Prediction of the lower serum anti-Müllerian hormone threshold for ovarian stimulation prior to in-vitro fertilization using the Elecsys® AMH assay: a prospective observational study.
Anti-Müllerian hormone (AMH)
In vitro fertilization (IVF)
Ovarian stimulation
Poor ovarian response
Receiver operating characteristics (ROC) curve analysis
Journal
Reproductive biology and endocrinology : RB&E
ISSN: 1477-7827
Titre abrégé: Reprod Biol Endocrinol
Pays: England
ID NLM: 101153627
Informations de publication
Date de publication:
11 Jan 2019
11 Jan 2019
Historique:
received:
12
10
2018
accepted:
03
01
2019
entrez:
13
1
2019
pubmed:
13
1
2019
medline:
29
1
2019
Statut:
epublish
Résumé
In assisted reproductive technology, prediction of treatment failure remains a great challenge. The development of more sensitive assays for measuring anti-Müllerian hormone (AMH) has allowed for the possibility to investigate if a lower threshold of AMH can be established predicting very limited or no response to maximal ovarian stimulation. A prospective observational multicenter study of 107 women, < 40 years of age with regular menstrual cycle and serum AMH levels ≤ 12 pmol/L, treated with 300 IU/day of HP-hMG in a GnRH-antagonist protocol. AMH was measured before treatment start using the Elecsys® AMH assay by Roche Diagnostics. The ability of AMH to predict follicular development and ovarian response was assessed by receiver operating characteristics (ROC). Furthermore, the relationship between AMH at start of stimulation and cycle outcome was investigated using multivariate logistic regression analysis. Five out of 107 cycles (4.7%) were cancelled due to lack of follicular development and 60/107 (56%) women did not reach the classical hCG criteria for ovulation induction (≥ 3 follicles of ≥17 mm). An AMH threshold of 4 pmol/L predicted failure to reach the classical hCG criteria with 89% specificity and 53% sensitivity and an area under the curve (AUC) of 0.76 (95% CI 0.66-0.85). AMH predicted cycle cancellation due to lack of follicular development, using a cut-off value of 1.5 pmol/L, with a specificity of 96% and sensitivity of 80% (AUC = 0.92, 95% CI 0.79-1.00). A single-unit increase in AMH was associated with a 29% decrease in odds of failure to reach the classical hCG criteria (OR 0.71 95% CI 0.59-0.85, p < 0.01). The lowest AMH value compatible with a live birth was 1.3 pmol/L. Among women with a limited ovarian reserve, pre-treatment serum AMH levels significantly predicted failure to reach the classical hCG triggering criteria and predicted lack of follicular development using a new sensitive assay, but AMH was not suitable for withholding fertility treatment, as even very low levels were associated with live births. Not relevant.
Sections du résumé
BACKGROUND
BACKGROUND
In assisted reproductive technology, prediction of treatment failure remains a great challenge. The development of more sensitive assays for measuring anti-Müllerian hormone (AMH) has allowed for the possibility to investigate if a lower threshold of AMH can be established predicting very limited or no response to maximal ovarian stimulation.
METHODS
METHODS
A prospective observational multicenter study of 107 women, < 40 years of age with regular menstrual cycle and serum AMH levels ≤ 12 pmol/L, treated with 300 IU/day of HP-hMG in a GnRH-antagonist protocol. AMH was measured before treatment start using the Elecsys® AMH assay by Roche Diagnostics. The ability of AMH to predict follicular development and ovarian response was assessed by receiver operating characteristics (ROC). Furthermore, the relationship between AMH at start of stimulation and cycle outcome was investigated using multivariate logistic regression analysis.
RESULTS
RESULTS
Five out of 107 cycles (4.7%) were cancelled due to lack of follicular development and 60/107 (56%) women did not reach the classical hCG criteria for ovulation induction (≥ 3 follicles of ≥17 mm). An AMH threshold of 4 pmol/L predicted failure to reach the classical hCG criteria with 89% specificity and 53% sensitivity and an area under the curve (AUC) of 0.76 (95% CI 0.66-0.85). AMH predicted cycle cancellation due to lack of follicular development, using a cut-off value of 1.5 pmol/L, with a specificity of 96% and sensitivity of 80% (AUC = 0.92, 95% CI 0.79-1.00). A single-unit increase in AMH was associated with a 29% decrease in odds of failure to reach the classical hCG criteria (OR 0.71 95% CI 0.59-0.85, p < 0.01). The lowest AMH value compatible with a live birth was 1.3 pmol/L.
CONCLUSIONS
CONCLUSIONS
Among women with a limited ovarian reserve, pre-treatment serum AMH levels significantly predicted failure to reach the classical hCG triggering criteria and predicted lack of follicular development using a new sensitive assay, but AMH was not suitable for withholding fertility treatment, as even very low levels were associated with live births.
TRIAL REGISTRATION
BACKGROUND
Not relevant.
Identifiants
pubmed: 30634990
doi: 10.1186/s12958-019-0452-4
pii: 10.1186/s12958-019-0452-4
pmc: PMC6330486
doi:
Substances chimiques
Anti-Mullerian Hormone
80497-65-0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
11Références
Mol Hum Reprod. 2004 Feb;10(2):77-83
pubmed: 14742691
Hum Reprod. 2006 Dec;21(12):3217-27
pubmed: 16873892
Ultrasound Obstet Gynecol. 2009 Apr;33(4):477-83
pubmed: 19212944
Fertil Steril. 2011 Jun;95(7):2369-72
pubmed: 21497340
Hum Reprod. 2011 Jul;26(7):1616-24
pubmed: 21505041
Hum Reprod. 2011 Jul;26(7):1768-74
pubmed: 21558332
Hum Reprod. 2011 Sep;26(9):2353-62
pubmed: 21672928
Fertil Steril. 2012 Mar;97(3):561-71
pubmed: 22244781
Hum Reprod. 2012 Oct;27(10):3085-91
pubmed: 22777530
Hum Reprod Update. 2013 Jan-Feb;19(1):26-36
pubmed: 23188168
J Clin Diagn Res. 2012 Dec;6(10):1636-9
pubmed: 23373017
Fertil Steril. 2013 May;99(6):1644-53
pubmed: 23394782
J Reprod Infertil. 2011 Oct;12(4):241-8
pubmed: 23926510
J Assist Reprod Genet. 2013 Oct;30(10):1361-5
pubmed: 23963620
Fertil Steril. 2014 Apr;101(4):1012-8.e1
pubmed: 24491452
Fertil Steril. 2014 Jun;101(6):1766-72.e1
pubmed: 24726216
Hum Reprod Update. 2015 Nov-Dec;21(6):698-710
pubmed: 25489055
Hum Reprod. 2015 Feb;30(2):432-40
pubmed: 25492411
Fertil Steril. 2015 Apr;103(4):1074-1080.e4
pubmed: 25681853
Fertil Steril. 2015 Sep;104(3):643-8
pubmed: 26158904
Fertil Steril. 2015 Dec;104(6):1435-41
pubmed: 26348275
Reprod Biol Endocrinol. 2015 Sep 22;13:107
pubmed: 26394617
Clin Biochem. 2016 Feb;49(3):260-7
pubmed: 26500002
Fertil Steril. 2016 Feb;105(2):385-93.e3
pubmed: 26515380
Fertil Steril. 2016 Dec;106(7):1800-1806
pubmed: 27692436
Fertil Steril. 2017 Feb;107(2):387-396.e4
pubmed: 27912901
Hum Reprod. 2017 Mar 1;32(3):544-555
pubmed: 28137754
Maturitas. 2017 Jul;101:12-16
pubmed: 28539163
Br J Obstet Gynaecol. 1997 May;104(5):521-7
pubmed: 9166190