Can anti-Müllerian hormone concentrations be used to determine gonadotrophin dose and treatment protocol for ovarian stimulation?

Abstract

The ability to predict the response potential of women to ovarian stimulation may allow the development of individualized ovarian stimulation protocols. This tailored approach to ovarian stimulation could reduce the incidence of ovarian hyperstimulation syndrome in women predicted to have an excessive response to stimulation or could improve pregnancy outcomes in women classed as poor responders. Namely, variation of the type of gonadotrophin-releasing hormone (GnRH) analogue or the form and dosage of gonadotrophin used for stimulation could be adjusted according to an individual's response potential. The serum concentration of anti-Müllerian hormone (AMH) is established as a reliable marker of ovarian reserve, with decreasing concentrations correlated with reduced response potential. This review examines the current evidence evaluating individualized ovarian stimulation protocols using AMH concentration as a predictive marker of ovarian response. The rationale behind why specific treatment protocols based on individual response potential may be more suitable is also discussed. Based on current evidence, it appears that the use of AMH serum concentrations to predict ovarian response and optimize treatment strategies is a promising approach for improving pregnancy outcomes in women undergoing ovarian stimulation. However, prospective randomized controlled trials evaluating this approach are needed before any firm conclusions can be drawn.

Single nucleotide polymorphisms in the Anti-Müllerian hormone (AMH Ile49Ser) and Anti-Müllerian hormone type II receptor (AMHRII −482 A>G) as genetic markers in assisted reproduction technology

“…A recent review published by Fleming et al concluded that further research is needed in order to establish whether individualized treatment protocols based on serum AMH concentrations result in improved clinical outcome by reducing poor response rates, lowering the incidence of OHSS and increasing live birth rates [42]. On the other hand pharmacogenetic studies showed that gene polymorphisms of ESR1 and FSHR are associated with ovarian response and pregnancy outcome, representing a useful tool for the prediction of IVF treatment outcome.…”

Assessing ovarian response: antral follicle count versus anti-Müllerian hormone

“…within, centres has been observed with AFC, and is consistently greater with AFC versus AMH (Arce et al, 2013a(Arce et al, , 2013bBroekmans et al, 2006;Broer et al, 2009;Fleming et al, 2013;Iliodromiti et al, 2014a;La Marca et al, 2010). This variation may be caused by differences in training, specific methodology, technological resources, i.e.…”

“…Women with a low ovarian reserve are more likely to respond to ovarian stimulation with a modest degree of follicular development ('poor responders') and may require greater management of their expectations for outcome success La Marca et al, 2012). At the other end of the spectrum, women with a high ovarian reserve are at increased risk for excessive ovarian response that can lead to ovarian hyperstimulation syndrome (OHSS) (Broer et al, 2011;Fleming et al, 2013;La Marca et al, 2012), which is a common (occurring in up to 30% of IVF cycles) and potentially severe (even rarely fatal) iatrogenic adverse outcome associated with gonadotrophin preparations (Broer et al, 2011;Humaidan et al, 2010).…”

“…basal FSH. (Biasoni et al, 2011;Broekmans et al, 2006;Broer et al, 2010;Fleming et al, 2013;La Marca et al, 2012). In recent years, data have emerged to support AFC and AMH level as preferred methods for predicting ovarian reserve with a varied degree of precision (Hendriks et al, 2005;Iliodromiti et al, 2014a;La Marca et al, 2010;Lukaszuk et al, 2013;Polyzos et al, 2013).…”

Antimüllerian hormone as a predictor of good-quality supernumerary blastocyst cryopreservation among women with levels <1 ng/mL versus 1–4 ng/mL

“…Furthermore, there have been data to suggest that AMH levels can guide the individualization of protocols for controlled ovarian hyperstimulation (COH) for IVF (5,11,12).…”