Dynamic antimullerian hormone levels during controlled ovarian hyperstimulation predict in vitro fertilization response and pregnancy outcomes

Capsule:
The rate of antimullerian hormone decline during controlled ovarian hyperstimulation is associated with ovarian reserve, in vitro fertilization response, and clinical pregnancy, particularly in women older than 35 years of age.

Authors:
Aaron K. Styer, M.D., Audrey J. Gaskins, Sc.D., Paula C. Brady, M.D., Patrick M. Sluss, Ph.D., Jorge E. Chavarro, M.D., Sc.M., Sc.D., Russ B. Hauser, M.D., M.P.H., Sc.D., Thomas L. Toth, M.D.

Volume 104, Issue 5, Pages 1153-1161

Abstract:

Objective:
To evaluate the patterns of change in serum antimüllerian hormone (AMH) during controlled ovarian hyperstimulation (COH) and their relation to concurrent response and in vitro fertilization (IVF) pregnancy outcomes.

Design:
Prospective cohort study.

Setting:
Academic medical center.

Patient(s):
113 consecutive fresh IVF embryo transfer cycles from September 1, 2012 through January 1, 2013.

Intervention(s):
Serial serum AMH measurements were analyzed on each day that serum estradiol (E2) was drawn during COH.

Main Outcome Measure(s):
Relationship among the rate of COH AMH change [Δ ng/mL per day] (stratified into tertiles), ovarian response, and pregnancy outcomes.

Result(s):
During COH, AMH declined. Age and ovarian reserve testing were associated with the rate of AMH decline (RAD). Women with intermediate and minimal RAD had statistically significantly fewer follicles ≥12 mm, lower peak serum E2, fewer oocytes, and inferior early embryo development compared with women with the greatest RAD. Compared with patients with the lowest RAD, clinical pregnancy was more likely in patients with the greatest RAD in the total population (adjusted odds ratio 3.51; 95% confidence interval, 1.03, 11.94) and among patients older than 35 years (adjusted odds ratio 6.95; 95% confidence interval, 1.09, 44.1).

Conclusion(s):
The rate of COH AMH decline was associated with ovarian reserve testing, oocyte yield, embryo progression, and clinical pregnancy rates, particularly in women older than 35 years. These results suggest that dynamic AMH levels may provide a novel intracycle approach to predict response and treatment outcomes after IVF.

  • Jason M. Franasiak

    A very interesting manuscript, congratulations. Given there is some data to suggest AMH levels are affected by OCPs, albeit long-term OCPs, what percentage of patients did not receive OCPs prior to starting their stimulated cycle?

    Do the authors feel this provided additional prognostic information beyond observing estradiol rise and follicle count?

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