Anti-mullerian hormone levels in patients treated with assisted reproductive techniques

Abstract

OBJECTIVE: Measure anti-Mullerian hormone (AMH) levels in sera from ART cycles to correlate with outcomes including age, oocyte and embryo numbers, and pregnancy. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: AMH was assayed in 204 sera from 166 cycles. Residual sera had been stored below -70°C until analyzed by ELISA (DSL, Webster, TX) in duplicate. The values were merged with ART database to allow comparison with outcomes. RESULTS: Assays with dynamic range of 0.01 to 15.0 ng/mL had intra- and inter-assay coefficients of variation of 3.5% and 7.3%, respectively. In 35 cases, paired samples, on the average of 6 days apart (range 3 to 14 days), were assayed with one sample obtained in patients suppressed with GnRH agonist and a second obtained on day 3 to 6 of gonadotropin treatment. The values, 1.3 versus 1.0 ng/mL, respectively, did not differ (p=0.10, paired Student's t test), and the regression coefficient of 0.81 was significant (p<0.001). In further analyses performed using single samples or the average of repeat samples for 166 cases, AMH levels were related to age (p<0.001) with a regression coefficient of -0.26. In ART cycles where ova were retrieved, AMH levels were significantly (p < 0.001) related to number of ova collected, number of mature ova, and number of ova fertilized by either IVF or ICSI with regression coefficients of 0.37, 0.44, and 0.44, respectively. Considering pregnancy outcomes for initiated ART cycles, ROC analyses were performed for biochemical pregnancies and clinical pregnancies. AMH greater than 1.0 ng/mL was a significant (p<0.001) criterion for biochemical pregnancy with sensitivity of 68% and specificity of 64%, and a significant (p<0.001) criterion for clinical pregnancy with sensitivity of 70% and specificity of 63%. CONCLUSIONS: AMH levels at the time of initiation of ART cycles were found to be related to number of oocytes retrieved and fertilized, and to pregnancy outcomes suggesting a potential use in patient prospective management.