Anti-Mullerian hormone (AMH) levels in serum and follicular fluid as predictors of ovarian response in stimulated (IVF and ICSI) cycles

Abstract

Introduction: Anti-Mullerian Hormone (AMH) was recently introduced as a marker of ovarian reserve in assisted reproduction. The cutoff values of AMH for prediction of poor response have not yet been determined.

Material and methods: Ninety women undergoing their first IVF/ICSI cycle were prospectively included in this clinical, non-interventional study. Baseline AMH, follicle stimulating hormone (FSH) and antral follicle count (AFC) were measured before starting ovarian stimulation. AMH was also measured on day 5 of stimulation and in the follicular fluid of the first aspirated follicle. The predictive value of baseline AMH, day 5 AMH and follicular fluid AMH were assessed comparatively to FSH and AFC for ovarian response. Ovarian response was defined as poor (<4 oocytes), high (>12 oocytes) or normal (≥4 oocytes and ≤12 oocytes). However, only 3 patients met the criterion for high ovarian response and thus analysis was focused on the prediction of poor response.

Results: Significant differences were present between poor responders and non-poor responders regarding FSH (p = 0.019), baseline AMH (p = 0.002), AFC (p < 0.001), day 5 AMH (p = 0.005) but not for follicular AMH (p = 0.183). The largest AUC (area under the curve) for poor ovarian response was obtained by AFC (AUC = 0.81) followed by baseline AMH (AUC = 0.70). At a level below 2.74 ng/mL, the sensitivity of the test is 69% and specificity is 70.5%.

Conclusion: Baseline AMH is almost as good a predictor for poor ovarian response as AFC.

Keywords::

• Anti-Mullerian hormone/IVF
• outcome/follicular fluid/antral
• follicle count

Acknowledgements

The authors thank Lefteris Angelis, Associate Professor in Statistics (Department of Informatics, Aristotle’s University of Thessaloniki), for the statistical analysis of the results and Dr. Eustratios Kolibianakis, Lecturer in Reproductive Medicine (1st Department of Obstetrics and gynaecology, Aristotle’s University of Thessaloniki) for his help in revising this paper.

Declaration of interest: The authors report no conflicts of interest.