Anti-Mullerian hormone as a predictor of ovarian response to controlled ovarian stimulation
Objectives: (i) To establish if anti-Mullerian hormone (AMH) can predict ovarian response better than chronological age and Follicle stimulating hormone (FSH) in IVF/ICSI cycles (ii) To establish cut off levels for AMH that would determine poor response. Study design: This was a prospective, observa...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2011-01-01
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| Series: | Current Medicine Research and Practice |
| Subjects: | |
| Online Access: | http://www.cmrpjournal.org/article.asp?issn=2352-0817;year=2011;volume=1;issue=3;spage=111;epage=117;aulast=Satwik |
| Summary: | Objectives: (i) To establish if anti-Mullerian hormone (AMH) can predict ovarian response better than chronological age and Follicle stimulating hormone (FSH) in IVF/ICSI cycles (ii) To establish cut off levels for AMH that would determine poor response. Study design: This was a prospective, observational study conducted over a period of 13 months (October 2008 to October 2009) at Sir Ganga Ram Hospital, a tertiary referral centre in New Delhi. Methods: All women who enrolled for IVF/intracytoplasmic sperm injection (ICSI) cycles irrespective of their age, indication for IVF or stimulation regimes were included. Baseline pelvic scan; day 2/3 FSH, luteinizing hormone (LH) and oestradiol estimations, AMH measurement on any random day of cycle, were obtained. The subjects underwent IVF according to long agonist or antagonist protocol regimen. The primary outcome measure was the number of oocytes aspirated. Three categories of ovarian response were defined. Poor response: oocyte recovery (OCR) of <3. Average response: oocyte recovery of 4 to 15. Hyper- response: oocyte recovery of >15. Ovarian response was correlated with studied variables. Results: Of the 198 patients enrolled in the study, poor, average and hyper-response to superovulation in IVF-ICSI cycles was observed in 23%, 63% and 14%, respectively. The correlation coefficient for AMH with ovarian response was r=0.591. The areas under the curve (AUCs) for poor response for AMH, subject’s age and FSH were 0.768, 0.624 and 0.635, respectively. The discriminatory levels of AMH for prediction of absolute poor response were 2 pmol/L with a specificity of 98% and sensitivity of 20%. Conclusions: AMH fares better than FSH and age in predicting overall ovarian response and poor response though it cannot be an absolute predictor of non-responder status. Levels of 2 pmol/L are discriminatory for poor response. |
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| ISSN: | 2352-0817 2352-0825 |