Anti-Müllerian hormone-based approach to controlled ovarian stimulation for assisted conception.

BACKGROUND: Individualization of controlled ovarian stimulation (COS) for assisted conception is complicated by variable ovarian response to follicle stimulating hormone. We hypothesized that anti-Müllerian hormone (AMH), a predictor of oocyte yield, may facilitate treatment strategies for women undergoing COS, to optimize safety and clinical pregnancy rates. METHODS: Prospective cohort study of 538 patients in two centres with differential COS strategies based on a centralized AMH measurement. RESULTS: AMH was associated with oocyte yield after ovarian stimulation in both centres, and a 'reduced' AMH (1 to <5 pmol/l) was associated with a reduced clinical pregnancy rate. Women with a 'normal' AMH (5 to <15 pmol/l) treated with a long GnRH-agonist protocol (both centres) showed a low incidence of excess response (0%) and poor response (0%). In women with 'high' AMH (>15 pmol/l), the antagonist protocol eliminated the need for complete cryopreservation of embryos due to excess response (P < 0.001) and showed a higher fresh cycle clinical pregnancy rate than agonist cycles [OR 4.40 (95% CI 1.95-9.93), P < 0.001]. CONCLUSIONS: The use of circulating AMH to individualize treatment strategies for COS may result in reduced clinical risk, optimized treatment burden and maintained pregnancy rates, and is worthy of prospective randomized examination.

Serum anti-Müllerian hormone and FSH: prediction of live birth and extremes of response in stimulated cycles--implications for individualization of therapy.

BACKGROUND: Serum concentrations of anti-Müllerian hormone (AMH) correlate with oocyte yield in assisted reproduction treatment (ART) cycles, however, performance of AMH for prediction of live birth is unknown. METHODS: A total of 340 first cycle IVF/ICSI patients (median age 34.0 years, inter-quartile range 31.0-37.0 years), had basal plasma AMH and FSH measured and their predictive values for live birth and oocyte yield compared. RESULTS: AMH predicts live birth [contribution to variance (CTV) 3.84%, P < 0.001] and oocyte yield (r = 0.71, P < 0.0001, CTV 7.3%, P < 0.0001). Compared with age and FSH, AMH performs better in prediction of live births [area under receiver operating characteristic curve (AUC) 0.62, 95% CI 0.55-0.68; FSH AUC 0.42, 95% CI 0.35-0.49; age AUC 0.48, 95% CI 0.41-0.55, P = 0.0028] and excessive response to ovarian stimulation (AMH AUC 0.90, 95% CI 0.83-0.96; FSH AUC 0.32, 95% CI 0.23-0.40; age AUC 0.57, 95% CI 0.43-0.71, P < 0.001). AMH prediction of oocyte yield is independent of age (r = -0.28, P < 0.0001, CTV 1.4%, P = 0.006), however, a significant negative interaction (CTV 3.6%, P < 0.0001) exists. AMH demonstrates improved differential distributions for non-, poor, normal and excessive ovarian responses relative to FSH and age. CONCLUSIONS: Plasma AMH is a superior predictor of live birth and anticipated oocyte yield compared with FSH and age, facilitating individualization of therapy prior to first ART cycle.