Is AMH useful to reduce low ovarian response to GnRH antagonist protocol in oocyte donors?

Abstract

We aimed to establish the reference values of Anti-Müllerian hormone (AMH) in our oocyte donor population and correlate them with the ovarian response to an antagonist stimulation protocol and to study the predictive capacity of AMH for poor response (PR). Normal AMH curves were obtained for 172 candidates. AMH levels decreased with age although they showed great heterogeneity and spread in absolute values at any age range. AMH levels showed a positive correlation, statistically significant, with the Antral Follicle Count (r = 0,705), and number of oocytes retrieved (r = 0,356). In receiver operating characteristic curve analysis a threshold value of AMH = 2.31 ng/ml predictive for retrieval <6 MII (area under the curve (AUC) 0.675) was identified. This cut-off predicted PR with a sensitivity of 70.4% and a specificity of 61.8%, (PPV = 39.6%; NPV = 85.5%, p = 0.004). When performing a multiple logistic regression analysis including age, AFC and FSH, an AUC = 0.668 for PR was obtained whereas if AMH was added to the model it resulted in an AUC = 0.713. In oocyte donors aged 18 to 35 with an AFC ≥ 10 and basal FSH <10 mIU/ml, measuring AMH levels improved just slightly the prediction for PR.

• AMH
• GnRH antagonist
• oocyte donor
• ovarian response
• poor ovarian response

Acknowledgements

F Martínez, E Clua, R Tur and I Rodriguez have participated in study design, execution, analysis, and manuscript drafting. O Carreras has participated in study execution. PN Barri has participated in the critical discussion of the manuscript. The authors are indebted to all those young women and oocyte donors who have altruistically contributed to this study. The authors thank Cristina Durán, Jessica Roa and Yunaida Mimun for their enthusiasm in the recruitment and data collection and also Mònica Reig and Fulvia Mancini for her assistance with the translation of the manuscript. This work has been performed under the auspices of the Cátedra de Investigación en Obstertricia y Ginecología of the Department of Obstetrics and Gynaecology, Institut Universitari Dexeus, Universitat Autònoma de Barcelona.