Relevance of anti-Mullerian hormone measurement in a routine IVF program

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Abstract

BACKGROUND

Diminished ovarian reserve has become a major cause of infertility. Anti-Mullerian hormone (AMH) seems to be a promising candidate to assess ovarian reserve and predict the response to controlled ovarian hyperstimulation (COH). This prospective study was conducted to evaluate the relevance of AMH in a routine IVF program.

METHODS

Three hundred and sixteen patients were prospectively enrolled to enter their first IVF/ICSI-cycle. Age, FSH-, inhibin B- and AMH-levels and their predictive values for ovarian response and clinical pregnancy rate were compared by discriminant analyses.

RESULTS

A total of 132 oocyte retrievals were performed. A calculated cut-off level ≤1.26 ng/ml AMH alone detected poor responders (≤4 oocytes) with a sensitivity of 97%, and there was a 98% correct prediction of normal response in COH if levels were above this threshold. With levels <0.5 ng/ml, a correct prediction of very poor response (≤2 oocytes) was possible in 88% of cases. Levels of AMH ≥0.5 ng/ml were not significantly correlated with clinical pregnancy rates.

CONCLUSIONS

AMH is a predictor of ovarian response and suitable for screening. Levels ≤1.26 ng/ml are highly predictive of reduced ovarian reserve and should be confirmed by a second line antral follicle count. Measurement of AMH supports clinical decisions, but alone it is not a suitable predictor of IVF success.

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