Anti-mullerian hormone cut-off values for predicting poor ovarian response to exogenous ovarian stimulation in in-vitro fertilization

Abstract

OBJECTIVES:(a) To establish the cut-off levels for anti-Mullerian hormone (AMH) in a population of Indian women that would determine poor response. (b) To determine which among the three ie.,: age, follicle stimulating hormone (FSH), or AMH, is the better determinant of ovarian reserve.STUDY DESIGN:Prospective observational study.SETTING:In vitro fertilization (IVF) unit of a tertiary hospital.MATERIALS AND METHODS:The inclusion criterion was all women who presented to the center for in-vitro fertilization/Intracytoplasmic sperm injection (IVF/ICSI). The exclusion criteria were age >45 years, major medical illnesses precluding IVF or pregnancy, FSH more than 20 IU/L, and failure to obtain consent. The interventions including baseline pelvic scan, day 2/3 FSH, luteinizing hormone (LH), estradiol estimations, and AMH measurement on any random day of cycle were done. Subjects underwent IVF according to long agonist or antagonist protocol regimen. Oocyte recovery was correlated with studied variables. The primary outcome measure was the number of oocytes aspirated (OCR). Three categories of ovarian response were defined: poor response, OCR ≤ 3; average response, OCR between 4 and 15; hyperresponse, OCR > 15.RESULTS:Of the 198 patients enrolled, poor, average, and hyperresponse were observed in 23%, 63%, and 14% respectively. Correlation coefficient for AMH with ovarian response was r = 0.591. Area under the curve (AUCs) for poor response for AMH, subject's age, and FSH were 0.768, 0.624, and 0.635, respectively. The discriminatory level of AMH for prediction of absolute poor response was 2 pmoL/l, with 98% specificity and 20% sensitivity.CONCLUSIONS:AMH fares better than age and FSH in predicting the overall ovarian response and poor response, though it cannot be the absolute predictor of non-responder status. A level of 2 pmol/l is discriminatory for poor response.

Reduced ovarian reserve in patients with adult polymyositis

“…Regarding treatment, immunosuppressive agents, particularly intravenous cyclophosphamide, may alter menstrual cycles and ovarian reserve in female SLE and juvenile DM [5,17,18,22,23]. However, in the present study, the possible role of treatment in reduced ovarian reserve cannot be completely excluded since all patients had long-term exposure to multiple immunosuppressives and one of them was treated with cyclophosphamide.…”

“…Moreover, as recent studies have reported that decreased AMH levels can be observed in women using hormonal contraceptives [17,18], the ovarian hormonal profile described herein was determined without the effect of any exogenous hormone for a period of at least 6 months to avoid this possible bias.…”

“…In adult and adolescent SLE [18], menstruation abnormalities, especially amenorrhoea, was particularly associated with disease activity and damage. In contrast, our PM patients revealed normal menstrual cycles, with a mild and controlled disease.…”

The impact of FMR1 gene mutations on human reproduction and development: a systematic review

“…Notwithstanding the extensive number of scientific papers in the last few years, no definitive consensus exists on the characterization of altered ovarian function [29]. A combination of hormonal markers like serum follicle-stimulating hormone (FSH) [52], serum AMH [79] and the antral follicle count [77] may help in diagnosing early decline in ovarian follicular activity. The antral follicle count remains perhaps the best predictor of the ovarian response to the controlled ovarian stimulation after the AMH assay itself [80,88] Although early follicular phase serum FSH levels are a well established marker of ovarian reserve [18], the correlation may be poor compared to other markers.…”

Can serum estradiol levels on the fourth day of IVF/ICSI cycle predict outcome in poor responder women?

“…Early predictive tests that emphasize the probability of achieving high quality oocytes during ovarian stimulation are needed to decide whether to continue or abandon the current cycle. Although high gonadotropin utilization with longer periods of stimulation achieves fewer and possibly low quality follicles and a lower estradiol increase during ovarian stimulation of these patients adversely impact the success of the assisted reproductive techniques [Satwik et al 2012]. Ovarian response to COH is monitored by serial maternal serum estradiol (E2) level measurements and ultrasonographic surveillance of follicle growth.…”