title: Dynamic antimüllerian hormone levels during controlled ovarian hyperstimulation predict in vitro fertilization response and pregnancy outcomes.
abstract: OBJECTIVE
  To evaluate the patterns of change in serum antimüllerian hormone (AMH) during controlled ovarian hyperstimulation (COH) and their relation to concurrent response and in vitro fertilization (IVF) pregnancy outcomes.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  A total of 113 consecutive fresh IVF embryo transfer cycles from September 1, 2012 through January 1, 2013.
  
  
  METHODS
  Serial serum AMH measurements were analyzed on each day that serum estradiol (E2) was drawn during COH.
  
  
  METHODS
  Relationship between the rate of COH AMH change [Δ ng/mL per day] (stratified into tertiles), and ovarian response, and pregnancy outcomes.
  
  
  RESULTS
  During COH, AMH declined. Age and ovarian reserve testing were associated with the rate of AMH decline (RAD). Women with intermediate and minimal RAD had statistically significantly fewer follicles ≥ 12 mm, lower peak serum E2, fewer oocytes, and inferior early embryo development compared with women with the greatest RAD. Compared with patients with the lowest RAD, clinical pregnancy was more likely in patients with the greatest RAD in the total population (adjusted odds ratio 3.51; 95% confidence interval, 1.03, 11.94) and among patients older than 35 years (adjusted odds ratio 6.95; 95% confidence interval, 1.09, 44.1).
  
  
  CONCLUSIONS
  The rate of COH AMH decline was associated with ovarian reserve testing, oocyte yield, embryo progression, and clinical pregnancy rates, particularly in women older than 35 years. These results suggest that dynamic AMH levels may provide a novel intracycle approach to predict response and treatment outcomes after IVF.
authors: Vincent Department of Obstetrics and Gynecology, Vincent Reproductive Medicine and IVF, Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Medical School, Harvard University, Boston, Massachusetts. Electronic address: astyer@mgh.harvard.edu.
authors: Aaron K
authors: AK
authors: Styer
authors: Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
authors: Audrey J
authors: AJ
authors: Gaskins
authors: Vincent Department of Obstetrics and Gynecology, Vincent Reproductive Medicine and IVF, Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Medical School, Harvard University, Boston, Massachusetts.
authors: Paula C
authors: PC
authors: Brady
authors: Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
authors: Patrick M
authors: PM
authors: Sluss
authors: Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts.
authors: Jorge E
authors: JE
authors: Chavarro
authors: Vincent Department of Obstetrics and Gynecology, Vincent Reproductive Medicine and IVF, Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Medical School, Harvard University, Boston, Massachusetts; Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
authors: Russ B
authors: RB
authors: Hauser
authors: Vincent Department of Obstetrics and Gynecology, Vincent Reproductive Medicine and IVF, Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Medical School, Harvard University, Boston, Massachusetts.
authors: Thomas L
authors: TL
authors: Toth
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects; D006801:Humans; D007246:Infertility / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D054315:Oocyte Retrieval; D065851:Ovarian Reserve; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D004958:Estradiol; D054304:Anti-Mullerian Hormone
keywords: Antimüllerian hormone; assisted reproductive technology; controlled ovarian hyperstimulation; in vitro fertilization