic data including age and BMI were recorded along with day 3 FSH values, obtained in proximity to cycle initiation. Primary endpoints evaluated were number of oocytes retrieved, peak estradiol levels and clinical pregnancy rates. Student's t-tests was used to analyze continuous variables and multilinear regression was used to control for confounding variables. RESULTS: There was a direct correlation between AMH values and the number of oocytes retrieved (R = 0.4, P < .001). A similar correlation was found with AMH values at time of HCG administration. This relationship remained significant when controlling for age and prior FSH values (P = .002). AMH at baseline was also predictive of clinical pregnancy rate and this finding was independent of the effect of age, FSH level or the combination of age and FSH. FSH alone was predictive of oocytes retrieved but not of clinical pregnancy rate. CONCLUSIONS: AMH levels drawn at the onset of stimulation were a better predictor of outcome of IVF cycles in this study than age or prior FSH. My research assistant is paid by unrestricted research support from Beckman Coulter.