Is anti-mullerian hormone (AMH) a predictor of ovarian response in infertile women < 35 years of age with an elevated day 3 FSH level?

Abstract

OBJECTIVE: To determine whether serum AMH levels predict IVF/ICSI cycle outcomes in infertile women <35 years old with an elevated day 3 FSH level undergoing ovarian stimulation. DESIGN: Prospective case-control study. MATERIALS AND METHODS: 903 cycles of all infertile women <35 years old undergoing IVF/ICSI between January 2008 and September 2008 were reviewed. 53 cycles met criteria with a day 3 FSH >10 IU/L, while 850 cycles had an FSH <10 IU/L. Women with multiple cycles during the time period had only their first cycle reviewed. Those with a day 3 FSH >10 IU/L were compared to age-matched controls. Day 3 serum AMH levels and antral follicle counts were assessed in both groups. All patients were followed prospectively and cycle outcomes were recorded. Ovarian response was assessed by days of stimulation, total gonadotropins used, peak estradiol level, number of oocytes retrieved, and embryos obtained. Statistical analysis was performed with a t-test and simple linear regression analysis. RESULTS: Twelve women, who were <35 years old and had a day 3 FSH level >10 IU/L, underwent IVF/ICSI. Eleven women, with a day 3 FSH of <10 IU/L, served as controls. With increasing levels of FSH, the number of oocytes collected significantly decreased (p=0.022). Serum AMH levels were significantly lower in women with FSH levels >10 IU/L (0.88 ng/mL vs 2.38 ng/mL, p=0.036). However, neither AMH nor AFC were correlated with peak E2 or numbers of oocytes retrieved whether or not stratified by day 3 FSH. CONCLUSIONS: A significant relationship was found between AMH levels and FSH values in women <35 years old. Larger prospective studies are needed to determine if AMH is a useful predictor of response to gonadotropins in women <35 years old with elevated FSH levels undergoing ART.