Journal of Assisted Reproduction and Genetics

, Volume 30, Issue 10, pp 1361–1365

Determining an anti-mullerian hormone cutoff level to predict clinical pregnancy following in vitro fertilization in women with severely diminished ovarian reserve

  • Zaher Merhi
  • Athena Zapantis
  • Dara S. Berger
  • Sangita K. Jindal
Assisted Reproduction Technologies

DOI: 10.1007/s10815-013-0077-z

Cite this article as:
Merhi, Z., Zapantis, A., Berger, D.S. et al. J Assist Reprod Genet (2013) 30: 1361. doi:10.1007/s10815-013-0077-z
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Abstract

Purpose

Serum anti-Mullerian hormone (AMH) levels estimate ovarian reserve. The purpose of this study was to identify a minimum serum AMH level that correlates with acceptable clinical pregnancy rate (CPR) in women with severe diminished ovarian reserve (DOR) undergoing in vitro fertilization (IVF).

Methods(s)

A historical cohort of severe DOR participants (age ≥35) with day 3 FSH of >10 ng/mL were included (n = 120). Participants were categorized into 3 groups: AMH <0.2 (Group 1, n = 38), AMH = 0.2-0.79 (Group 2, n = 57) and AMH ≥ 0.8 (Group 3, n = 25) ng/mL. The main outcome was CPR. The number of retrieved and mature oocytes, transferred embryos, spontaneous abortion (SAB) and live birth (LB) rates were also evaluated.

Result(s)

Among the three groups, there was no difference in day 3 FSH and estradiol, total gonadotropins dose used per cycle, or LB. Participants in Group 1 were two years older than those in Group 2 and had significantly higher BMI than those in Groups 2 and 3. The three groups significantly differed in AFC (Group 1< Group 2< Group 3; p = 0.001) and cycle cancellation rate (Group 1> Group 2> Group 3; p = 0.006), and had a trend toward significance in SAB rate (Group 1> Group 2> Group 3; p = 0.06). Group 3 had significantly more retrieved and mature oocytes than Groups 1 or 2. Group 2 and 3 had significantly higher CPR per cycle start compared to Group 1. Although Group 2 had significantly fewer oocytes retrieved and mature oocytes than Group 3, CPR per cycle start for both groups was not different. ROC curve indicated that the point of maximal inflection between lower and higher CPR represents an AMH value of 0.2 ng/mL.

Conclusion(s)

AMH of 0.2 ng/mL appears to be a meaningful threshold for predicting CPR in women with severe DOR at our practice. This information can be crucial during the pre-cycle counseling of these women.

Keywords

Anti-Mullerian hormoneDiminished ovarian reserveClinical pregnancyIn vitro fertilization

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Zaher Merhi
    • 1
  • Athena Zapantis
    • 2
  • Dara S. Berger
    • 2
  • Sangita K. Jindal
    • 2
    • 3
  1. 1.Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Endocrinology and InfertilityUniversity of Vermont College of MedicineBurlingtonUSA
  2. 2.Department of Obstetrics & Gynecology and Women’s HealthMontefiore’s Institute for Reproductive Medicine and HealthHartsdaleUSA
  3. 3.Department of Obstetrics & Gynecology and Women’s Health, Division of Reproductive Endocrinology and InfertilityAlbert Einstein College of Medicine and Montefiore Medical CenterBronxUSA