August 23rd, 2019

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The Significance of Low Anti-Müllerian Hormone Levels in Young Women Undergoing in Vitro Fertilization
Authors:  Caitlin Haswell, M.D., Estil Strawn, Jr., M.D., Aniko Szabo, Ph.D., Joseph Davis, D.O., and Kate D. Schoyer, M.D.
  OBJECTIVE: To determine if young women (aged ≤35 years) with low anti-Müllerian hormone (AMH) levels undergoing their first in vitro fertilization (IVF) cycle have lower pregnancy rates as compared to young women with normal AMH levels.

STUDY DESIGN: Retrospective cohort study.

RESULTS: Thirty-two women with an AMH <1 ng/mL and 130 with an AMH ≥1 ng/mL met study criteria. Patients with AMH <1 ng/mL had higher average FSH levels (8.1 mIU/mL vs. 6.5 mIU/mL) and were slightly older (31.6 vs. 30.4 years). Both groups had comparable numbers of embryos transferred (AMH <1, 1.5±0.6 vs. AMH ≥1, 1.3±0.5). Clinical pregnancy rates per embryo transfer were higher in women with AMH ≥1 ng/mL (47.6% vs. 21.9%). A sensitivity analysis demonstrated lower clinical pregnancy rates in those with AMH <1 ng/mL when excluding those patients with abnormal day 2 FSH or estradiol.

CONCLUSION: AMH levels <1 ng/mL in women ≤35 years old appear to predict lower clinical pregnancy rates in women undergoing IVF, even in the setting of normal day 2-3 ovarian reserve testing. Providers may consider transferring 2 embryos in women ≤35 years with low AMH values. AMH may be used as a sole measure of ovarian reserve in young women if significantly low.
Keywords:  anti-Mullerian hormone, antimullerian hormone, assisted reproductive techniques, assisted reproductive technologies, diminished ovarian reserve, in vitro fertilization
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