Determining an anti-mullerian hormone cutoff level to predict clinical pregnancy following in vitro fertilization in women with severely diminished ovarian reserve

Abstract

Purpose Serum anti-Mullerian hormone (AMH) levels estimate ovarian reserve. The purpose of this study was to identify a minimum serum AMH level that correlates with acceptable clinical pregnancy rate (CPR) in women with severe diminished ovarian reserve (DOR) undergoing in vitro fertilization (IVF). Methods(s) A historical cohort of severe DOR participants (age ≥35) with day 3 FSH of >10 ng/mL were included (n =120). Participants were categorized into 3 groups: AMH <0.2 (Group 1, n =38), AMH=0.2-0.79 (Group 2, n =57) and AMH≥0.8 (Group 3, n =25) ng/mL. The main outcome was CPR. The number of retrieved and mature oocytes, transferred embryos, spontaneous abortion (SAB) and live birth (LB) rates were also evaluated. Result(s) Among the three groups, there was no difference in day 3 FSH and estradiol, total gonadotropins dose used per cycle, or LB. Participants in Group 1 were two years older than those in Group 2 and had significantly higher BMI than those in Groups 2 and 3. The three groups significantly differed in AFC (Group 1< Group 2< Group 3; p =0.001) and cycle cancellation rate (Group 1> Group 2> Group 3; p =0.006), and had a trend toward significance in SAB rate (Group 1> Group 2> Group 3; p =0.06). Group 3 had significantly more retrieved and mature oocytes than Groups 1 or 2. Group 2 and 3 had significantly higher CPR per cycle start compared to Group 1. Although Group 2 had significantly fewer oocytes retrieved and mature oocytes than Group 3, CPR per cycle start for both groups was not different. ROC curve indicated that the point of maximal inflection between lower and higher CPR represents an AMH value of 0.2 ng/mL. Conclusion(s) AMH of 0.2 ng/mL appears to be a meaningful threshold for predicting CPR in women with severe DOR at our practice. This information can be crucial during the precycle counseling of these women.

The influence of age, body mass index, waist-to-hip ratio and anti-Mullerian hormone level on clinical pregnancy rates in ART

“…We know that a correlation exists between AMH levels and oocyte retrieval numbers, antral follicle count, pregnancy rates and birth rates. The role of AMH as an efficient prognostic factor in determining the probability of pregnancy has been largely discussed [5][6][7][8]. Revelli et al [9] calculated that in women with very low circulating AMH level the probability of pregnancy was significantly affected by age.…”

Luteal-phase ovarian stimulation increases the number of mature oocytes in older women with severe diminished ovarian reserve

“…Poor ovarian response after in vitro fertilization (IVF) treatments is a challenge for both patients and their clinicians (Karande 2003). Clinicians are constantly seeking ways to improve the outcome of poor responders, especially in older women with severely diminished ovarian reserve (DOR) (Gleicher et al 2010;Merhi et al 2013). It is not uncommon to have no oocytes retrieved in women with severe DOR undergoing IVF, especially when there is very little follicular growth (Karande 2003).…”

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

“…Women with serum AMH below the 10th percentile of the general population have been reported to have an overall low global chance of achieving a viable pregnancy [9], and some authors suggested 0.15-0.2 ng/ml as the AMH cutoff value below which a clinical pregnancy may rarely be obtained after in vitro fertilization (IVF) [10,11]. Differently, other studies described ongoing pregnancies after IVF even in patients with low [12,13] or extremely low AMH levels (<0.1 ng/ml) [14], also including patients older than 40 [15].…”