Ongoing Pregnancy Rates in Women with Low and Extremely Low AMH Levels. A Multivariate Analysis of 769 Cycles

Abstract

BackgroundThe ideal test for ovarian reserve should permit the identification of women who have no real chance of pregnancy with IVF treatments consequent upon an extremely reduced ovarian reserve. The aim of the current study was to evaluate pregnancy rates in patients with low AMH levels (0.2–1 ng/ml) and extremely low AMH levels (<0.2 ng/ml) and to determine the cumulative pregnancy rates following consecutive IVF treatments.MethodsWe conducted an historical cohort analysis at a tertiary medical center. Serum AMH levels were measured at initial clinic visit and prior to all following treatment cycles in 181 women (769 cycles) with an initial AMH level ≤1 ng/ml, undergoing IVF-ICSI. Main outcome measures were laboratory outcomes and pregnancy rates.ResultsSeventy patients undergoing 249 cycles had extremely low AMH levels (≤0.2 ng/ml), whereas 111 patients undergoing 520 cycles had low AMH levels (0.21–1.0 ng/ml). Number of oocytes retrieved per cycle, fertilized oocytes and number of transferred embryos were significantly lower in the extremely low AMH levels group compared to the low AMH levels (P<0.003). Crude ongoing pregnancy rates were 4.4% for both groups of patients. Among 48 cycles of women aged ≥42 with AMH levels of ≤0.2 ng/ml no pregnancies were observed. But, in patients with AMH levels of 0.2–1.0 ng/ml, 3 ongoing pregnancies out of 192 cycles (1.6%) were observed. However, in a multivariate regression analysis adjusted for age and cycle characteristics, no significant differences in ongoing pregnancy rates per cycle between the two groups were evident. Cumulative pregnancy rates of 20% were observed following five cycles, for both groups of patients.ConclusionsPatients with extremely low AMH measurements have reasonable and similar pregnancy rates as patients with low AMH. Therefore, AMH should not be used as the criterion to exclude couples from performing additional IVF treatments.

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

“…Results similar to ours were reported in another study, in which women aged <34 years having serum AMH ≤0.29 ng/ml obtained pregnancy and live birth rates comparable to those with higher AMH levels [26]. Also, a large prospective study on 769 IVF cycles reported that AMH in its lower range (0.2-1 ng/ml) was a reliable quantitative marker of the ovarian follicular pool, but performed poorly as a predictor of pregnancy [24]. Of note, no pregnancy was obtained in women above 42 years, suggesting that age, rather than AMH, is the main factor to be considered when dealing with patients with AMH in such a low range [24].…”

“…Indeed, moderate but still reasonable pregnancy and live birth rates were reported in a series of 128 patients with AMH levels <0.4 ng/ml [13], whereas a pregnancy rate of 7.4 % per started cycle was reported in another series of 188 IVF cycles performed in 101 women with the same very low AMH levels [23]. In the largest study published so far, appreciable cumulative pregnancy rates were observed also in women with AMH concentrations between 0.02 and 0.2 ng/ml [24].…”

“…Also, a large prospective study on 769 IVF cycles reported that AMH in its lower range (0.2-1 ng/ml) was a reliable quantitative marker of the ovarian follicular pool, but performed poorly as a predictor of pregnancy [24]. Of note, no pregnancy was obtained in women above 42 years, suggesting that age, rather than AMH, is the main factor to be considered when dealing with patients with AMH in such a low range [24].…”

Anti‐Müllerian hormone as a marker of ovarian reserve: What have we learned, and what should we know?

“…Several studies have shown that live births are possible even when AMH levels are undetectable [119,120]. Serum AMH level is generally considered a better marker of ovarian function than basal FSH level.…”

Anti-Müllerian hormone: a critical factor for female fertility and reproductive health

“…Decreased AMH concentrations do not exclude the possibility of getting pregnant, although the success rate is much lower. In a study by Kedema et al [23], conducted in 769 IVF/ICSI cycles, the rate of achieved pregnancies was the same and equal to 4.4% in two studied groups. In one group of patients the level of AMH was low (0,2-1,0 ng/mL) in second group extremely low (< 0.2 ng/mL).…”