Anti-Mullerian hormone: correlation of early follicular, ovulatory and midluteal levels with ovarian response and cycle outcome in intracytoplasmic sperm injection patients

Objective: To measure serum anti-Mullerian hormone (AMH) during different phases of the menstrual cycle and to correlate the measurements with ovarian response and clinical-pregnancy rates in intracytoplasmic sperm injection cycles. Design: Prospective cohort study. Setting: University IVF unit. Patient(s): Thirty-three patients undergoing their first intracytoplasmic sperm injection treatment cycle with a long protocol. Intervention(s): On day 3 of the menstrual cycle, measurements of AMH, FSH, and LH and ultrasound evaluation of mean ovarian volume and antral follicle count were performed. Anti-Mullerian hormone was remeasured at ovulation and 7-8 days later (midluteal). Main Outcome Measure(s): Poor response and number of oocytes were primary outcomes. Clinical pregnancy was a secondary outcome. Result(S): Levels of AMH were lower in poor ovarian responders than in normal responders. Number of oocytes retrieved was statistically significantly correlated with midluteal AMH, day 3 AMH, antral follicle count, ovulatory AMH, mean ovarian volume (r = 0.89, 0.88, 0.88, 0.86, 0.66, respectively) and with day 3 FSH (r = -0.41). Midluteal, day 3, and ovulatory AMH showed a good discriminatory potential for prediction of poor response (area under the receiver operating characteristics curves, 0.977, 0.9, and 0.89, respectively). Midluteal and early AMH were statistically significant predictors of clinical pregnancy. Conclusion(s): A strong association exists between midluteal, early follicular, ovulatory AMH levels and number of oocytes retrieved. Midluteal and early follicular AMH may offer good prognostic value for clinical pregnancy. (Fertil Steril (R) 2008;89:1670-6. (c) 2008 by American Society for Reproductive Medicine.).