Do AMH levels predict IVF pregnancy rates?

Anti-mullerian hormone (AMH) levels are now routinely used clinically to assess ovarian reserve. AMH levels are believed to reflect the pool of oocytes (eggs) that remain in the ovary (ies). Low AMH level are associated with a reduced number of eggs that are available and will often predict low ovarian response during IVF. AMH levels are therefore believed to reflect the quantity of eggs that remain. The question is, do AMH levels also reflect egg quality and therefore pregnancy rates with IVF?

This very issue was addressed by a group of Swedish researchers (Brodin et al., Antimullerian hormone levels are strongly associated with live-birth rates after assisted reproduction. J Clin Endocrinol Metab 98:1107-14, 2013). Brodin et al. studied AMH levels in 892 consecutive women undergoing 1230 IVF cycles. They log-transformed AMH values (a mathematical conversion to make sense of the data) and stratified them into four groups (25^th, 50^th and 75^th percentiles of the observations). Here are the results of the study.

The AMH levels ranged from 0.06 to 26.3 ng/ml. The median level was 1.6 ng/ml and the mean (SD) level was 2.3 (2.5) ng/ml. The pregnancy rate was positively correlated with AMH levels up to 5 ng/ml and then leveled. This correlation was true even after adjusting for age. The 25^th and 75^th percentiles were AMH 0.84 and 2.94 ng/ml, respectively.

There was no AMH level below which no pregnancies occurred. In patients with very low AMH levels (< 0.2 ng/ml), only 18 of 53 (34%, all ages) started cycles resulted in embryo transfer and only three cycles ended in a pregnancy and live birth.

AMH was independently significant in predicting pregnancy rate and live birth rate. The chances of live birth increased 42% for each AMH stratum upward.

So what does all this mean?

• AMH levels are strongly associated with IVF pregnancy rates.
• AMH levels are also associated with the number of eggs retrieved.
• The group with the highest AMH values (> 75^th percentile) had the best treatment outcome and included patients with polycystic ovary syndrome.

The authors therefore believe that AMH levels reflect both egg quantity and quality.