Correlation of Basal AMH & Ovarian Response in IVF Cycles; Predictive Value of AMH

Ahn, Young Sun; Kim, Jin Yeong; Cho, Yun Jin; Kim, Min Ji; Kim, Hye Ok; Park, Chan Woo; Song, In Ok; Koong, Mi Kyoung; Kang, Inn Soo

Abstract

OBJECTIVES
The aim of this study was to evaluate the usefulness of Anti-mullerian hormone (AMH) as a predictive marker for ovarian response and cycle outcome in IVF cycles.
METHODS
From Jan., to Aug., 2007, 111 patients undergoing IVF/ICSI stimulated by short or antagonist protocol were selected. On cycle day 3, basal serum AMH level and FSH level were measured. The correlation between basal serum AMH or FSH, and COH outcome was analyzed and IVF outcome was compared according to the AMH levels. To determine the threshold value of AMH for poor- and hyper- response, ROC curve was analyzed.
RESULTS
Serum AMH showed higher correlation coefficient (r=0.792, p<0.001) with the number of retrieved mature oocyte than serum FSH (r=-0.477, p<0.001). According to ovarian response, FSH and AMH leves showed significant differences among poor, normal , and hyperresponder. For predicting poor (< or =2 oocytes) and hyperresponse (> or =17 oocyets), AMH cut-off values were 0.5 ng/ml (the sensitivity 88.9% and the specificity 89.5%) and 2.5 ng/ml (sensitivity 85.7%, specificity 87.0%), respectively. According to the AMH level, patients were divided into 3 groups: low (< or =0.60 ng/ml), normal (0.60~2.60 ng/ml), and high AMH (> or =2.60 ng/ml). The number of retrieved mature oocytes was significantly higher (2.7+/-2.2, 8.1+/-4.8, 16.5+/-5.7) and total gonadotropin dose was lower (3530.5+/-1251.0, 2957.1+/-1057.6, and 2219.2+/-751.9 IU) in high AMH group (p<0.001). There was no significant difference in fertilization rates and pregnancy rates (23.8%, 34.0%, 37.5%) among the groups.
CONCLUSIONS
Basal serum AMH level correlated better with the number of retrieved mature oocytes than FSH level, suggesting its usefulness for predicting ovarian response. However, IVF outcome was not significantly different according to the AMH levels. Serum AMH level presented good cut-off value for poor- or hyper-responders, therefore it could be useful in prediction of cycle cancellation, gonadotropin dose, and OHSS risk in IVF cycles.