title: Anti-Mullerian hormone-tailored stimulation protocols improve outcomes whilst reducing adverse effects and costs of IVF.
abstract: BACKGROUND
  Anti-Müllerian hormone (AMH) is increasingly used to quantify ovarian reserve, but it has not yet realized its full clinical potential in assisted reproduction technology. We investigated the possible benefits of using novel, stratified ovarian hyperstimulation protocols, tailored to individual AMH levels, compared with conventional stimulation.
  
  
  METHODS
  Retrospective data were collected from 769 women (first cycle of IVF, using fresh embryos), in a UK tertiary care unit: 346 women using conventional stimulation protocols; 423 women treated under new AMH-tailored protocols.
  
  
  RESULTS
  Embryo transfer rates increased significantly (79-87%: P= 0.002) after the introduction of AMH-tailored stimulation protocols. Pregnancy rate per cycle started and live birth rate also increased significantly compared with conventionally treated women (17.9-27.7%, P= 0.002 and 15.9-23.9%, P = 0.007, respectively). Moreover, in the AMH group, the incidence of the ovarian hyperstimulation syndrome (OHSS) fell significantly (6.9-2.3%, P = 0.002) and failed fertilization fell from 7.8 to 4.5%. The cost of fertility drug treatment fell by 29% per patient and the overall cost of clinical management of OHSS fell by 43% in the AMH group. GnRH antagonist protocols, introduced as part of AMH-tailored treatment, may have contributed to the observed improvements: however, within the AMH-tailored group, the live birth rate was not significantly different between agonist and antagonist-treated groups.
  
  
  CONCLUSIONS
  Although large, prospective, multicentre studies are indicated, we have clearly demonstrated that individualized, AMH-guided, controlled ovarian hyperstimulation protocols significantly improved positive clinical outcomes, reduced the incidence of complications and reduced the financial burden associated with assisted reproduction.
authors.affiliation: Department of Clinical Biochemistry, Specialist Assay Lab, 2nd Floor, CSB3, Manchester Royal Infirmary, Manchester M13 9WL, UK. allen.yates@cmft.nhs.uk
authors.forename: A P
authors.initials: AP
authors.lastname: Yates
authors.forename: O
authors.initials: O
authors.lastname: Rustamov
authors.forename: S A
authors.initials: SA
authors.lastname: Roberts
authors.forename: H Y N
authors.initials: HY
authors.lastname: Lim
authors.forename: P W
authors.initials: PW
authors.lastname: Pemberton
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.forename: L G
authors.initials: LG
authors.lastname: Nardo
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D001723:Birth Rate; D003365:Costs and Cost Analysis; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors; D017048:Health Care Costs; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000453:epidemiology; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007987:Gonadotropin-Releasing Hormone; D054304:Anti-Mullerian Hormone