Antimullerian hormone (AMH) level and IVF/ICSI cycle outcome in expected poor responders

Abstract

Objective: to study AMH level effect on IVF/ICSI cycle outcome in expected poor responders undergoing ART. Design: retrospective cohort study. Setting: IVF unit at king Abdulaziz medical city, Riyadh, KSA. Materials and methods: 258 patients expected to be poor responders according to Bolonga criteria (aged >37or previous poor ovarian response or patients with decreased ovarian reserve) had their serum AMH level obtained and underwent IVF/ICSI cycles between April 2013 to April 2015. Outcome: pregnancy and cancellation rates. Results: patients were divided into three groups according to their AMH level, 60 Patients with AMH level ≤2.8, 98 patients with AMH level 2.9-14.9, and 100 patients with AMH level >15 pmol/l. Patients with lowest AMH had lowest AFC, highest FSH, and lowest number of previous delivery. Lowest AMH patients had lowest number of oocytes collected (p < .0001), lowest pregnancy rate (p = .001), and highest cancellation rate (p < .001).The receiver operating characteristic (ROC) curve analysis was used to establish the cut-off value for serum AMH level in predicting cancellation of ART cycle. It revealed a cutoff point of 2.8 pmol/L with sensitivity of 85% and specificity of 45% (DeLong SE = 0.04: CI 0.58-0.75). ROC of AMH level and pregnancy prediction showed a cut off point of 16.2 pmol/L with sensitivity 54% and specificity of 66% (DeLong SE = 0.04: CI 0.53-0.69). Conclusion: Low AMH level in expected poor responders in ART cycles had lower pregnancy rate and higher cancellation rate. Keywords: Anti mullerian hormone (AMH), Intra cytoplasmic sperm injection (ICSI), Assisted reproductive technology (ART), In vitro fertilization (IVF), Pregnancy rate