Comparing four ovarian reserve markers – associations with ovarian response and live births after assisted reproduction

Brodin, Thomas; Hadziosmanovic, Nermin; Berglund, Lars; Olovsson, Matts; Holte, Jan

doi:10.1111/aogs.12710

Cited by 44 publications

(30 citation statements)

References 34 publications

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“…Some studies, in fact, showed a correlation between AMH and live birth rate after IVF, depending solely on oocyte yield [6,28,29], whereas a recent study suggested that AMH is an independent marker of pregnancy and live births after adjustment for female age and oocyte yield [30]. These somehow conflicting evidences could depend on the complexity of the interaction between age and AMH: age could affect mainly the proportion of follicles switching from the primordial to the recruitable pool, whereas AMH per se could mainly reflect the number of FSHsensitive, recruitable follicles [9].…”

Section: Discussionmentioning

confidence: 99%

IVF results in patients with very low serum AMH are significantly affected by chronological age

Revelli

Biasoni

Gennarelli

et al. 2016

J Assist Reprod Genet

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Purpose The aims of this study were to assess the outcome of in vitro fertilization (IVF) in women with very low circulating anti-müllerian hormone (AMH) and to investigate factors affecting their probability of pregnancy. Methods The outcome of 448 IVF cycles in 361 women with circulating AMH <0.5 ng/ml was retrospectively analyzed. Results Cycle cancellation rate was 14.5 %; patients whose cycle was cancelled had significantly lower AMH than women who reached oocyte pickup (OPU). Among those who reached OPU, age significantly affected the success rate: despite comparable AMH levels, patients below 35 years obtained significantly more oocytes and a better clinical pregnancy rate (CPR)/OPU than patients aged 35-39 or 40-43 (31 % vs. 23.2 % vs. 10.2 %, respectively; p = 0.001). Differently, comparable IVF results were observed stratifying patients for AMH levels in the range 0.14-0.49 ng/ml. Multivariable logistic regression analysis confirmed that the probability of pregnancy was significantly affected by age, but not by small differences in AMH level. Conclusions Women with very low (<0.5 ng/ml) AMH levels undergoing IVF still have reasonable chances of achieving a pregnancy, but their prognosis is significantly affected by chronological age. Very low AMH levels are associated with a relevant risk of cycle cancellation but should not be considered a reason to exclude a couple from IVF.

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Section: Discussionmentioning

confidence: 99%

IVF results in patients with very low serum AMH are significantly affected by chronological age

Revelli

Biasoni

Gennarelli

et al. 2016

J Assist Reprod Genet

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show abstract

“…In addition, the statistical model developed evidenced that the decrease in plasma AMH concentrations with age is more marked in the low AFC group compared with the high one. In this regard, AFC and AMH are widely used to predict ovarian reserve and ovarian response to controlled stimulation with exogenous gonadotropins for assisted reproductive technologies (ARTs) treatments (La Marca et al 2007, Aflatoonian et al 2009, Fleming et al 2015; moreover, a better prediction of ovarian responsiveness is achieved when using AMH, AFC, and age together (Brodin et al 2015). Taken together, these results immediately suggest that high AFC and AMH concentrations in the early prepubertal period may represent a precocious marker of the ovarian reserve of a given individual, considering that the quantity and quality of non-growing follicles in the ovary is positively associated with the number of growing follicles, plasma AMH concentrations, and reproductive life-span .…”

Section: Discussionmentioning

confidence: 99%

Postnatal pituitary and follicular activation: a revisited hypothesis in a sheep model

Torres-Rovira¹,

Succu²,

Pasciu³

et al. 2016

Reproduction

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The importance of postnatal pituitary activation as regards female reproductive development is not yet understood. By taking advantage of the experimental model developed in a previous study, i.e. ewe lambs expressing markedly different ovarian phenotypes at 50 days of age, we designed this study to determine whether differences found in ovarian status during the early prepubertal period are due to different patterns of postnatal pituitary activation, and to assess whether these differences have long lasting effects on subsequent reproductive performance. Results showed that ewe lambs with high antral follicle count (AFC) at 50 days of age had significantly lower plasma FSH concentrations and higher anti-Mullerian hormone (AMH) concentrations during the first 9 weeks of age compared with low AFC ewe lambs (P!0.0001). With a longitudinal experiment we showed that a high AFC in the early prepubertal period is associated with consistently higher AMH concentrations and numbers of antral follicles up to the postpubertal period, and with higher pregnancy rates in the first breeding season. In addition, the effect of age in decreasing AMH concentrations was more marked in the low AFC group. Results of the present study demonstrate that ewe lambs undergo different patterns of postnatal pituitary activation. A high AFC at 50 days of age indicates an advanced phase of ovarian maturation, which was accompanied by constantly higher AMH concentrations up to the postpubertal period, a greater ovarian response to FSH stimulation and by higher pregnancy rates at first mating, as compared with the low AFC group.

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“…For prediction of poor and excessive response the best model included AMH, AFC and age (c-statistic 0.89). 13 Lauren Z et al found that among 97 women who underwent AMH testing, 32 (33.0%) had elevated AMH levels. Hyperandrogenism was reported by 8 (25.0%) women with elevated AMH and none with AMH concentrations lower than 4.7 ng/mL (P <0.001).…”

Section: Resultsmentioning

confidence: 99%

Anti-Mullerian hormone (AMH) as predictor of ovarian reserve

Shembekar¹,

Upadhye²,

Shembekar³

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: Anti-Müllerian hormone (AMH) is produced by the granulosa cells of preantral and small antral follicles and its levels can be assessed in serum. Since the number of ovarian follicles declines with increasing age, AMH levels might be used as a marker for ovarian ageing. Therefore, we studied the relationship between AMH levels and ovarian response during ovarian stimulation for In vitro fertilization.Methods: A total of 100 patients who have undergone their ICSI treatment cycle using a GnRH antagonist protocol were retrospectively included. Co-relation between AMH and antral follicular count (AFC) was assessed.Results: In present study, 36% patients had normal AMH, 18% patients were in low normal range, 5% patients had low values and 2% patients had very low values. 41% of patients had values in high range suggestive of PCOS. Amongst this, 21% had values between 4 to 8 ng/ml where we got good AFC count and good result in terms of pregnancy. 80% were good responders while 20% were poor responders. When we evaluated the relationship of retrieved oocyte counts with the parameters included, we found that only basal AMH levels and the number of antral follicles were statistically correlated.Conclusions: High AMH levels correlated with low cancellation rates, retrieval of more eggs, higher live birth rates and a high chance for freezing of embryos. Low AMH levels (alone) do not predict low success rates in women under 35 years of age.

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Comparing four ovarian reserve markers – associations with ovarian response and live births after assisted reproduction

Abstract: AMH improves the ability to estimate live birth rates after assisted reproduction compared with female age alone. AMH, AFC and age together constituted the best model for prediction of ovarian response.

Cited by 44 publications

References 34 publications

IVF results in patients with very low serum AMH are significantly affected by chronological age

IVF results in patients with very low serum AMH are significantly affected by chronological age

Postnatal pituitary and follicular activation: a revisited hypothesis in a sheep model

Anti-Mullerian hormone (AMH) as predictor of ovarian reserve

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