Ongoing Pregnancy Rates in Women with Low and Extremely Low AMH Levels. A Multivariate Analysis of 769 Cycles

Alon Kedem,Jigal Haas,Yinon Gilboa,Ettie Maman,Gil Yerushalmi,Liat Lerner Geva,Ariel Hourvitz,Mirit Hanochi,Hanna Kanety,Bin He

doi:10.1371/journal.pone.0081629

Abstract

BackgroundThe ideal test for ovarian reserve should permit the identification of women who have no real chance of pregnancy with IVF treatments consequent upon an extremely reduced ovarian reserve. The aim of the current study was to evaluate pregnancy rates in patients with low AMH levels (0.2–1 ng/ml) and extremely low AMH levels (<0.2 ng/ml) and to determine the cumulative pregnancy rates following consecutive IVF treatments.MethodsWe conducted an historical cohort analysis at a tertiary medical center. Serum AMH levels were measured at initial clinic visit and prior to all following treatment cycles in 181 women (769 cycles) with an initial AMH level ≤1 ng/ml, undergoing IVF-ICSI. Main outcome measures were laboratory outcomes and pregnancy rates.ResultsSeventy patients undergoing 249 cycles had extremely low AMH levels (≤0.2 ng/ml), whereas 111 patients undergoing 520 cycles had low AMH levels (0.21–1.0 ng/ml). Number of oocytes retrieved per cycle, fertilized oocytes and number of transferred embryos were significantly lower in the extremely low AMH levels group compared to the low AMH levels (P<0.003). Crude ongoing pregnancy rates were 4.4% for both groups of patients. Among 48 cycles of women aged ≥42 with AMH levels of ≤0.2 ng/ml no pregnancies were observed. But, in patients with AMH levels of 0.2–1.0 ng/ml, 3 ongoing pregnancies out of 192 cycles (1.6%) were observed. However, in a multivariate regression analysis adjusted for age and cycle characteristics, no significant differences in ongoing pregnancy rates per cycle between the two groups were evident. Cumulative pregnancy rates of 20% were observed following five cycles, for both groups of patients.ConclusionsPatients with extremely low AMH measurements have reasonable and similar pregnancy rates as patients with low AMH. Therefore, AMH should not be used as the criterion to exclude couples from performing additional IVF treatments.

Highlights

One of the most challenging topics in fertility treatment is the decision concerning those patients who should be denied further treatment and who require referral to an egg donation program, especially in an environment where fertility treatments are covered by the National Health Service
The aim of the current study was to evaluate the pregnancy of patients either presenting with low anti-Mullerian hormone (AMH) levels or extremely low AMH levels (#0.2 ng/ml) and to determine the cumulative pregnancy rates following consecutive IVF treatments in these specific patient groups
Patients Between January 2006 and June 2011 we evaluated all 181 women who underwent IVF treatments at the IVF unit Sheba Medical Center and had AMH levels #1 ng/ml at initial clinic visit

Summary

Introduction

One of the most challenging topics in fertility treatment is the decision concerning those patients who should be denied further treatment and who require referral to an egg donation program, especially in an environment where fertility treatments are covered by the National Health Service. The ideal test for ovarian reserve should permit the identification of women who have no real chance of pregnancy with IVF treatments consequent upon an extremely reduced ovarian reserve The exclusion of these couples from assisted reproduction techniques (ART) could effectively reduce costs for the health system. The counseling and management of women with low AMH levels presents a significant challenge where either cycle cancellation or poor response is anticipated These couples require protracted treatment programs and should be informed about their probabilities for cycle cancelation, poor response, and low number of embryos for transfer and lower pregnancy rates. The aim of the current study was to evaluate pregnancy rates in patients with low AMH levels (0.2–1 ng/ml) and extremely low AMH levels (,0.2 ng/ml) and to determine the cumulative pregnancy rates following consecutive IVF treatments

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