title: Anti-Mullerian Hormone (AMH) levels in serum and follicular fluid as predictors of ovarian response in stimulated (IVF and ICSI) cycles.
abstract: BACKGROUND
  Anti-Mullerian Hormone (AMH) was recently introduced as a marker of ovarian reserve in assisted reproduction. The cutoff values of AMH for prediction of poor response have not yet been determined.
  
  
  METHODS
  Ninety women undergoing their first IVF/ICSI cycle were prospectively included in this clinical, non-interventional study. Baseline AMH, follicle stimulating hormone (FSH) and antral follicle count (AFC) were measured before starting ovarian stimulation. AMH was also measured on day 5 of stimulation and in the follicular fluid of the first aspirated follicle. The predictive value of baseline AMH, day 5 AMH and follicular fluid AMH were assessed comparatively to FSH and AFC for ovarian response. Ovarian response was defined as poor (<4 oocytes), high (>12 oocytes) or normal (≥4 oocytes and ≤12 oocytes). However, only 3 patients met the criterion for high ovarian response and thus analysis was focused on the prediction of poor response.
  
  
  RESULTS
  Significant differences were present between poor responders and non-poor responders regarding FSH (p = 0.019), baseline AMH (p = 0.002), AFC (p < 0.001), day 5 AMH (p = 0.005) but not for follicular AMH (p = 0.183). The largest AUC (area under the curve) for poor ovarian response was obtained by AFC (AUC = 0.81) followed by baseline AMH (AUC = 0.70). At a level below 2.74 ng/mL, the sensitivity of the test is 69% and specificity is 70.5%.
  
  
  CONCLUSIONS
  Baseline AMH is almost as good a predictor for poor ovarian response as AFC.
authors.affiliation: Gynaecology and Fertility Centre, Thessaloniki, Greece. athantol@doctors.net.uk
authors.forename: A
authors.initials: A
authors.lastname: Tolikas
authors.forename: E
authors.initials: E
authors.lastname: Tsakos
authors.forename: S
authors.initials: S
authors.lastname: Gerou
authors.forename: Y
authors.initials: Y
authors.lastname: Prapas
authors.forename: A
authors.initials: A
authors.lastname: Loufopoulos
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000378:metabolism*; D019540:Area Under Curve; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000097:blood; D015571:Follicular Fluid / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D006080:Ovarian Follicle / Q000378:metabolism*; D010062:Ovulation Induction / Q000379:methods* / Q000592:standards; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone