Discordant anti-müllerian hormone (AMH) and follicle stimulating hormone (FSH) among women undergoing in vitro fertilization (IVF): which one is the better predictor for live birth?

Abstract

BackgroundThis study sought to clarify the roles of Anti-müllerian hormone (AMH) and follicle stimulating hormone (FSH) in predicting live birth, especially in patients with discordant AMH and FSH. A large IVF data set provided by eIVF®, consisting of 13,964 cycles with AMH, FSH, age, BMI, and birth outcomes were evaluated. Patients were categorized into four groups: Good prognosis group (AMH ≥1 ng/ml; FSH < 10 mIU/ml), Poor prognosis group (AMH < 1 ng/ml; FSH ≥10 mIU/ml), Reassuring AMH group (AMH ≥1 ng/ml; FSH ≥10 mIU/ml), and Reassuring FSH group (AMH < 1 ng/ml; FSH < 10 mIU/ml). The interaction between AMH, FSH, and their impact on live birth rate among these four groups was evaluated using Generalized Additive Mixed Modeling (GAMM).ResultsAnalysis revealed a nonlinear relationship of AMH and FSH with live birth rate among all ages. Among the four groups, the good prognosis group had the highest live birth rate while the poor prognosis group had the lowest live birth rate (29.3% vs 13.1%, p < 0.005). In the discordant groups, the live birth rate of the reassuring AMH group was significantly higher than the reassuring FSH group (22.8% vs 15.6%, p < 0.005).ConclusionsAlthough both FSH and AMH are widely use to assess the ovarian reserve in women undergoing evaluation for infertility, AMH appears to be superior to FSH among all age groups. This is particularly important for patients with discordant AMH and FSH where reassuring AMH is a better clinical predictor of cycle success.Electronic supplementary materialThe online version of this article (10.1186/s13048-018-0430-z) contains supplementary material, which is available to authorized users.

Age effect on in vitro fertilization pregnancy mediated by anti-Mullerian hormone (AMH) and modified by follicle stimulating hormone (FSH)

“…Details about the inclusion and exclusion criteria of the study were documented as a flowchart in Fig. 1 in the previous paper [24] and in our Supplementary Materials.…”

<p>Can Anti-Müllerian Hormone Be a Reliable Biomarker for Assessing Ovarian Function in Women Postchemotherapy?</p>

“… 6 , 7 Previous investigations have validated the serum AMH level as a quantitative marker of ovarian reserve and ovarian dysfunction in in vitro fertilization (IVF) and polycystic ovary syndrome. 8 – 10 However, the role of AMH in predicting the recovery of ovarian function in postchemotherapy patients remains controversial.…”

Correlation and discordance of anti-mullerian hormone with follicle stimulating hormone in infertile women with premature ovarian insufficiency and diminished ovarian reserve

“…In young women less than 35 years, abnormally high serum FSH combined with abnormally high AMH do not reflect poor functional poor ovarian reserve because during IVF they do not have low oocyte yield and have favorable outcomes. 7,[14][15][16] There may be an elevated FSH (FSH>10 IU/l) but reassuring AMH (>0.6 ng/ml), or normal age specific AMH with abnormal FSH. However women in this group had higher oocyte yield during in vitro fertilization compared to those with random AMH levels<0.6ng/dl but lower oocyte yield than those with concordant and normal age specific AMH and FSH.…”

“…7 Analysis of a large IVF data comprising 13,964 cycles revealed that in discordant groups a reassuring AMH (AMH≥1 ng/dl, FSH>10 IU/l)) suggest a better likelihood of live birth compared to reassuring FSH (FSH<10 IU/l, AMH<1ng/dl) in the older (37-40 years) women. 14 In older women (>40 years) AMH is not that much specific in predicting poor response to stimulation when FSH is in assuring levels. 16 The higher prevalence of discordance in women with diminished ovarian reserve in comparison to premature ovarian insufficiency in our study may be a reflection of higher prevalence of discordance in women of younger reproductive age.…”