title: Ongoing pregnancy rates in women with low and extremely low AMH levels. A multivariate analysis of 769 cycles.
abstract: BACKGROUND
  The ideal test for ovarian reserve should permit the identification of women who have no real chance of pregnancy with IVF treatments consequent upon an extremely reduced ovarian reserve. The aim of the current study was to evaluate pregnancy rates in patients with low AMH levels (0.2-1 ng/ml) and extremely low AMH levels (<0.2 ng/ml) and to determine the cumulative pregnancy rates following consecutive IVF treatments.
  
  
  METHODS
  We conducted an historical cohort analysis at a tertiary medical center. Serum AMH levels were measured at initial clinic visit and prior to all following treatment cycles in 181 women (769 cycles) with an initial AMH level ≤1 ng/ml, undergoing IVF-ICSI. Main outcome measures were laboratory outcomes and pregnancy rates.
  
  
  RESULTS
  Seventy patients undergoing 249 cycles had extremely low AMH levels (≤0.2 ng/ml), whereas 111 patients undergoing 520 cycles had low AMH levels (0.21-1.0 ng/ml). Number of oocytes retrieved per cycle, fertilized oocytes and number of transferred embryos were significantly lower in the extremely low AMH levels group compared to the low AMH levels (P<0.003). Crude ongoing pregnancy rates were 4.4% for both groups of patients. Among 48 cycles of women aged ≥42 with AMH levels of ≤0.2 ng/ml no pregnancies were observed. But, in patients with AMH levels of 0.2-1.0 ng/ml, 3 ongoing pregnancies out of 192 cycles (1.6%) were observed. However, in a multivariate regression analysis adjusted for age and cycle characteristics, no significant differences in ongoing pregnancy rates per cycle between the two groups were evident. Cumulative pregnancy rates of 20% were observed following five cycles, for both groups of patients.
  
  
  CONCLUSIONS
  Patients with extremely low AMH measurements have reasonable and similar pregnancy rates as patients with low AMH. Therefore, AMH should not be used as the criterion to exclude couples from performing additional IVF treatments.
authors.affiliation: IVF unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Alon
authors.initials: A
authors.lastname: Kedem
authors.affiliation: IVF unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Jigal
authors.initials: J
authors.lastname: Haas
authors.affiliation: Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research Ltd, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Liat Lerner
authors.initials: LL
authors.lastname: Geva
authors.affiliation: IVF unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Gil
authors.initials: G
authors.lastname: Yerushalmi
authors.affiliation: IVF unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yinon
authors.initials: Y
authors.lastname: Gilboa
authors.affiliation: Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Hanna
authors.initials: H
authors.lastname: Kanety
authors.affiliation: Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Mirit
authors.initials: M
authors.lastname: Hanochi
authors.affiliation: IVF unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ettie
authors.initials: E
authors.lastname: Maman
authors.affiliation: IVF unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Hourvitz
mesh_terms: D000328:Adult; D000367:Age Factors; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D010053:Ovary / Q000166:cytology / Q000502:physiology*; D011247:Pregnancy; D018873:Pregnancy Rate; D012044:Regression Analysis; D020554:Sperm Injections, Intracytoplasmic; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D054304:Anti-Mullerian Hormone