Influence of age on response to controlled ovarian stimulation in women with low levels of serum anti-Müllerian hormone

Abstract

This study aims at detecting and evaluating differences in quantitative response to controlled ovarian stimulation (COS) with high doses of gonadotropins in women with low serum anti-Müllerian hormone (AMH). About 369 first cycles in a real-life scenario in women between 21 and 43 years old and with AMH ≤0.9 ng/ml were analyzed. Older women had a significantly worse outcome with respect to young women, not only qualitatively, but also in terms of quantitative ovarian response to COS [odd ratio (OR) to obtain at least three MII oocytes with each increasing year of female age: 0.89, 95% CI: 0.85 − 0.94; p < .001]. This study endorses that age is a significant factor when counseling patients with low AMH. AMH levels per se are not a reason to exclude patients from a COS treatment, since pregnancy and live birth can be achieved, especially in younger patients. However, with an AMH equally low, the ovarian response worsens with age, making questionable the effectiveness of a stimulation with high-dose gonadotropins in the older subgroup.

摘要

本研究旨在检测和评估血清抗苗勒氏管激素（AMH）水平低的女性对高剂量促性腺激素促排卵（COS）的定量反应差异。我们纳入了369名21-43岁且AMH≤0.9ng/ml的女性分析其促排卵的第一周期。与年轻女性相比, 不仅在定性上, 而且在卵巢对COS的定量反应上, 高龄女性的结局明显更差[随着女性年龄的增加, 至少获得三个MII卵母细胞的比值比（OR）：0.89, 95%CI：0.85-0.94；p<0.001]。这项研究证实, 在抗苗勒氏管激素水平低的患者咨询促排卵时, 年龄是一个重要的因素。抗苗勒氏管激素水平并不是将患者排除在COS治疗之外的理由, 因为妊娠和活产是可能实现的, 特别是对年轻的患者。然而在同样低水平的抗苗勒氏管激素的情况下, 卵巢反应随着年龄的增长而降低, 这使得年龄较大组中应用高剂量的促性腺激素刺激的有效性存在质疑。

Keywords:

• IVF
• AntiMullerian hormone (AMH)
• ovarian reserve
• controlled ovarian stimulation

Disclosure statement

All authors report no conflicts of interest to declare.