The value of anti-Mullerian hormone measurement in the long GnRH agonist protocol: association with ovarian response and gonadotrophin-dose adjustments

Abstract

BACKGROUNDThis study evaluated the predictive value of serum and follicular fluid (FF) concentrations of anti-Müllerian hormone (AMH) with respect to treatment outcome variables in an IVF cycle.METHODSA retrospective analysis was performed with data from 731 normogonadotrophic women undergoing controlled ovarian stimulation after stimulation with highly purified menotrophin (HP-hMG) or rFSH following a long GnRH agonist protocol.RESULTSIn both treatment groups, the serum AMH concentration at the start of the stimulation was significantly (P < 0.001) positively correlated with the serum levels of estradiol (HP-hMG: r = 0.45; rFSH: r = 0.55), androstenedione (HP-hMG: r = 0.50; rFSH: 0.49) and total testosterone (HP-hMG: r = 0.40; rFSH: r = 0.36) at the end of the stimulation as well as the number of oocytes retrieved (HP-hMG: r = 0.48; rFSH: r = 0.62), the AMH concentration in FF (HP-hMG: r = 0.55; rFSH: 0.61) and the serum progesterone concentration (HP-hMG: r = 0.39; rFSH: r = 0.50) at oocyte retrieval. For both treatments, serum AMH at the start of the stimulation was a good predictor of the need to increase or decrease the gonadotrophin dose on stimulation day 6 and of ovarian response below (<7 oocytes) or above (>15 oocytes) the target. No significant relationships were observed between serum AMH and embryo quality or ongoing pregnancy.CONCLUSIONThe serum AMH concentration at the start of the stimulation in IVF patients down-regulated with GnRH agonist in the long protocol revealed a positive relationship with ovarian response to gonadotrophins in terms of oocytes retrieved and accompanying endocrine response. AMH is a good predictor of the need for gonadotrophin-dose adjustment on stimulation day 6 for patients with a fixed starting dose, but a poor predictor of embryo quality and pregnancy chances in individual patients.

Anti-Mullerian as predictor of reproductive outcome in infertile women: follow up

“…Although its physiological roles and the mechanisms involved in the regulation of AMH still remain poorly established, recent studies have pointed out this hormone as an attractive marker for assessing of ovarian activity. Basal AMH, determined before stimulation (usually cycle day 3), was found to be a better measure for the assessment of a decreased ovarian reserve and the ovarian response to controlled ovarian hyperstimulation (COH) with gonadotropins (Anckaert et al, 2012;Nardo et al, 2009) when compared to the classic parameters such as an increase in follicle stimulating hormone (FSH), the decrease of inhibin B, or the antral follicle count (Fanchin et al, 2005;Tremellen et al, 2005;Hazout, 2006). It has also been shown that AMH was inversely correlated, in addition to age, to basal FSH values (Piltonen et al, 2005).…”

“…In addition, a high serum concentration of AMH before the start of COH has been shown to be associated with increased risk of developing ovarian hyperstimulation syndrome (OHSS) (Nardo et al, 2009). As with other ovarian reserve tests, AMH has not proven to be a good predictor of embryo quality or pregnancy in COS cycles, suggesting that AMH is a marker of quantitative rather than qualitative aspects of the ovarian reserve (Anckaert et al, 2012;Broer et al, 2011). The association between the ovarian response and the basal AMH production was confirmed by other studies, showing an increased yield of mature oocytes after controlled stimulation in women presenting high serum AMH levels (Fleming et al, 2006;Smeenk et al, 2007;Ebner et al, 2006;Ficicioglu et al, 2006).…”

Comparison of antimüllerian hormone levels and antral follicle count as predictor of ovarian response to controlled ovarian stimulation in good-prognosis patients at individual fertility clinics in two multicenter trials

“…Two metaanalyses of a number of these relatively small, singlecenter studies indicated that AMH and AFC have similar levels of accuracy and clinical value for the prediction of poor (16) as well as excessive response (17). In marked contrast to these reports, three recent large, prospective, multicenter trials in IVF/ICSI patients of good prognosis consistently concluded that AMH was a better predictor of ovarian response than AFC in GnRH agonist (18) and antagonist (19,20) cycles, regarding the number of oocytes retrieved as well as categorization of low and high responders. Furthermore, in models of ovarian response AFC did not provide any additional predictive value beyond that provided by AMH (18)(19)(20).…”

Measurement of antral follicle count in patients undergoing in vitro fertilization treatment: results of a worldwide web-based survey

“…Since AFC is tied to AMH level and vice versa, a number of studies have compared AFC with AMH level as predictors of ovarian response in IVF. Three recent multicenter trials of good prognosis IVF patients showed that the AMH level was a better predictor of ovarian response than AFC in both gonadotropinreleasing hormone (GnRH) agonist and antagonist cycles [14][15][16]. In contrast, Mutlu et al (2013) conducted a prospective study which demonstrated that AFC determines p o o r o v a r i a n r e s p o n s e b e t t e r t h a n A M H [ 1 7 ] .…”