Niveles de hormona antimulleriana en suero y líquidos foliculares como marcadores predictivos de respuesta ovárica en tratamientos de reproducción asistida

Abstract

IntroductionThe anti-Mullerian hormone (AMH) is considered an extremely useful biochemical marker in the field of Assisted Reproduction. This study evaluates the method for the determination of AMH (ECLIA Roche Diagnostics) in follicular fluid specimens. The main objective is to determine its use as a predictive marker of reserve and response to controlled ovarian stimulation, in serum and follicular fluid, as well as the cut-off point for diagnosis of low ovarian response in our population. Material and methodsThe levels of follicle-stimulating hormone (FSH), oestradiol, and serum AMH were determined on day 3 of the cycle in 100 patients being submitted to assisted reproduction techniques, together with the concentration of AMH in follicular fluid aspirated during the ovarian puncture. A count was also made of antral follicles under baseline conditions and the number of oocytes retrieved after treatment. All these patients complied with the inclusion criteria for IVF/ICSI techniques as per the guidelines for Assisted Reproduction of the Andalusian Health Service. ResultsPositive relationships were detected between AMH (both serum and follicular) and the antral follicle count [AFC] (r=0.69 and r=0.83, respectively), as well as ovarian response (r=0.62 and 0.87, respectively) with P<.01. The correlation was negative for FSH with values of r=0.31 and r=0.19, respectively with P<.05. The cut-off point calculated using the area under the curve (ROC) for the detection of low ovarian response (<5 oocytes retrieved) was 0.83 for serum AMH and 0.81 for concentrations of follicular AMH. ConclusionsThe ECLIA method by Roche Diagnostics for the quantitation of AMH in follicular fluid specimens is considered validated. The AMH concentration in either serum or follicular fluids is shown to be a better predictor of ovarian reserve and ovarian response than FSH, and the cut-off points established in our population for the detection of women with low response expectations, and therefore low probability of reproductive success, and those with high responses, in order to prevent ovarian hyperstimulation syndrome.