Automated anti-Mullerian hormone measurement: data review to provide insights and interpretation

Abstract

Objective and Methods: All women seen at the Homerton Fertility Center, London (Site 1, n = 1787) and Hewitt Fertility Center, Liverpool (Site 2, n = 1258) in 15 months had serum AMH measured using the Access 2 fully automated benchtop immunoassay analyzer(Beckman Coulter Inc,) and a subset (n = 2031) were followed up to determine eggs collected and clinical pregnancy rates (CPR).

Results

AMH results were pooled and a table with 2.5 and 97.5 percentiles for each age group constructed. Based on Youden index, the optimal cut off for low responders (0–3 eggs), was 5.5 pmol/l (87% sensitivity, 55% specificity) and for high responders (>15 eggs) 15.6 pmol/l (78% sensitivity, 57% specificity). AMH correlated with number of eggs collected (r = 0.48) and clinical pregnancies (r = 0.14), (p < .0001).

Conclusions

The table of AMH levels measured using the Access 2 fully automated immunoassay system according to age may be used as a reference and cutoff levels for high and poor responders are clearly defined to help tailor controlled ovarian stimulation, maximizing efficiency and ensuring patient safety. The use of a random access automated immunoassay system means that blood sampled on arrival can produce an AMH result in 40 mins by the time the subject enters the doctor’s clinic together with other relevant endocrine markers.

摘要

目的和方法：所有的女性均在15个月内分别在伦敦霍默顿生育中心（中心1, n=1787）和利物浦休伊特生育中心（中心2, n=1258）应用Access 2全自动台式免疫分析仪（Beckman Coulter Inc,）检测血清AMH。其中一部分进行随访（n=2030）卵子数和临床妊娠率（CPR）。

结果：汇总AMH结果, 每个年龄组都有2.5%和97.5%的表格。根据约登指数, 低反应者（0-3卵）的最佳截断值为5.5 pmol/l（灵敏度87％, 特异度为87％）和高反应者（> 15个卵）为15.6pmol/L（灵敏度78％, 特异度57％）。AMH与募集的卵子数（r=0.48）和临床妊娠率均相关（r=0.14）, （P <.0001）。 结论：Access 2全自动免疫分析系统根据年龄测量的AMH水平表可以作为参考, 明确定义高反应者和低反应者的截断值水平, 以帮助控制卵巢刺激, 最大限度地提高效率并确保患者安全。随机存取自动免疫分析系统的使用意味着, 当受试者进入医生诊所采血后40分钟内, AMH检测结果可以与其他相关的内分泌指标一起报告。

Keywords:

• AMH
• IVF
• pregnancy rate
• oocytes
• ovarian response

Acknowledgments

We gratefully acknowledge the statistical analyses and advice of Dr Lindsay Sun Scientific Affairs, Beckman Coulter.

Author contributions

RH and SF conceived and designed the study. RH and SF wrote the manuscript. All the rest of the authors acquired the data, critically reviewed the manuscript and all approved of the version for publication.

Disclosure statement

SF performs consulting work for Beckman Coulter.

Additional information

Funding

SF performs consulting work for Beckman Coulter.