Value of antimüllerian hormone as a prognostic indicator of in vitro fertilization outcome.
OBJECTIVE
To determine the predictive attributes of antimüllerian hormone (AMH) in terms of oocyte yield, cycle cancellation, and pregnancy outcomes.


METHODS
Retrospective cohort.


METHODS
Academic center.


METHODS
All patients initiating IVF at the Weill-Cornell Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine from April 2010 through January 2013.


METHODS
In vitro fertilization without preimplantation genetic testing.


METHODS
Number of oocytes retrieved, cycle cancellation, clinical and ongoing pregnancy, implantation, and miscarriage rates.


RESULTS
Antimüllerian hormone was positively correlated with number of eggs retrieved. Number of oocytes retrieved increased with increasing AMH within each age group and diminished slightly within AMH groupings as age increased. Overall, AMH was significantly correlated with risk of cycle cancellation, with an area under the curve (AUC) of 0.74. Patients with undetectable AMH had a 13.3-fold increased risk of cancellation as compared with patients with an AMH >2.0 ng/mL. Antimüllerian hormone had an AUC of 0.83 for prediction of three or fewer oocytes; undetectable AMH exhibited sensitivity and specificity of 21.1% and 98.2%, respectively, for three or fewer oocytes retrieved. Antimüllerian hormone was less predictive of pregnancy, with AUCs ranging from 0.55 to 0.65. Even with undetectable AMH, 23.5% of patients <40 years old achieved live birth after transfer.


CONCLUSIONS
Antimüllerian hormone is a fairly robust metric for the prediction of cancellation and how many oocytes may be retrieved after stimulation but is a relatively poor test for prediction of pregnancy after any given treatment cycle. Patients with extremely low levels of AMH still can achieve reasonable treatment outcomes and should not be precluded from attempting IVF solely on the basis of an AMH value.
The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, New York.
David E
DE
Reichman
The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, New York.
Dan
D
Goldschlag
The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, New York. Electronic address: zrosenw@med.cornell.edu.
Zev
Z
Rosenwaks
D000022:Abortion, Spontaneous / Q000097:blood* / Q000453:epidemiology*; D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data*; D006801:Humans; D007247:Infertility, Female / Q000097:blood* / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D016896:Treatment Outcome
D015415:Biomarkers; D054304:Anti-Mullerian Hormone
AMH; IVF; antimüllerian hormone; cancellation; predictive value