Evaluation of anti-Müllerian hormone as a test for the prediction of ovarian reserve

Objective

To compare in an integral way the value of the basal serum anti-Müllerian hormone (AMH) level with most of the established ovarian reserve tests.

Design

Prospective randomized controlled trial.

Setting

Fertility center of a university hospital in the Netherlands.

Patient(s)

One hundred ten patients undergoing their first IVF cycle who were randomized, by a computer-designed four-block system, into two groups.

Intervention(s)

Fifty-six patients underwent a clomiphene citrate challenge test (CCCT), and 54 patients underwent an exogenous FSH ovarian reserve test (EFORT). In all patients, basal AMH, basal FSH, basal inhibin B, antral follicle count (AFC), and basal volume of the ovaries were measured. In all patients, the test was followed by a standard IVF treatment.

Main Outcome Measure(s)

Ovarian response after ovarian hyperstimulation in an IVF treatment, expressed as the total number of stimulated follicles, retrieved oocytes, and ongoing pregnancies.

Result(s)

The best prediction of ovarian reserve (Y) was seen in a multiple regression prediction model that simultaneously included AFC, inhibin B increment in the EFORT, and basal volume of the ovaries. Univariate logistic regression showed that the best predictors for poor response were AMH, the CCCT, basal FSH, and the AFC. For hyperresponse, univariate logistic regression showed that the best predictor was AFC. Multiple logistic regression analysis did not produce a better model in terms of improving the prediction of poor response or hyperresponse. The best predictors for the prediction of non-pregnancy were the CCCT and the E₂ increment in the EFORT.

Conclusion(s)

Anti-Müllerian hormone is comparable with other commonly used ovarian reserve tests but is probably most applicable in general practice.

Key Words: AMH, basal FSH, basal inhibin B, CCCT, EFORT, IVF, ovarian reserve