Relevance of anti-Mullerian hormone measurement in a routine IVF program.
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 < or =1.26 ng/ml AMH alone detected poor responders (< or =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 (< or =2 oocytes) was possible in 88% of cases. Levels of AMH > or =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 < or =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.
Gnoth
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Center for Family Planning, Gynecological Endocrinology and Reproductive Medicine, Rheydter Strasse 143, 41515 Grevenbroich, Germany. dr.christian.gnoth@rmz-nrw.de
Schuring
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AN
Friol
K
K
Tigges
J
J
Mallmann
P
P
Godehardt
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E
D000328:Adult; D000367:Age Factors; D054304:Anti-Mullerian Hormone / Q000097:blood*; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007265:Inhibins / Q000097:blood; D054315:Oocyte Retrieval; D010053:Ovary / Q000378:metabolism; D011237:Predictive Value of Tests; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D012680:Sensitivity and Specificity
C422364:inhibin B; D007265:Inhibins; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone