Anti-Müllerian hormone-based approach to controlled ovarian stimulation for assisted conception

• Published in: Human reproduction (Oxford) Vol. 24; no. 4; pp. 867 - 875
• Main Authors: Nelson, Scott M., Yates, Robin W., Lyall, Helen, Jamieson, Maybeth, Traynor, Isabel, Gaudoin, Marco, Mitchell, Paul, Ambrose, Pat, Fleming, Richard
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-04-2009; Oxford Publishing Limited (England)
• Subjects: Adult; Anti-Mullerian Hormone - blood; anti-Müllerian hormone; Biological and medical sciences; Clinical Protocols; Cohort Studies; Female; Follicle Stimulating Hormone - administration & dosage; GNRH AG/ANTAG; Gonadotropin-Releasing Hormone - agonists; Gonadotropin-Releasing Hormone - antagonists & inhibitors; Gynecology. Andrology. Obstetrics; Humans; Infant, Newborn; Medical sciences; ovarian stimulation; Ovulation Induction - methods; Pregnancy; Pregnancy Outcome; Prospective Studies; GNRH AG/ANTAG; ovarian stimulation; anti-Müllerian hormone; Hypothalamic hormone; Antimüllerian hormone; Vertebrata; Mammalia; Ovarian stimulation; Gonadotropin RH; Assisted procreation; Hormone releasing factor
• ISSN: 0268-1161; 1460-2350
• DOI: 10.1093/humrep/den480

BACKGROUND Individualization of controlled ovarian stimulation (COS) for assisted conception is complicated by variable ovarian response to follicle stimulating hormone. We hypothesized that anti-Müllerian hormone (AMH), a predictor of oocyte yield, may facilitate treatment strategies for women undergoing COS, to optimize safety and clinical pregnancy rates. METHODS Prospective cohort study of 538 patients in two centres with differential COS strategies based on a centralized AMH measurement. RESULTS AMH was associated with oocyte yield after ovarian stimulation in both centres, and a ‘reduced’ AMH (1 to <5 pmol/l) was associated with a reduced clinical pregnancy rate. Women with a ‘normal’ AMH (5 to <15 pmol/l) treated with a long GnRH-agonist protocol (both centres) showed a low incidence of excess response (0%) and poor response (0%). In women with ‘high’ AMH (>15 pmol/l), the antagonist protocol eliminated the need for complete cryopreservation of embryos due to excess response (P < 0.001) and showed a higher fresh cycle clinical pregnancy rate than agonist cycles [OR 4.40 (95% CI 1.95–9.93), P < 0.001]. CONCLUSIONS The use of circulating AMH to individualize treatment strategies for COS may result in reduced clinical risk, optimized treatment burden and maintained pregnancy rates, and is worthy of prospective randomized examination.