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.
Nelson
Scott M
SM
Section of Reproductive and Maternal Medicine, Faculty of Medicine, University of Glasgow, 10 Alexandra Parade, Glasgow G31 2ER, UK.
Yates
Robin W
RW
Lyall
Helen
H
Jamieson
Maybeth
M
Traynor
Isabel
I
Gaudoin
Marco
M
Mitchell
Paul
P
Ambrose
Pat
P
Fleming
Richard
R
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
D007987:Gonadotropin-Releasing Hormone; D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone