Relevance of anti-Mullerian hormone measurement in a routine IVF program
C. Gnoth1,2,5, A.N. Schuring3, K. Friol1, J. Tigges1, P. Mallmann2 and E. Godehardt4
1 Center for Family Planning, Gynecological Endocrinology and Reproductive Medicine, Rheydter Strasse 143, 41515 Grevenbroich, Germany 2 Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany 3 Department of Obstetrics and Gynecology, University of Muenster, Muenster, Germany 4 Biometric Research Group, Clinic for Thoracic and Cardiovascular Surgery, Heinrich-Heine University of Duesseldorf, Duesseldorf, Germany
5 Correspondence address. Tel: +49-2181-491513; Fax: +49 2181-491534; E-mail:
dr.christian.gnoth@rmz-nrw.de
BACKGROUND: Diminished ovarian reserve has become a major cause of infertility. Anti-Mullerian hormone (AMH) seems to be a promising candidate to assess ovarian reserve and predict the response to controlled ovarian hyperstimulation (COH). This prospective study was conducted to evaluate the relevance of AMH in a routine IVF program.
METHODS: Three hundred and sixteen patients were prospectively enrolled to enter their first IVF/ICSI-cycle. Age, FSH-, inhibin B- and AMH-levels and their predictive values for ovarian response and clinical pregnancy rate were compared by discriminant analyses.
RESULTS: A total of 132 oocyte retrievals were performed. A calculated cut-off level ≤1.26 ng/ml AMH alone detected poor responders (≤4 oocytes) with a sensitivity of 97%, and there was a 98% correct prediction of normal response in COH if levels were above this threshold. With levels <0.5 ng/ml, a correct prediction of very poor response (≤2 oocytes) was possible in 88% of cases. Levels of AMH ≥0.5 ng/ml were not significantly correlated with clinical pregnancy rates.
CONCLUSIONS: AMH is a predictor of ovarian response and suitable for screening. Levels ≤1.26 ng/ml are highly predictive of reduced ovarian reserve and should be confirmed by a second line antral follicle count. Measurement of AMH supports clinical decisions, but alone it is not a suitable predictor of IVF success.
Submitted on August 21, 2007; resubmitted on March 3, 2008; accepted on March 12, 2008.
značajnost mjerenja razine AMH u IVF postupku
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