Can highly sensitive antimullerian hormone testing predict failed response to ovarian stimulation
Using a cut point of 0.5 ng/mL, antimullerian hormone (AMH) performs well to identify patients at risk of failure of ovarian stimulation for in vitro fertilization. PicoAMH does not provide superior ability to predict failed response.
Heather R. Burks, M.D., Lauren Ross, M.D., Neisha Opper, M.P.H., Erika Paulson, B.A., Frank Z. Stanczyk, Ph.D., Karine Chung, M.D.
Volume 104, Issue 3, Pages 643-648
To determine whether a newer commercially available antimüllerian hormone (AMH) enzyme-linked immunosorbent assay (picoAMH ELISA, AnshLabs) with a lower threshold of detection is predictive of successful ovarian stimulation in a population of women with diminished ovarian reserve (DOR).
Retrospective case-control study.
University-based IVF program.
Cases were patients whose first IVF cycle was cancelled for lack of ovarian response (<3 follicles; n = 24). Controls were patients with DOR (early follicular FSH of ≥10 IU/L), whose first cycle resulted in aspiration of at least 3 oocytes (n = 24). Intervention(s):
Frozen serum samples collected during routine clinical care between 2008 and 2012 before starting IVF were analyzed for AMH using the picoAMH ELISA.
Main Outcome Measure(s):
Serum AMH levels in patients who successfully reached oocyte retrieval compared with patients with a failed controlled ovarian hyperstimulation (COH) cycle. Receiver operator curve analysis was used to identify a predictive threshold AMH value.
No demographic differences were found between groups. The successful group had a higher antral follicle count (8.5 vs. 6) and higher AMH levels (847 vs. 406 pg/mL). The AMH level correlated with the antral follicle count (R = 0.61). The AMH level of >500 pg/mL had 83.3% sensitivity and 70.8% specificity to detect patients who proceeded to successful oocyte retrieval. Below AMH levels of 100 pg/mL, no patients achieved oocyte retrieval.
Due to a lower threshold of detection, picoAMH may be able to predict successful ovarian stimulation among women with DOR using a threshold of 500 pg/mL, with good sensitivity and specificity.