title: Anti-Müllerian hormone-based approach to controlled ovarian stimulation for assisted conception.
abstract: 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.
authors.affiliation: Section of Reproductive and Maternal Medicine, Faculty of Medicine, University of Glasgow, 10 Alexandra Parade, Glasgow G31 2ER, UK.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Nelson
authors.forename: Robin W
authors.initials: RW
authors.lastname: Yates
authors.forename: Helen
authors.initials: H
authors.lastname: Lyall
authors.forename: Maybeth
authors.initials: M
authors.lastname: Jamieson
authors.forename: Isabel
authors.initials: I
authors.lastname: Traynor
authors.forename: Marco
authors.initials: M
authors.lastname: Gaudoin
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.forename: Pat
authors.initials: P
authors.lastname: Ambrose
authors.forename: Richard
authors.initials: R
authors.lastname: Fleming
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D002985:Clinical Protocols; D015331:Cohort Studies; D005260:Female; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors; D006801:Humans; D007231:Infant, Newborn; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies
chemical_list: D007987:Gonadotropin-Releasing Hormone; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone