Pretreatment antimüllerian hormone levels and outcomes of ovarian stimulation with gonadotropins/intrauterine insemination cycles
Article In Press
Published
Authors:
Stylianos Vagios, M.D., Jennifer Y. Hsu, M.D., Caitlin R. Sacha, M.D., Irene Dimitriadis, M.D., Georgios Christou, M.D., Kaitlyn E. James, Ph.D., Charles L. Bormann, Ph.D., Irene Souter, M.D.
Abstract:
Objective
To evaluate the association, if any, between serum antimüllerian hormone (AMH) levels and probability of clinical pregnancy and spontaneous abortion (SAB) in the infertility setting.
Design
Retrospective cohort study.
Setting
Academic fertility center.
Patient(s)
A total of 1,861 gonadotropin stimulation/intrauterine insemination cycles stratified by AMH levels into 3 groups: Low, <25th percentile (<0.7 ng/mL); Middle, ≥25th and <75th percentile (0.7–4.4 ng/mL); and High, ≥75th percentile (≥4.5 ng/mL).
Intervention(s)
Intrauterine insemination after stimulation with gonadotropins.
Main Outcome Measure(s)
Cumulative probability of clinical pregnancy over a maximum of 3 and/or 6 cycles and SAB incidence risk rate (IRR). The Kaplan-Meier failure function (log rank test), Cox proportional hazards models, and multilevel mixed-effects Poisson regression models were performed to compare outcomes among the AMH groups.
Result(s)
Overall, in both unadjusted and adjusted models, the probability of achieving a clinical pregnancy was higher in the Middle and High AMH groups compared with that in the Low AMH group, both over 3 (hazard ratios [95% confidence interval], 1.55 [1.05–2.29] and 1.85 [1.22–2.81], respectively) and 6 (1.71 [1.17–2.48] and 2.12 [1.42–3.16], respectively) cycles.
In the unadjusted models, the SAB IRR was higher among the Low AMH group (IRR [95% confidence interval], 2.17 (1.11–4.24]), with the relationship persisting after adjusting for age (1.83 [0.93–3.60]). When the SAB IRR were calculated separately for the subpopulations with and without polycystic ovary syndrome, a similar relationship was noted among the latter in the unadjusted (1.94 [0.97–3.88]) and adjusted (1.74 [0.86–3.49]) analyses.
Conclusion(s)
In women undergoing gonadotropin stimulation/intrauterine insemination, AMH appears to affect the probability of achieving a clinical pregnancy. A possible negative impact, independent of age, on the risk of SAB was also suggested.
