AMH (Anti Mullerian Hormone) may be predictive for ovarian response in IVF

Researchers have determined cutoff levels at which anti-Mullerian hormone (AMH) predicts IVF success.

But they still suggest that AMH is used to support clinical decisions, with confirmation from a second-line antral follicle count, rather than being used alone.

Christian Gnoth (University of Cologne, Germany) and colleagues compared the predictive values of age, follicle-stimulating hormone (FSH), inhibin-B, and AMH levels for ovarian response in 316 women entering their first IVF cycle.

AMH levels alone at a calculated cutoff level of 1.26 ng/ml or below detected poor responders (≤ 4 oocytes) with a sensitivity of 97 percent, and there was a 98 percent correct prediction of normal response in controlled ovarian hyperstimulation if levels were above this threshold.

Age, FSH, and inhibin B alone or in combination were less precise.

The researchers note that there was aged-related heterogeneity between poor and normal responder groups, and so combing age with AMH levels improved the specificity for predicting a poor response from just 36 percent to 62 percent.

The sensitivity and prediction of normal response with AMH alone were much more robust and remained unchanged even if there was high age-related heterogeneity.

"AMH is suitable as a screening test," concludes the team, "and may replace FSH, which gains relevance only in the late reproductive phase."