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. 2016 Jun 10;14(1):172.
doi: 10.1186/s12967-016-0924-7.

Definition by FSH, AMH and embryo numbers of good-, intermediate- and poor-prognosis patients suggests previously unknown IVF outcome-determining factor associated with AMH

Norbert Gleicher  1   2   3 , Vitaly A Kushnir  4   5 , Aritro Sen  4   6 , Sarah K Darmon  4 , Andrea Weghofer  4   7 , Yan-Guang Wu  4 , Qi Wang  4 , Lin Zhang  4 , David F Albertini  4   8 , David H Barad  4   9   10
Affiliations

Definition by FSH, AMH and embryo numbers of good-, intermediate- and poor-prognosis patients suggests previously unknown IVF outcome-determining factor associated with AMH

Norbert Gleicher et al. J Transl Med. .

Abstract

Background: Though outcome models have been proposed previously, it is unknown whether cutoffs in clinical pregnancy and live birth rates at all ages are able to classify in vitro fertilization (IVF) patients into good-, intermediate- and poor prognosis.

Methods: We here in 3 infertile patient cohorts, involving 1247, 1514 and 632 women, built logistic regression models based on 3 functional ovarian reserve (FOR) parameters, including (1) number of good quality embryos, (2) follicle stimulating hormone (FSH, mIU/mL) and (3) anti-Müllerian hormone (AMH, ng/mL), determining whether clinical pregnancy and live birth rates can discriminate between good, intermediate and poor prognosis patients.

Results: All models, indeed, allowed at all ages for separation by prognosis, though cut offs changed with age. In the embryo model, increasing embryo production resulted in linear improvement of IVF outcomes despite transfer of similar embryo numbers; in the FSH model outcomes and FSH levels related inversely, while the association of AMH followed a bell-shaped polynomial pattern, demonstrating "best" outcomes at mid-ranges. All 3 models demonstrated increasingly poor outcomes with advancing ages, though "best" AMH even above age 43 was still associated with unexpectedly good pregnancy and delivery outcomes. Excessively high AMH, in contrast, was at all ages associated with spiking miscarriage rates.

Conclusions: At varying peripheral serum concentrations, AMH, thus, demonstrates hithero unknown and contradictory effects on IVF outcomes, deserving at different concentrations investigation as a potential therapeutic agent, with pregnancy-supporting and pregnancy-interrupting properties.

Keywords: Anti-Müllerian hormone (AMH); Embryo number; Follicle stimulating hormone (FSH); In vitro fertilization (IVF); Live birth rates; Prediction models; Prognosis.

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Figures

Fig. 1
Fig. 1
Age-specific model of pregnancies and live births based on good quality embryos produced per cycle. a, b reflect clinical pregnancy rates; c, d reflect live birth rates; In (a) and (c), blue background denotes good-prognosis, white denoted intermediate- and yellow poor-prognosis
Fig. 2
Fig. 2
Age-specific model of pregnancies and live births based on FSH levels (in mIU/nL). a, b Reflect clinical pregnancy rates; c, d reflect live birth rates; In (a) and (c) blue background denotes good-prognosis, white background intermediate- and yellow background poor-prognosis
Fig. 3
Fig. 3
Age-specific model of pregnancies and deliveries based on AMH levels (in ng/ml). a, b Reflect clinical pregnancy rates; c, d reflect live birth rates; In (a) and (c) blue background denotes good prognosis, white average- and yellow poor-prognosis patients
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