title: Can highly sensitive antimüllerian hormone testing predict failed response to ovarian stimulation?
abstract: OBJECTIVE
  To determine whether a newer commercially available antimüllerian hormone (AMH) enzyme-linked immunosorbent assay (picoAMH ELISA, AnshLabs) with a lower threshold of detection is predictive of successful ovarian stimulation in a population of women with diminished ovarian reserve (DOR).
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  University-based IVF program.
  
  
  METHODS
  Cases were patients whose first IVF cycle was cancelled for lack of ovarian response (<3 follicles; n = 24). Controls were patients with DOR (early follicular FSH of ≥10 IU/L), whose first cycle resulted in aspiration of at least 3 oocytes (n = 24).
  
  
  METHODS
  Frozen serum samples collected during routine clinical care between 2008 and 2012 before starting IVF were analyzed for AMH using the picoAMH ELISA.
  
  
  METHODS
  Serum AMH levels in patients who successfully reached oocyte retrieval compared with patients with a failed controlled ovarian hyperstimulation (COH) cycle. Receiver operator curve analysis was used to identify a predictive threshold AMH value.
  
  
  RESULTS
  No demographic differences were found between groups. The successful group had a higher antral follicle count (8.5 vs. 6) and higher AMH levels (847 vs. 406 pg/mL). The AMH level correlated with the antral follicle count (R = 0.61). The AMH level of >500 pg/mL had 83.3% sensitivity and 70.8% specificity to detect patients who proceeded to successful oocyte retrieval. Below AMH levels of 100 pg/mL, no patients achieved oocyte retrieval.
  
  
  CONCLUSIONS
  Due to a lower threshold of detection, picoAMH may be able to predict successful ovarian stimulation among women with DOR using a threshold of 500 pg/mL, with good sensitivity and specificity.
authors.affiliation: Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Heather R
authors.initials: HR
authors.lastname: Burks
authors.affiliation: Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Lauren
authors.initials: L
authors.lastname: Ross
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Neisha
authors.initials: N
authors.lastname: Opper
authors.affiliation: Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Erika
authors.initials: E
authors.lastname: Paulson
authors.affiliation: Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Frank Z
authors.initials: FZ
authors.lastname: Stanczyk
authors.affiliation: Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California. Electronic address: Karine.Chung@med.usc.edu.
authors.forename: Karine
authors.initials: K
authors.lastname: Chung
mesh_terms: D054304:Anti-Mullerian Hormone / Q000097:blood*; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D043373:Follicle Stimulating Hormone, Human / Q000097:blood; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D054315:Oocyte Retrieval; D065851:Ovarian Reserve / Q000187:drug effects*; D010062:Ovulation Induction; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D015415:Biomarkers; D005300:Fertility Agents, Female; D043373:Follicle Stimulating Hormone, Human; D054304:Anti-Mullerian Hormone
keywords: Ovarian reserve; antimullerian hormone; in vitro fertilization