Serum Anti-Mullerian Hormone Levels in Early Follicular Phase Can Predict Ovarian Reserve and Pregnancy Outcome in In-Vitro Fertilization Cycles

Objective: The aim of this study is to investigate whether anti-Mullerian hormone (AMH) levels and antral follicle count (AF) can be useful in predicting the ovarian reserve and pregnancy outcome in IVF cycles. Study Design: A prospective observational clinical study carried out at Kuwait Maternity Hospital, between March 2007 and December 2008. Patients and Methods: A total of 60 patients undergoing their first ICSI treatment cycle using a long protocol with GnRH agonist were included. Patients with an oocyte count 2:4 were considered good responders (group I) and those with 4 were considered as poor responders (group II). On day three of a spontaneous menstrual cycle. blood sample was taken from each patient for measurement of serum levels of AMH, FSH, LH, E2, and inhibin B. Thereafter, ovarian ultrasound scanning was performed to assess the number and size of antral follicles. Results: Parameters such as LH and E2 levels were not statistically different between the two groups. Whereas, the difference between serum AMH, FSH and inhibin B levels; AFC and retrieved oocyte counts were statistically significant in the two groups. The mean±SD serum anti- Mullerian hormone level was 33. 19±12.84 and 11.51 ±8.41 pmoliL in groups 1.11, respectively (p 0.001), the number of basal antral follicles was 9. 73±4. 10 versus 2.60±0.81 in normal and poor responders groups, respccti vely (p 0.001). Serum AMH levels were highly correlated with the number of antral follicles (r=0 77; p 0.01) and the number of oocytes retrieved (r=0.57; p 0.01). A negative association was found between AMH levels and poor ovarian response (fewer than 4 oocytes or cycle cancellation; OR 0.80, 95% CI 0.73-0.89 p 0.001). Inclusion of Inhibin Band FSH concentrations to AMH in a multivariate model improved the prediction of ovarian response. The number of chemical pregnancies was 8 (7%) versus 3 (30%), p=0.013 and the number of clinical pregnancies was 8 (89%) versus I (11%), p=0.011 in groups I and II, respectively. Conclusion: It appears that there is an association between the serum level of anti-Mullcrian hormone in early follicular phase and ovarian reserve. Poor response in IVF treatment cycles, indicative of a diminished ovarian reserve, is associated with reduced baseline serum AMH levels. Furthermore, a higher serum level of AMH on day three is associated with chemical pregnancy success. It appears that AMH can be used as a marker for ovarian ageing.