Definition by FSH, AMH and embryo numbers of good-, intermediate- and poor-prognosis patients suggests previously unknown IVF outcome-determining factor associated with AMH.
Though outcome models have been proposed previously, it is unknown whether cutoffs in clinical pregnancy and live birth rates at all ages are able to classify in vitro fertilization (IVF) patients into good-, intermediate- and poor prognosis.



We here in 3 infertile patient cohorts, involving 1247, 1514 and 632 women, built logistic regression models based on 3 functional ovarian reserve (FOR) parameters, including (1) number of good quality embryos, (2) follicle stimulating hormone (FSH, mIU/mL) and (3) anti-Müllerian hormone (AMH, ng/mL), determining whether clinical pregnancy and live birth rates can discriminate between good, intermediate and poor prognosis patients.



All models, indeed, allowed at all ages for separation by prognosis, though cut offs changed with age. In the embryo model, increasing embryo production resulted in linear improvement of IVF outcomes despite transfer of similar embryo numbers; in the FSH model outcomes and FSH levels related inversely, while the association of AMH followed a bell-shaped polynomial pattern, demonstrating "best" outcomes at mid-ranges. All 3 models demonstrated increasingly poor outcomes with advancing ages, though "best" AMH even above age 43 was still associated with unexpectedly good pregnancy and delivery outcomes. Excessively high AMH, in contrast, was at all ages associated with spiking miscarriage rates.



At varying peripheral serum concentrations, AMH, thus, demonstrates hithero unknown and contradictory effects on IVF outcomes, deserving at different concentrations investigation as a potential therapeutic agent, with pregnancy-supporting and pregnancy-interrupting properties.
The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA. ngleicher@thechr.com.|The Foundation for Reproductive Medicine, New York, NY, USA. ngleicher@thechr.com.|Stem Cell Biology and Molecular Embryology Laboratory, The Rockefeller University, New York, NY, USA. ngleicher@thechr.com.
Norbert
N
Gleicher
The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.|Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, NC, USA.
Vitaly A
VA
Kushnir
The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.|Division of Medical Endocrinology and Metabolism, Department of Medicine, Rochester University School of Medicine and Dentistry, Rochester, NY, USA.
Aritro
A
Sen
The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.
Sarah K
SK
Darmon
The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.|Vienna University School of Medicine, Vienna, 1090, Austria.
Andrea
A
Weghofer
The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.
Yan-Guang
YG
Wu
The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.
Qi
Q
Wang
The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.
Lin
L
Zhang
The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.|Department of Molecular and Integrative Physiology, The University of Kansas Medical Center, Kansas City, KS, USA.
David F
DF
Albertini
The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.|The Foundation for Reproductive Medicine, New York, NY, USA.|Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY, USA.
David H
DH
Barad
D000328:Adult; D000367:Age Factors; D054304:Anti-Mullerian Hormone / Q000378:metabolism*; D015331:Cohort Studies; D036861:Delivery, Obstetric; D004622:Embryo, Mammalian / Q000166:cytology*; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000378:metabolism*; D006801:Humans; D008954:Models, Biological; D011247:Pregnancy; D011379:Prognosis; D016896:Treatment Outcome
D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone
Anti-Müllerian hormone (AMH); Embryo number; Follicle stimulating hormone (FSH); In vitro fertilization (IVF); Live birth rates; Prediction models; Prognosis