The association between anti-Müllerian hormone and IVF pregnancy outcomes is influenced by age

Abstract

The conflicting results from studies on the predictive capabilities of serum anti-Müllerian hormone (AMH) for IVF pregnancy outcomes may be attributed to small sample sizes and disparities in the age of the study populations. The relationship between AMH and IVF pregnancy outcomes was clarified with retrospective cross-tabulation analyses (n=1558) stratified by age to control for its confounding effects. Serum AMH concentrations were divided into tertiles (≤ 0.29, 0.30-1.20, ≥ 1.21 ng/ml) and ages into four groups (<34, 34-37, 38-41, ≥ 42 years). For women <34, having serum AMH in the lowest tertile did not reduce the chance of IVF pregnancy/live birth compared with those with higher AMH concentrations. For women 34-41, a significant positive relationship existed between serum AMH and pregnancy rates. For women ≥ 42, serum AMH concentrations ≤ 0.29 ng/ml were associated with a 3% chance of pregnancy, and women with AMH ≥ 1.21 ng/ml had the same pregnancy rate as women with concentrations 0.30-1.20 ng/ml. In conclusion, AMH has limited predictive value for IVF outcomes in the two extremes of female reproductive age; however, for women between 34 and 41, higher serum AMH concentrations are associated with significantly greater chances of pregnancy (P<0.01).

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

“…On the contrary, in the present study, no significant trend toward improving IVF outcome was observed with increasing AMH concentration. 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].…”

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

“…In these our published studies, there were no significant difference in AMH levels between pregnant and non-pregnant under aged 40 years women in both normoresponder and PCOS patient groups (3.9±2.5 vs 3.8±3.0 ng/ml, p=0.831; 6.79±2.9 vs 7.16± 4.29 ng/ml, p=0.594, respectively). However, in the current study, we found that there was significant difference in AMH levels between pregnant and nonpregnant advanced age [14]. In a large prospective study included 340 patients, Nelson et al demonstrated that a single measurement of circulating AMH can be used to individualize treatment strategies for IVF [24].…”

“…Although some studies have shown that AMH could be a predictor of ovarian reserve and the success rates of IVF [14,15], others could not find to predict power of pregnancy outcomes [16,17]. In our previous two studies on AMH and pregnancy prediction, we were unable to show AMH as being a good pregnancy prediction marker in both normoresponder and polycystic ovary syndrome (PCOS) groups [18,19].…”

“…The value of AMH in the prediction of pregnancy has been studied in various studies which showed inconsistent results [14][15][16][17][18][19]. Broer et al [20] conducted a meta-analysis of 13 AMH trials and 17 AFC trials.…”

“…The lowest level of serum AMH was 0.63 ng/ml in the pregnant group. Wang et al [14] investigated the relationship between IVF clinical pregnancy rates per initiated cycle and serum AMH tertiles stratified by age in 1,558 women in all age groups and determined that age influenced the AMH & clinical pregnancy rate relationship. They showed that for women aged ≥42 years with AMH ≤0.29 ng/ml, CPR was significantly lower than those of the middle and higher quartiles, whereas CPR for women in the middle and highest tertiles were not significantly different.…”