Dynamic antimullerian hormone levels during controlled ovarian hyperstimulation predict in vitro fertilization response and pregnancy outcomes

The rate of antimullerian hormone decline during controlled ovarian hyperstimulation is associated with ovarian reserve, in vitro fertilization response, and clinical pregnancy, particularly in women older than 35 years of age.

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Authors

Aaron K. Styer, M.D., Audrey J. Gaskins, Sc.D., Paula C. Brady, M.D., Patrick M. Sluss, Ph.D., Jorge E. Chavarro, M.D., Sc.M., Sc.D., Russ B. Hauser, M.D., M.P.H., Sc.D., Thomas L. Toth, M.D.

Volume 104, Issue 5, Pages 1153-1161

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.

Design:

Prospective cohort study.

Setting:

Academic medical center.

Patient(s):

113 consecutive fresh IVF embryo transfer cycles from September 1, 2012 through January 1, 2013.

Intervention(s):

Serial serum AMH measurements were analyzed on each day that serum estradiol (E2) was drawn during COH.

Main Outcome Measure(s):

Relationship among the rate of COH AMH change [Δ ng/mL per day] (stratified into tertiles), ovarian response, and pregnancy outcomes.

Result(s):

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).

Conclusion(s):

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.

Read the full text at: http://www.fertstert.org/article/S0015-0282(15)01673-8/fulltext


Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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