Abstract
Purpose
The aims of this study were to assess the outcome of in vitro fertilization (IVF) in women with very low circulating anti-müllerian hormone (AMH) and to investigate factors affecting their probability of pregnancy.
Methods
The outcome of 448 IVF cycles in 361 women with circulating AMH <0.5 ng/ml was retrospectively analyzed.
Results
Cycle cancellation rate was 14.5 %; patients whose cycle was cancelled had significantly lower AMH than women who reached oocyte pickup (OPU). Among those who reached OPU, age significantly affected the success rate: despite comparable AMH levels, patients below 35 years obtained significantly more oocytes and a better clinical pregnancy rate (CPR)/OPU than patients aged 35–39 or 40–43 (31 % vs. 23.2 % vs. 10.2 %, respectively; p = 0.001). Differently, comparable IVF results were observed stratifying patients for AMH levels in the range 0.14–0.49 ng/ml. Multivariable logistic regression analysis confirmed that the probability of pregnancy was significantly affected by age, but not by small differences in AMH level.
Conclusions
Women with very low (<0.5 ng/ml) AMH levels undergoing IVF still have reasonable chances of achieving a pregnancy, but their prognosis is significantly affected by chronological age. Very low AMH levels are associated with a relevant risk of cycle cancellation but should not be considered a reason to exclude a couple from IVF.
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References
Broekmans FJ, Knauff EA, te Velde ER, Macklon NS, Fauser BC. Female reproductive ageing: current knowledge and future trends. Trends Endocrinol Metab. 2007;18:58–65.
Steiner AZ. Clinical implications of ovarian reserve testing. Obstet Gynecol Surv. 2009;64:120–8.
Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006;12:685–718.
Dewailly D, Andersen CY, Balen A, Broekmans F, Dilaver N, Fanchin R, et al. The physiology and clinical utility of anti-mullerian hormone in women. Hum Reprod Update. 2014;20:370–85.
La Marca A, Giulini S, Tirelli A, Bertucci E, Marsella T, Xella S, et al. Anti-müllerian hormone measurement on any day of the menstrual cycle strongly predicts ovarian response in assisted reproductive technology. Hum Reprod. 2007;22:766–71.
Nelson SM, Yates RW, Fleming R. Serum anti-müllerian hormone and FSH: prediction of live birth and extremes of response in stimulated cycles—implications for individualization of therapy. Hum Reprod. 2007;22:2414–21.
Muttukrishna S, Suharjono H, McGarrigle H, Sathanandan M. Inhibin B and anti-mullerian hormone: markers of ovarian response in IVF/ICSI patients? Bjog. 2004;111:1248–53.
Lekamge DN, Barry M, Kolo M, Lane M, Gilchrist RB, Tremellen KP. Anti-müllerian hormone as a predictor of IVF outcome. Reprod Biomed Online. 2007;14:602–10.
Koshy AK, Gudi A, Shah A, Bhide P, Timms P, Homburg R. Pregnancy prognosis in women with anti-müllerian hormone below the tenth percentile. Gynecol Endocrinol. 2013;29:662–5.
Nelson SM, Yates RW, Lyall H, Jamieson M, Traynor I, Gaudoin M, et al. Anti-müllerian hormone-based approach to controlled ovarian stimulation for assisted conception. Hum Reprod. 2009;24:867–75.
Merhi Z, Zapantis A, Berger DS, Jindal SK. Determining an anti-mullerian hormone cutoff level to predict clinical pregnancy following in vitro fertilization in women with severely diminished ovarian reserve. J Assist Reprod Genet. 2013;30:1361–5.
Tocci A, Ferrero S, Iacobelli M, Greco E. Negligible serum anti-mullerian hormone: pregnancy and birth after a 1-month course of an oral contraceptive, ovarian hyperstimulation, and intracytoplasmic sperm injection. Fertil Steril. 2009;92:395 e399–12.
Weghofer A, Dietrich W, Barad DH, Gleicher N. Live birth chances in women with extremely low-serum anti-mullerian hormone levels. Hum Reprod. 2011;26:1905–9.
Fraisse T, Ibecheole V, Streuli I, Bischof P, de Ziegler D. Undetectable serum anti-müllerian hormone levels and occurrence of ongoing pregnancy. Fertil Steril. 2008;89:723 e729–711.
Tokura Y, Yoshino O, Ogura-Nose S, Motoyama H, Harada M, Osuga Y, et al. The significance of serum anti-müllerian hormone (AMH) levels in patients over age 40 in first IVF treatment. J Assist Reprod Genet. 2013;30:821–5.
Holte J, Berglund L, Milton K, Garello C, Gennarelli G, Revelli A, et al. Construction of an evidence-based integrated morphology cleavage embryo score for implantation potential of embryos scored and transferred on day 2 after oocyte retrieval. Hum Reprod. 2007;22:548–57.
Marinakis G, Nikolaou D. What is the role of assisted reproduction technology in the management of age-related infertility? Hum Fertil (Camb). 2011;14:8–15.
La Marca A, Sunkara SK. Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: from theory to practice. Hum Reprod Update. 2014;20:124–40.
Nardo LG, Gelbaya TA, Wilkinson H, Roberts SA, Yates A, Pemberton P, et al. Circulating basal anti-müllerian hormone levels as predictor of ovarian response in women undergoing ovarian stimulation for in vitro fertilization. Fertil Steril. 2009;92:1586–93.
Gleicher N, Weghofer A, Barad DH. Anti-müllerian hormone (AMH) defines, independent of age, low versus good live-birth chances in women with severely diminished ovarian reserve. Fertil Steril. 2010;94:2824–7.
Brodin T, Hadziosmanovic N, Berglund L, Olovsson M, Holte J. Antimüllerian hormone levels are strongly associated with live-birth rates after assisted reproduction. J Clin Endocrinol Metab. 2013;98:1107–14.
Iliodromiti S, Kelsey TW, Wu O, Anderson RA, Nelson SM. The predictive accuracy of anti-müllerian hormone for live birth after assisted conception: a systematic review and meta-analysis of the literature. Hum Reprod Update. 2014;20:560–70.
Lukaszuk K, Kunicki M, Liss J, Bednarowska A, Jakiel G. Probability of live birth in women with extremely low anti-müllerian hormone concentrations. Reprod Biomed Online. 2014;28:64–9.
Kedem A, Haas J, Geva LL, Yerushalmi G, Gilboa Y, Kanety H, et al. Ongoing pregnancy rates in women with low and extremely low AMH levels. A multivariate analysis of 769 cycles. PLoS ONE. 2013;8:e81629.
Gianaroli L, Magli MC, Ferraretti AP, Fortini D, Tabanelli C, Gergolet M. Gonadal activity and chromosomal constitution of in vitro generated embryos. Mol Cell Endocrinol. 2000;161:111–6.
Wang JG, Douglas NC, Nakhuda GS, Choi JM, Park SJ, Thornton MH, et al. The association between anti-müllerian hormone and IVF pregnancy outcomes is influenced by age. Reprod Biomed Online. 2010;21:757–61.
van Loendersloot LL, van Wely M, Limpens J, Bossuyt PM, Repping S, van der Veen F. Predictive factors in in vitro fertilization (IVF): a systematic review and meta-analysis. Hum Reprod Update. 2010;16:577–89.
Lee RK, Wu FS, Lin MH, Lin SY, Hwu YM. The predictability of serum anti-müllerian level in IVF/ICSI outcomes for patients of advanced reproductive age. Reprod Biol Endocrinol. 2011;9:115.
Bhide P, Gudi A, Shah A, Timms P, Grayson K, Homburg R. Anti-müllerian hormone as a predictor of pregnancy following IVF. Reprod Biomed Online. 2013;26:247–52.
Brodin T, Hadziosmanovic N, Berglund L, Olovsson M, Holte J. Comparing four ovarian reserve markers—associations with ovarian response and live births after assisted reproduction. Acta Obstet Gynecol Scand. 2015;94:1056–63.
Honnma H, Baba T, Sasaki M, Hashiba Y, Oguri H, Fukunaga T, et al. Different ovarian response by age in an anti-müllerian hormone-matched group undergoing in vitro fertilization. J Assist Reprod Genet. 2012;29:117–25.
Casadei L, Manicuti C, Puca F, Madrigale A, Emidi E, Piccione E. Can anti-müllerian hormone be predictive of spontaneous onset of pregnancy in women with unexplained infertility? J Obstet Gynaecol. 2013;33:857–61.
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Capsule: Women with very low (<0.5 ng/ml) AMH levels undergoing IVF have an increased risk of cycle cancellation, and their prognosis is significantly affected by chronological age.
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Revelli, A., Biasoni, V., Gennarelli, G. et al. IVF results in patients with very low serum AMH are significantly affected by chronological age. J Assist Reprod Genet 33, 603–609 (2016). https://doi.org/10.1007/s10815-016-0675-7
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DOI: https://doi.org/10.1007/s10815-016-0675-7