In the April 2014 issue of the journal Fertility and Sterility (Fertil Steril 2014;101:1012-8), Reichman et al. assessed the value of anti-mullerian hormone (AMH) as a prognostic indicator of in vitro fertilization (IVF) outcome. They assessed data from 2760 IVF patients that were seen over a 3-year period at The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, New York.
The objective was to determine the predictive attributes of AMH in terms of number of eggs retrieved, cycle cancellation, and pregnancy outcomes. The results are interesting especially the data on patients with undetectable or very low AMH levels. Here is what they found.
AMH was positively correlated with the number of eggs retrieved. Number of eggs retrieved increased with increasing AMH within each age group and diminished slightly with AMH groupings as age increased. Overall, AMH was significantly correlated with risk of cycle cancellation. Patients with undetectable AMH had a 13.3-fold increased risk of cancellation as compared with patients with an AMH >2.0 ng/mL.
Undetectable AMH levels were an excellent predictor (AUC of 0.83, sensitivity of 21.1% and specificity of 98.2%) of three or fewer eggs retrieved. AMH was less predictive of pregnancy (AUC 0.55 – 0.65). Even with undetectable AMH, 23.5% of patients <40 years old achieved live birth after transfer.
Here are some of the other details from the study:
This study is important as it comes from a very well-respected group under the leadership of Dr Zev Rosenwaks. The take home message is that AMH is a powerful predictor of cycle cancellation and number of eggs retrieved. It however, is a relatively poor predictor of pregnancy, with no cutoff able to exclude the possibility of pregnancy.
Their data contain a relatively large proportion of patients with low AMH, revealing reasonable pregnancy rates with their own eggs and without preimplantation genetic screening, even at the lower limits of the assay.
At InVia Fertility Specialists, we routinely accept patients with low AMH levels in our IVF program. Our data is consistent with the findings in this paper.
Dr. Karande is Board Certified in the specialty of Obstetrics and Gynecology as well as the subspecialty of Reproductive Endocrinology and Infertility. He is a Fellow of the American College of Obstetricians and Gynecologists and Member of the American Society for Reproductive Medicine.
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