Serum anti-Mullerian hormone and FSH: prediction of live birth and extremes of response in stimulated cycles implications for individualization of therapy

Purpose To investigate whether serum anti-müllerian hormone (AMH), follicle stimulating hormone (FSH), or antral follicle count (AFC) are predictive for clinical pregnancy in women who underwent IVF cycles at the age of 35 and older Methods A total of 240 consecutive women who underwent IVF cycles at the age of 35 and older were enrolled in this crsoss-sectional study. Pregnant and nonpregnant women were compared. Results The median AMH level of pregnant women was higher than non-pregnant women [3.20 (0.63-9.60) vs 1.15 (0.01-14.90) ng/ml, p<0.001]. On logistic regression analysis, AMH was an independent predictor of clinical pregnancy rate (CPR) (OR 1.353; 95 % CI 1.141-1.605; P<0.001). After controlling for the other independent variables (the number of retrieved oocytes, AFC and age), the significant association between AMH and clinical pregnancy rate remained strong (OR 1.677; 95 % CI 1.216-2.311; p=0.002) on multivariate logistic regression analysis. Conclusions AMH is an effective measure of quantitative ovarian reserve and it can predict ovarian response to controlled stimulation for advanced age women. The CPR tends to increase as AMH increases.

Section: Discussioncontrasting

confidence: 60%

Anti-Müllerian hormone levels as a predictor of the pregnancy rate in women of advanced reproductive age

Şahmay

Öncül

Tüten

et al. 2014

“…This is especially seen with analyzing pregnancy rates and live births. In several series, AMH levels are associated with live births [18,23]; however, in others, no association was identified [24]. In a recent 2015 meta-analysis conducted by Tal et al, 19 studies were analyzed by specific subpopulations comparing the predictive value of AMH with implantation and pregnancy rates, and they concluded that AMH has some association, but its predictive value is weak [25].…”

Section: Discussionmentioning

confidence: 99%

Use of anti-mullerian hormone for testing ovarian reserve: a survey of 796 infertility clinics worldwide

Tobler

Shoham

Christianson

et al. 2015

Purpose The aim of this study is to assess how anti-mullerian hormone (AMH) is used worldwide to test ovarian reserve and guide in vitro fertilization (IVF) cycle management. Methods An internet-based survey was sent electronically to registered IVF providers within the IVF-Worldwide.com network. This survey consisted of nine questions which assessed the clinics' use of AMH. The questionnaire was completed online through the IVF-Worldwide.com website, and quality assurance tools were used to verify that only one survey was completed per clinical IVF center. Results are reported as the proportion of IVF cycles represented by a particular answer choice. Results Survey responses were completed from 796 globally distributed IVF clinics, representing 593,200 IVF cycles worldwide. Sixty percent of the respondent-IVF cycles reported to use AMH as a first line test, and 54 % reported it as the best test for evaluating ovarian reserve. Eighty-nine percent reported that AMH results were extremely relevant or relevant to clinical practice. However in contrast, for predicting live birth rate, 81 % reported age as the best predictor. Conclusions AMH is currently considered a first line test for evaluating ovarian reserve and is considered relevant to clinical practice by the majority of IVF providers.

“…Recent studies into AMH have shown that increasing age and lower AMH levels both independently predict reduced oocyte yield following superovulation for assisted conception [21][22][23]. Thus AMH is emerging as an indirect approximation of age-related NGF populations and rates of recruitment.…”

Section: Assessing Ovarian Reservementioning

confidence: 99%

What is the best treatment option for infertile women aged 40 and over?

Armstrong

Akande

2013

Purpose To summarise the causes of decreased fecundity with age and review chronological vs biological ovarian ageing. To explore the clinician's means of assessing a woman's ovarian reserve. To review the recent literature on the effectiveness of different assisted reproductive technology (ART) techniques for women aged 40 and over and offer a single best treatment option. Methods Pubmed and google scholar were searched for relevant articles using key words. Data were extracted based on authors, year, aims, sample and results. Results Success rates for women aged 40 or over with clomiphene, IUI, IUI with FSH are all extremely low, at less than 1 % live birth per cycle. However, IVF offers a success rate of around 13.7 % per cycle. Conclusion An exploration of the effectiveness of available treatment options for older infertile women using their own gametes suggests that IVF offers the best prospects of success. Attempting treatments other than IVF will delay conception unnecessarily.