In patients with high AMH level, IVF outcome by GnRH agonist protocol is higher than antagonist protocol

Abstract

Anti-Müllerian hormone (AMH) has been suggested as a marker of ovarian reserved and predictor of ovarian response to controlled ovarian hyperstimulation (COH). The aim of this study was compared IVF outcome of COH protocols using GnRH agonist vs.GnRH antagonist in women according to serum AMH level. Retrospective study. The study included 420 cycles between June 2010 and March 2011 in IVF cycles, except for PCOD patients, controlled ovarian hyperstimularion were per formed with GnRH agonist long protocol(n = 158) and GnRH antagonist short protocol(n = 262). Excessive response to stimulation was defines as requirement for freezing of all embryos (‘Freeze all'). The patients were divided into three groups according to serum AMH level(ng/ml): A(<2, n = 113), B(2≤ <5, n = 173), C(≥5, n = 134). In each group, we compared pregnancy rates in GnRH agonist and GnRH antagonist cycles. The 420 cycles of IVF performed during the study period in 185 pregnancies (44.0%), 16 ‘Freeze all’ (5.9%). The pregnancy rates (23.9%(27/113) vs. 43.5%(73/173) vs. C-64.3%(85/143)) and ‘freeze all’ rates (0%(0/113) vs. 2.9%(5/173)vs. C-7.6%(11/143))were increased according to serum AMH level (P<0.01). In group A and B GnRH antagonist protocol had similar pregnancy rates as compared with GnRH agonist protocol (A: 28.1%(9/32) vs. 22.2%(18/81), B: 44.8%(30/69) vs. 42.6%(43/104)). In group C, pregnancy rates of antagonist protocol were significantly lower than GnRH agonist protocol (51.9%(27/87) vs. 70.4%(50/77), P<0.001). The ‘Freeze all’ rates were similar (A:0% vs. 0%, B:2.9%(2/69) vs. 2.9%(3/104)), C:8.8%(5/57) vs. 7.8%(6/77)). Our results showed that AMH level can be considered as a main predictor of pregnancy rates in IVF cycles. When serum AMH level was above 5 in the patients, long protocol by GnRH agonist showed a much better outcome than GnRH antagonist protocol. And in the patients at risk of OHSS, all embryos were cryopreserved in order to minimize both the incidence and degree of OHSS.