Antimüllerian hormone in gonadotropin releasing hormone antagonist cycles Prediction of ovarian response and cumulative treatment outcome in good prognosis patients

Capsule:
AMH predicts oocyte yield and poor and excessive ovarian response in GnRH antagonist cycles and is associated with increased cumulative live-birth rates after single-blastocyst transfer in fresh and cryopreserved cycles.

Authors:
Joan-Carles Arce, M.D., Ph.D., Antonio La Marca, M.D., Ph.D., Bjarke Mirner Klein, Ph.D., Anders Nyboe Andersen, M.D., Richard Fleming, Ph.D.

Volume 99, Issue 6, Pages 1644-1653.e1, May 2013

Abstract:

Objective:
To assess the relationships between serum anti-Müllerian hormone (AMH) and ovarian response and treatment outcome in good-prognosis patients undergoing controlled ovarian stimulation (COS) using a GnRH antagonist protocol.

Design:
Secondary analysis of data prospectively collected in a randomized, assessor blind trial comparing two different gonadotropin preparations with respect to ongoing pregnancy rate.

Setting:
Twenty-five centers in seven countries.

Patients:
749 women, aged 21 to 34 years, with primary diagnosis of infertility being unexplained infertility or mild male factor infertility and with serum follicle-stimulating hormone (FSH) level 1–12 IU/L and antral follicle count (AFC) ≥10.

Interventions:
Controlled ovarian stimulation with highly purified human menopausal gonadotropin (hphMG) or recombinant FSH in a GnRH antagonist cycle with compulsory single-blastocyst transfer and potential subsequent 1-year cryopreserved blastocyst replacement in natural cycles.

Main Outcome Measure(s):
Relationships between AMH at start of stimulation and ovarian response and treatment outcome.

Results:
Serum AMH concentration was strongly correlated with oocyte yield: AMH accounted for 85%, FSH for 14%, and inhibin B and AFC for <1% each of the explained variation in oocyte yield. Also, AMH showed a high accuracy for the prediction of poor (≤3 oocytes) and high response (≥15 oocytes), which was statistically significantly better than basal FSH, AFC, or inhibin B. AMH was statistically significantly positively associated with ongoing pregnancy rate in the fresh cycle as well as with the 1-year cumulative ongoing pregnancy and live-birth rates.

Conclusion(s):
There is a positive relationship between AMH and oocyte yield in GnRH antagonist cycles. AMH is the best predictor for identifying patients with poor and high ovarian response. The positive association between AMH and cumulative live birth rates after fresh and cryopreserved cycles reflects the availability of more oocyte/blastocysts, not a higher quality.

Clinical Trial registration Number:
NCT00884221.

Translate »