Serum anti-Mullerian hormone and FSH: prediction of live birth and extremes of response in stimulated cycles - implications for individualization of therapy

BACKGROUND: Serum concentrations of anti-Mullerian hormone (AMH) correlate with oocyte yield in assisted reproduction treatment (ART) cycles, however, performance of AMH for prediction of live birth is unknown. METHODS: A total of 340 first cycle IVF/ICSI patients (median age 34.0 years, inter-quartile range 31.0-37.0 years), had basal plasma AMH and FSH measured and their predictive values for live birth and oocyte yield compared. RESULTS: AMH predicts live birth [contribution to variance (CTV) 3.84%, P < 0.001] and oocyte yield (r = 0.71, P < 0.0001, CTV 7.3%, P < 0.0001). Compared with age and FSH, AMH performs better in prediction of live births [area under receiver operating characteristic curve (AUC) 0.62, 95% CI 0.55-0.68; FSH AUC 0.42, 95% CI 0.35-0.49; age AUC 0.48, 95% CI 0.41-0.55, P = 0.0028] and excessive response to ovarian stimulation (AMH AUC 0.90, 95% Cl 0.83-0.96; FSH AUC 0.32, 95% CI 0.23-0.40; age AUC 0.57, 95% CI 0.43-0.71, P < 0.001). AMH prediction of oocyte yield is independent of age (r = - 0.28, P < 0.0001, CTV 1.4%, P = 0.006), however, a significant negative interaction (CTV 3.6%, P < 0.0001) exists. AMH demonstrates improved differential distributions for non-, poor, normal and excessive ovarian responses relative to FSH and age. CONCLUSIONS: Plasma AMH is a superior predictor of live birth and anticipated oocyte yield compared with FSH and age, facilitating individualization of therapy prior to first ART cycle.