Value of antimüllerian hormone as a prognostic indicator of in vitro fertilization outcome

Capsule:
Antimüllerian hormone is highly correlated with number of eggs retrieved. Very low levels are associated with diminished yet reasonable pregnancy rates, mediated through number of oocytes retrieved as opposed to oocyte quality.

Authors:
David E. Reichman M.D., Dan Goldschlag M.D., Zev Rosenwaks M.D.

Volume 101, Issue 4, Pages 1012-1018.e1

Abstract:

Objective:
To determine the predictive attributes of antimüllerian hormone (AMH) in terms of oocyte yield, cycle cancellation, and pregnancy outcomes.

Design:
Retrospective cohort.

Setting:
Academic center.

Patient(s):
All patients initiating IVF at the Weill-Cornell Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine from April 2010 through January 2013.

Intervention(s):
In vitro fertilization without preimplantation genetic testing.

Main Outcome Measure(s):
Number of oocytes retrieved, cycle cancellation, clinical and ongoing pregnancy, implantation, and miscarriage rates.

Result(s):
Antimüllerian hormone was positively correlated with number of eggs retrieved. Number of oocytes retrieved increased with increasing AMH within each age group and diminished slightly within AMH groupings as age increased. Overall, AMH was significantly correlated with risk of cycle cancellation, with an area under the curve (AUC) of 0.74. Patients with undetectable AMH had a 13.3-fold increased risk of cancellation as compared with patients with an AMH >2.0 ng/mL. Antimüllerian hormone had an AUC of 0.83 for prediction of three or fewer oocytes; undetectable AMH exhibited sensitivity and specificity of 21.1% and 98.2%, respectively, for three or fewer oocytes retrieved. Antimüllerian hormone was less predictive of pregnancy, with AUCs ranging from 0.55 to 0.65. Even with undetectable AMH, 23.5% of patients

Conclusion(s):
Antimüllerian hormone is a fairly robust metric for the prediction of cancellation and how many oocytes may be retrieved after stimulation but is a relatively poor test for prediction of pregnancy after any given treatment cycle. Patients with extremely low levels of AMH still can achieve reasonable treatment outcomes and should not be precluded from attempting IVF solely on the basis of an AMH value.

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