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Randomized Controlled Trial
. 2012 Jun;27(6):1829-39.
doi: 10.1093/humrep/des101. Epub 2012 Apr 3.

The value of anti-Mullerian hormone measurement in the long GnRH agonist protocol: association with ovarian response and gonadotrophin-dose adjustments

Ellen Anckaert  1 , Johan Smitz, Johan Schiettecatte, Bjarke M Klein, Joan-Carles Arce
Affiliations
Randomized Controlled Trial

The value of anti-Mullerian hormone measurement in the long GnRH agonist protocol: association with ovarian response and gonadotrophin-dose adjustments

Ellen Anckaert et al. Hum Reprod. 2012 Jun.

Abstract

Background: This study evaluated the predictive value of serum and follicular fluid (FF) concentrations of anti-Müllerian hormone (AMH) with respect to treatment outcome variables in an IVF cycle.

Methods: A retrospective analysis was performed with data from 731 normogonadotrophic women undergoing controlled ovarian stimulation after stimulation with highly purified menotrophin (HP-hMG) or rFSH following a long GnRH agonist protocol.

Results: In both treatment groups, the serum AMH concentration at the start of the stimulation was significantly (P < 0.001) positively correlated with the serum levels of estradiol (HP-hMG: r = 0.45; rFSH: r = 0.55), androstenedione (HP-hMG: r = 0.50; rFSH: 0.49) and total testosterone (HP-hMG: r = 0.40; rFSH: r = 0.36) at the end of the stimulation as well as the number of oocytes retrieved (HP-hMG: r = 0.48; rFSH: r = 0.62), the AMH concentration in FF (HP-hMG: r = 0.55; rFSH: 0.61) and the serum progesterone concentration (HP-hMG: r = 0.39; rFSH: r = 0.50) at oocyte retrieval. For both treatments, serum AMH at the start of the stimulation was a good predictor of the need to increase or decrease the gonadotrophin dose on stimulation day 6 and of ovarian response below (<7 oocytes) or above (>15 oocytes) the target. No significant relationships were observed between serum AMH and embryo quality or ongoing pregnancy.

Conclusion: The serum AMH concentration at the start of the stimulation in IVF patients down-regulated with GnRH agonist in the long protocol revealed a positive relationship with ovarian response to gonadotrophins in terms of oocytes retrieved and accompanying endocrine response. AMH is a good predictor of the need for gonadotrophin-dose adjustment on stimulation day 6 for patients with a fixed starting dose, but a poor predictor of embryo quality and pregnancy chances in individual patients.

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Figures

Figure 1
Figure 1
ROC curve analysis showing the predictive value of serum AMH at the start of the stimulation for the estimation of number of oocytes at retrieval below (<7) (A) and above (>15) the target (B) after COS in patients treated with HP-hMG or rFSH in the long GnRH agonist protocol. The diagonal line is the reference line of no discrimination (AUC = 0.5). Cut-off values for response below the target were 21.2 pmol/l for HP-hMG (sens. 66.7%, spec. 75.2%) and 16.4 pmol/l for rFSH (sens. 81.0%, spec. 88.3%). The cut-off values for response above the target were 29.8 pmol/l for HP-hMG (sens. 73.3%, spec. 67.0%) and 29.5 pmol/l for rFSH (sens. 82.5%, spec. 70.4%).
Figure 2
Figure 2
ROC curve analysis showing the predictive value of serum AMH at the start of the stimulation for the need for a gonadotrophin-dose increase (A) or decrease (B) on stimulation day 6 in patients treated with HP-hMG or rFSH in the long GnRH agonist protocol. All patients had received starting doses of 225 IU/day for the first 5 days. The diagonal line is the reference line of no discrimination (AUC = 0.5). Cut-off values for increased dose were 23.0 pmol/l for HP-hMG (sens. 67.8%, spec. 67.1%) and 21.4 pmol/l for rFSH (sens. 74.6%, spec. 73.6%). The cut-off values for decreased dose were 32.4 pmol/l for HP-hMG (sens. 70.8%, spec. 72.6%) and 37.4 pmol/l for rFSH (sens. 75.0%, spec. 80.7%).
Figure 3
Figure 3
ROC curve analysis showing the predictive value of serum AMH at the start of the stimulation for ongoing pregnancy in patients treated with HP-hMG or rFSH in the long agonist protocol. The diagonal line is the reference line of no discrimination (AUC = 0.5).
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