Clinical application of AMH as a predictor of COH outcome: the first clinical assay data in Korea

Abstract

OBJECTIVE: Although numerous studies have confirmed the usefulness of anti-Müllerian hormone(AMH) as an outcome predictor of controlled ovarian hyperstimulation(COH), there have been no confirmed reference values of serum AMH level for prediction of ovarian response. Moreover, most studies showed data from experimental laboratory measurement of AMH level. Thus, practical use of AMH was hindered by the lack of clinical data and reference values. In Korea, measurement of AMH is performed clinically in large commercial laboratory center from September 2009. The objective of this study was to, for the first time, demonstrate clinically assayed data for AMH as a predictor of ovarian response to COH. DESIGN: Resrospective analysis. MATERIALS AND METHODS: A total of 162 women underwent COH cycles were included. Blood samples were obtained on cycle day 3 before gonadotropin stimulation started. Serum samples were transferred to commercial laboratory center for AMH measurement. In commercial center, AMH was measured using enzyme-linked immunosorbent assays. Receiver operating characteristic curve analysis was performed and cut-off value in AMH levels, sensitivity and specificity for poor and high responses were evaluated. RESULTS: Concentration of AMH was significantly correlated with age, and number of oocytes retrieved(OPU)(r=-0.447, P<0.001 for age; r=0.700, P<0.001 for OPU). Mean serum AMH level for poor(OPU ≤ 3), normal(4 ≤ OPU ≤ 19), and high(OPU ≥ 20) response are 0.94 ± 0.15, 2.79 ± 0.21, and 6.94 ± 0.90ng/mL respectively. AMH levels performed well in prediction of poor and high responses after COH(AUC 0.869, p<0.001; AUC 0.912, p<0.001 for poor and high responses, respectively). The cut-off level, sensitivity and specificity for poor and high responses were 1.08 ng/mL, 85.8%, 78.6% and 3.57 ng/mL, 94.4%, 83.3%, respectively. CONCLUSION: Our data present the first clinical reference values of serum AMH level for ovarian response in Korean women. Serum AMH level could be a clinically useful predictor of ovarian response to COH.