title: Anti-mullerian hormone cut-off values for predicting poor ovarian response to exogenous ovarian stimulation in in-vitro fertilization.
abstract: OBJECTIVE
  (a) To establish the cut-off levels for anti-Mullerian hormone (AMH) in a population of Indian women that would determine poor response. (b) To determine which among the three ie.,: age, follicle stimulating hormone (FSH), or AMH, is the better determinant of ovarian reserve.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  In vitro fertilization (IVF) unit of a tertiary hospital.
  
  
  METHODS
  The inclusion criterion was all women who presented to the center for in-vitro fertilization/Intracytoplasmic sperm injection (IVF/ICSI). The exclusion criteria were age >45 years, major medical illnesses precluding IVF or pregnancy, FSH more than 20 IU/L, and failure to obtain consent. The interventions including baseline pelvic scan, day 2/3 FSH, luteinizing hormone (LH), estradiol estimations, and AMH measurement on any random day of cycle were done. Subjects underwent IVF according to long agonist or antagonist protocol regimen. Oocyte recovery was correlated with studied variables. The primary outcome measure was the number of oocytes aspirated (OCR). Three categories of ovarian response were defined: poor response, OCR ≤ 3; average response, OCR between 4 and 15; hyperresponse, OCR > 15.
  
  
  RESULTS
  Of the 198 patients enrolled, poor, average, and hyperresponse were observed in 23%, 63%, and 14% respectively. Correlation coefficient for AMH with ovarian response was r = 0.591. Area under the curve (AUCs) for poor response for AMH, subject's age, and FSH were 0.768, 0.624, and 0.635, respectively. The discriminatory level of AMH for prediction of absolute poor response was 2 pmoL/l, with 98% specificity and 20% sensitivity.
  
  
  CONCLUSIONS
  AMH fares better than age and FSH in predicting the overall ovarian response and poor response, though it cannot be the absolute predictor of non-responder status. A level of 2 pmol/l is discriminatory for poor response.
authors.affiliation: Consultant Centre of IVF and Human Reproduction, Sir Ganga Ram Hospital, New Delhi 110060, India.
authors.forename: Ruma
authors.initials: R
authors.lastname: Satwik
authors.forename: Mohinder
authors.initials: M
authors.lastname: Kochhar
authors.forename: Shweta M
authors.initials: SM
authors.lastname: Gupta
authors.forename: Abha
authors.initials: A
authors.lastname: Majumdar