title: The cutoff values of serum AMH levels and starting recFSH doses for the individualization of IVF treatment strategies.
abstract: OBJECTIVE
  The main purpose of our study is to categorize starting doses of recombinant follicle-stimulating hormone (recFSH) based on various cutoff values of anti-Mullerian hormone (AMH) and to determine the effectiveness of serum AMH levels in the prediction of poor ovarian response.
  
  
  METHODS
  Prospective data analysis was conducted at IVF center. A total of 323 patients were included. All patients were divided into four groups according to the patients' serum AMH concentrations: Group 1 (AMH < 1 ng/ml; 450 IU/day n = 157); Group 2 (AMH 1-2 ng/ml; 375 IU/day, n = 55); Group 3 (AMH 2-3 ng/ml; 225 IU/day, n = 48); and Group 4 (AMH > 3 ng/ml; 150 IU/day, n = 63). Collected data included age, total gonadotropin dosage, duration of stimulations, the total number of oocytes retrieved, ovarian response, cancelation rate, and cPRs.
  
  
  RESULTS
  As serum AMH levels increased, there were significant decreases in the starting recFSH dose and total gonadotropin dosage, and a significant increase in the total number of oocytes retrieved. There was a significant trend toward increasing cycle cancelation rates and decreasing cPRs with decreasing serum AMH levels. Although there were no significant differences with regard to the proportion of cycles with hypo-response between all groups. A result of ≤0.83 was considered the cutoff value of AMH to predict a hypo-response to ovarian stimulation.
  
  
  CONCLUSIONS
  AMH is a useful marker in selecting the starting dose of recFSH and prediction of poor ovarian response. Our protocol may allow clinicians to modulate the starting dose of recFSH according to these cutoff values for serum AMH levels.
authors.affiliation: a Department of Obstetrics and Gynecology , Bezmialem University Faculty of Medicine , İstanbul , Turkey.|b Department of Obstetrics , Gynecology and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA.
authors.forename: Pinar
authors.initials: P
authors.lastname: Özcan
authors.affiliation: c Department of Obstetrics and Gynecology , Yeditepe University, Faculty of Medicine , Istanbul , Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Fiçicioğlu
authors.affiliation: a Department of Obstetrics and Gynecology , Bezmialem University Faculty of Medicine , İstanbul , Turkey.
authors.forename: Seda
authors.initials: S
authors.lastname: Ateş
authors.affiliation: d Department of Anesthesiology , Acibadem University, Faculty of Medicine , Istanbul , Turkey , and.
authors.forename: Meltem Güner
authors.initials: MG
authors.lastname: Can
authors.affiliation: e Department of Medical Informatics , Yeditepe University, Faculty of Medicine , Istanbul , Turkey.
authors.forename: Çiğdem
authors.initials: Ç
authors.lastname: Kaspar
authors.affiliation: c Department of Obstetrics and Gynecology , Yeditepe University, Faculty of Medicine , Istanbul , Turkey.
authors.forename: Oya
authors.initials: O
authors.lastname: Akçin
authors.affiliation: c Department of Obstetrics and Gynecology , Yeditepe University, Faculty of Medicine , Istanbul , Turkey.
authors.forename: Mert
authors.initials: M
authors.lastname: Yesiladali
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage*; D006801:Humans; D065851:Ovarian Reserve; D010062:Ovulation Induction / Q000379:methods*; D057285:Precision Medicine; D011247:Pregnancy; D018873:Pregnancy Rate
chemical_list: D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone
keywords: AMH; IVF; assisted reproduction technology; ovarian response; ovarian stimulation; poor response