Hum. Reprod. Advance Access originally published online on January 10, 2009
Human Reproduction 2009 24(4):867-875; doi:10.1093/humrep/den480
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Anti-Müllerian hormone-based approach to controlled ovarian stimulation for assisted conception
1 Section of Reproductive and Maternal Medicine, Faculty of Medicine, University of Glasgow, 10 Alexandra Parade, Glasgow G31 2ER, UK 2 Assisted Conception Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, UK 3 Glasgow Centre for Reproductive Medicine, 21 Fifty Pitches Way Cardonald Business Park, Glasgow G51 4FD, UK
4 Correspondence address. Tel: +44 141 891 8749; Fax: +44 141 883 4886; E-mail: Richard.Fleming{at}gcrm.co.uk
BACKGROUND: Individualization of controlled ovarian stimulation (COS) for assisted conception is complicated by variable ovarian response to follicle stimulating hormone. We hypothesized that anti-Müllerian hormone (AMH), a predictor of oocyte yield, may facilitate treatment strategies for women undergoing COS, to optimize safety and clinical pregnancy rates.
METHODS: Prospective cohort study of 538 patients in two centres with differential COS strategies based on a centralized AMH measurement.
RESULTS: AMH was associated with oocyte yield after ovarian stimulation in both centres, and a ‘reduced’ AMH (1 to <5 pmol/l) was associated with a reduced clinical pregnancy rate. Women with a ‘normal’ AMH (5 to <15 pmol/l) treated with a long GnRH-agonist protocol (both centres) showed a low incidence of excess response (0%) and poor response (0%). In women with ‘high’ AMH (>15 pmol/l), the antagonist protocol eliminated the need for complete cryopreservation of embryos due to excess response (P < 0.001) and showed a higher fresh cycle clinical pregnancy rate than agonist cycles [OR 4.40 (95% CI 1.95–9.93), P < 0.001].
CONCLUSIONS: The use of circulating AMH to individualize treatment strategies for COS may result in reduced clinical risk, optimized treatment burden and maintained pregnancy rates, and is worthy of prospective randomized examination.
Key words: anti-Müllerian hormone/GNRH AG/ANTAG/ovarian stimulation
Submitted on October 8, 2008; resubmitted on November 25, 2008; accepted on December 3, 2008.
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