Endocrine Abstracts

Objective: To evaluate the clinical significance of AMH in predicting IVF outcomes among patients over age 40 undergoing the first IVF cycle.

Design and methods: This is a retrospective study. Patients aged 40 or older who underwent their first IVF cycle from January 2013 to September 2014 in CHA Gangnam fertility center were included (n=201). All patients received gonadotropin-releasing hormone (GnRH) antagonist protocol, with a starting dose of 75–225IU recombinant FSH. Serum samples were collected prior to IVF treatment. Serum AMH level and other patient characteristics were analyzed. The main outcome was total retrieved-oocyte number and clinical pregnancy.

Results: The mean age was 41.8±2.1 years and the mean AMH level was 0.35±0.17 ng/ml. The 76% (n=153) of patients was diagnosed as poor responders, fulfilling the Bologna criteria. There was a positive correlation between serum AMH levels and the number of oocytes retrieved (R²=0.123, P<0.0001). 30 out of 201 patients achieved clinical pregnancy (14.9%) and the receiver operating characteristic (ROC) curve analysis for prediction of clinical pregnancy showed that AMH had an area under the curve (AUC) of 0.64. Both day 3 serum FSH and BMI had lower accuracy (AUC 0.50 and 0.43, respectively) than AMH. Furthermore, the optimum cut-off level of AMH was 0.27 ng/ml (sensitivity 93.3%, specificity 42.0%, respectively).

Conclusion: Serum AMH concentration is a promising biomarker for the prediction of the number of total oocytes retrieved and the clinical pregnancy in old aged patients, at the time of their first IVF cycle with GnRH antagonist protocol. The cut-off level of 0.27 ng/ml AMH can be used to predict clinical pregnancy.