Antimullerian hormone as a predictor of good-quality supernumerary blastocyst cryopreservation among women with levels <1 ng mL versus 1 4 ng mL

Capsule:
Antimullerian hormone (AMH) levels <1 ng/mL are associated with a statistically significantly lower likelihood of supernumerary good-quality blastocyst cryopreservation as compared with AMH levels between 1 and 4 ng/mL. Authors:
Shahryar K. Kavoussi, M.D., M.P.H., Kate C. Odenwald, M.S.N., R.N., Lynn M. Boehnlein, B.S., Roxanne B. Summers-Colquitt, M.S., Thomas B. Pool, Ph.D., Jason E. Swain, Ph.D., Jeffrey M. Jones, Ph.D., Mary J. Lindstrom, Ph.D., Dan I. Lebovic, M.D.

Volume 104, Issue 3, Pages 633-636

Abstract:

Objective:
To determine whether antimüllerian hormone (AMH) levels predict the availability of good-quality supernumerary blastocysts for cryopreservation.

Design:
Retrospective study.

Setting:
Two fertility centers.

Patient(s):
First fresh IVF cycles (n = 247) grouped as follows: 40 women <35 year old with AMH <1 ng/mL and 77 women with AMH of 1–4 ng/mL; 62 women ≥35 year old with AMH <1 ng/mL, and 68 women with AMH 1–4 ng/mL. Intervention(s):
AMH level measured before IVF with ovarian stimulation protocols based on patient age and AMH level, including short gonadotropin-releasing hormone (GnRH) agonist, GnRH antagonist, or GnRH agonist microdose flare; supernumerary good-quality blastocysts cryopreserved on days 5 or 6 after retrieval.

Main Outcome Measures(s):
Supernumerary good-quality blastocysts for cryopreservation in relation to AMH levels.

Result(s):
Among women <35 years of age, there was a statistically significant difference in the number of supernumerary good-quality blastocysts for cryopreservation between the groups with AMH <1 ng/mL and AMH of 1–4 ng/mL (30.0% vs. 58.4%) when adjusted for age. Among women ≥35 years of age, there was a statistically significant difference in the number of supernumerary good-quality blastocyst cryopreservation between groups with AMH <1 ng/mL and AMH of 1–4 ng/mL (16.1% vs. 42.6%), when adjusted for age. Conclusion(s):
Low AMH levels are associated with a statistically significantly lower likelihood of blastocysts for cryopreservation as compared with higher AMH levels. This effect was seen among women both <35 and ≥35 years of age. Patient counseling should include realistic expectations for the probability of good-quality supernumerary blastocysts available for cryopreservation.

  • Reshef Tal

    Thank you for this very interesting study. It provides useful information regarding the potential utility of AMH in predicting the likelihood of obtaining supernumerary blastocysts for cryopreservation during IVF. The authors divided their population according to AMH<1 or AMH 1-4 and age (<35 or over 35) and demonstrate impressive differences where AMH<1 was associated with significantly lower availability of blastocysts for cryopreservation for both age groups. It would be useful to have an AMH cut-off value which may predict this outcome for purpose of patient counseling. Do the authors have information regarding the area under the receiver-operating characteristic (ROC) curve for AMH in predicting cryopreservation in their population and which cut-off value may have the greatest sensitivity/specificity?

  • Jason M. Franasiak

    A very interesting article, congratulations. I see that you excluded patients with an AMH of >4ng/mL. What was the reasoning behind this? Did you make any observations regarding very high levels of AMH and connection with supernumerary blastocyst for cryopreservation? Although absolute numbers may be higher given high oocyte yield, it seems the proportion of good quality blastocysts may be lower in those individuals, perhaps due to oocyte quality? I would be interested in the authors opinion on the subject.

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