title: Clinical relevance of combined FSH and AMH observations in infertile women.
abstract: BACKGROUND
  FSH and anti-Müllerian hormone (AMH) are, individually, widely used to assess functional ovarian reserve (FOR) but demonstrate discrepancies in efficacy. How predictive they are combined is unknown.
  
  
  OBJECTIVE
  The purpose of this study was to assess predictive values of different FSH and AMH combinations on in vitro fertilization (IVF).
  
  
  METHODS
  FSH and AMH levels in patients were categorized as low, normal, and high, based on age-specific 95% confidence intervals. This allowed for establishment of nine combinations of low, normal, or high FSH/AMH patient categories. With use of various statistical methods, patients in individual categories were then compared in outcomes.
  
  
  METHODS
  We investigated 544 consecutive infertility patients in their first IVF cycles.
  
  
  METHODS
  IVF cycles were managed.
  
  
  METHODS
  Oocyte yields and implantation and pregnancy rates, adjusted for age and fragile X mental retardation 1 (FMR1) genotypes/subgenotypes, were measured.
  
  
  RESULTS
  The most notable repeated finding was a strong statistical association of the FSH/AMH high/high category (characterized by abnormally high FSH and AMH levels) with favorable IVF outcomes compared with outcomes for other FSH/AMH variations (4.34 times odds of high oocyte yields and 1.93 times odds of clinical pregnancy). Addition of age to the model only minimally further improved the odds of pregnancy to 2.03 times. The positive association with high oocyte yields, however, turned negative (0.75 times lower yields) with addition of FMR1 to the model for women with FSH/AMH high/high and the het-norm/low FMR1 subgenotype compared with women with the norm FMR1 genotype and other FSH/AMH categories.
  
  
  CONCLUSIONS
  In the absence of het-norm/low FMR1, abnormally high FSH and AMH, a seemingly contradictory combination, reflects highly beneficial outcomes in IVF compared with the other FSH/AMH categories, suggesting greater importance of FSH in early follicle maturation than currently recognized. The study also confirms adverse outcome effects of het-norm/low FMR1 and, therefore, the gene's importance for reproductive success.
authors.affiliation: The Center for Human Reproduction, 21 East 69th Street, New York, New York 10021, USA. ngleicher@thechr.com
authors.forename: Norbert
authors.initials: N
authors.lastname: Gleicher
authors.forename: Ann
authors.initials: A
authors.lastname: Kim
authors.forename: Vitaly
authors.initials: V
authors.lastname: Kushnir
authors.forename: Andrea
authors.initials: A
authors.lastname: Weghofer
authors.forename: Aya
authors.initials: A
authors.lastname: Shohat-Tal
authors.forename: Emanuela
authors.initials: E
authors.lastname: Lazzaroni
authors.forename: Ho-Joon
authors.initials: HJ
authors.lastname: Lee
authors.forename: David H
authors.initials: DH
authors.lastname: Barad
mesh_terms: D000328:Adult; D000367:Age Factors; D054304:Anti-Mullerian Hormone / Q000097:blood*; D004351:Drug Resistance; D005260:Female; D005300:Fertility Agents, Female / Q000494:pharmacology; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood*; D051860:Fragile X Messenger Ribonucleoprotein 1 / Q000235:genetics / Q000378:metabolism; D014644:Genetic Variation; D006801:Humans; D007247:Infertility, Female / Q000097:blood* / Q000209:etiology / Q000235:genetics / Q000628:therapy; D008954:Models, Biological; D009519:New York City / Q000453:epidemiology; D010053:Ovary / Q000187:drug effects; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D016649:Primary Ovarian Insufficiency / Q000235:genetics / Q000503:physiopathology; D012189:Retrospective Studies; D013223:Statistics as Topic; D015854:Up-Regulation
chemical_list: D054304:Anti-Mullerian Hormone; D005300:Fertility Agents, Female; D005640:Follicle Stimulating Hormone; D051860:Fragile X Messenger Ribonucleoprotein 1; C497683:FMR1 protein, human