Advertisement

Assessment of ovarian reserve with anti-Müllerian hormone: a comparison of the predictive value of anti-Müllerian hormone, follicle-stimulating hormone, inhibin B, and age

      Objective

      The objective of this study was to evaluate basal anti-Müllerian hormone as a marker for ovarian responsiveness to fertility treatment.

      Study Design

      Frozen basal menstrual cycle day 3 serum samples were evaluated retrospectively for anti-Müllerian hormone, inhibin B, and follicle-stimulating hormone levels in 123 in vitro fertilization cycles (93 patients) and compared with in vitro fertilization records.

      Results

      Anti-Müllerian hormone values correlated the best with the number of retrieved oocytes (r = 0.539; P < .001) relative to age (r = −0.323; P < .01), follicle-stimulating hormone (r = −0.317; P < .01), inhibin B (P > .05), luteinizing hormone (P > .05), and estradiol (r = −0.190; P < .05). Receiver operating characteristic curve analysis demonstrated that, for the prediction of <4 oocytes retrieved, anti-Müllerian hormone had the largest area under the curve (AUC = 0.81; P = .0001) relative to age (r = 0.74; P = .005), follicle-stimulating hormone (0.71; P = .02), inhibin B (0.66; P = .03), and estradiol (0.54; P > .05). Similarly, for the prediction of ≥15 retrieved oocytes, anti-Müllerian hormone had the largest area under the curve (0.80; P = .0001) relative to age (0.63; P = .02), follicle-stimulating hormone (0.64; P = .005), inhibin B (r = 0.57; P > .05), and estradiol (0.58; P > .05).

      Conclusion

      Anti-Müllerian hormone correlates better than age, follicle-stimulating hormone, luteinizing hormone, inhibin B, and estradiol with the number of retrieved oocytes. Receiver operating characteristic curves estimated that anti-Müllerian hormone accurately predicts ovarian responsiveness to controlled ovarian stimulation with high sensitivity and specificity.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Macklon N.S.
        • Stouffer R.L.
        • Giudice L.C.
        • Fauser B.C.
        The science behind 25 years of ovarian stimulation for in vitro fertilization.
        Endocr Rev. 2006; 27: 170-207
        • Faddy M.J.
        • Gosden R.G.
        • Gougeon A.
        • Richardson S.J.
        • Nelson J.F.
        Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause.
        Hum Reprod. 1992; 7: 1342-1346
        • McGee E.A.
        • Hsueh A.J.
        Initial and cyclic recruitment of ovarian follicles.
        Endocr Rev. 2000; 21: 200-214
        • te Velde E.R.
        • Pearson P.L.
        The variability of female reproductive ageing.
        Hum Reprod Update. 2002; 8: 141-154
        • Johnson N.P.
        • Bagrie E.M.
        • Coomarasamy A.
        • et al.
        Ovarian reserve tests for predicting fertility outcomes for assisted reproductive technology: the International Systematic Collaboration of Ovarian Reserve Evaluation protocol for a systematic review of ovarian reserve test accuracy.
        BJOG. 2006; 113: 1472-1480
        • Broekmans F.J.
        • Kwee J.
        • Hendriks D.J.
        • Mol B.W.
        • Lambalk C.B.
        A systematic review of tests predicting ovarian reserve and IVF outcome.
        Hum Reprod Update. 2006; 12: 685-718
        • Burger H.G.
        • Dudley E.C.
        • Hopper J.L.
        • et al.
        The endocrinology of the menopausal transition: a cross-sectional study of a population-based sample.
        J Clin Endocrinol Metab. 1995; 80: 3537-3545
        • Burger H.G.
        • Dudley E.C.
        • Hopper J.L.
        • et al.
        Prospectively measured levels of serum follicle-stimulating hormone, estradiol, and the dimeric inhibins during the menopausal transition in a population-based cohort of women.
        J Clin Endocrinol Metab. 1999; 84: 4025-4030
        • Hazout A.
        • Bouchard P.
        • Seifer D.B.
        • Aussage P.
        • Junca A.M.
        • Cohen-Bacrie P.
        Serum antiMüllerian hormone/Müllerian-inhibiting substance appears to be a more discriminatory marker of assisted reproductive technology outcome than follicle-stimulating hormone, inhibin B, or estradiol.
        Fertil Steril. 2004; 82: 1323-1329
        • Visser J.A.
        • de Jong F.H.
        • Laven J.S.
        • Themmen A.P.
        Anti-Müllerian hormone: a new marker for ovarian function.
        Reproduction. 2006; 131: 1-9
        • Durlinger A.L.
        • Visser J.A.
        • Themmen A.P.
        Regulation of ovarian function: the role of anti-Müllerian hormone.
        Reproduction. 2002; 124: 601-609
        • Durlinger A.L.
        • Gruijters M.J.
        • Kramer P.
        • et al.
        Anti-Müllerian hormone inhibits initiation of primordial follicle growth in the mouse ovary.
        Endocrinology. 2002; 143: 1076-1084
        • Nilsson E.
        • Rogers N.
        • Skinner M.K.
        Actions of anti-Mullerian hormone on the ovarian transcriptome to inhibit primordial to primary follicle transition.
        Reproduction. 2007; 134: 209-221
        • Weenen C.
        • Laven J.S.
        • Von Bergh A.R.
        • et al.
        Anti-Müllerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment.
        Mol Hum Reprod. 2004; 10: 77-83
        • Méduri G.
        • Massin N.
        • Guibourdenche J.
        • et al.
        Serum anti-Müllerian hormone expression in women with premature ovarian failure.
        Hum Reprod. 2007; 22: 117-123
        • Hehenkamp W.J.
        • Looman C.W.
        • Themmen A.P.
        • de Jong F.H.
        • Te Velde E.R.
        • Broekmans F.J.
        Anti-Müllerian hormone levels in the spontaneous menstrual cycle do not show substantial fluctuation.
        J Clin Endocrinol Metab. 2006; 91: 4057-4063
        • La Marca A.
        • Stabile G.
        • Artenisio A.C.
        • Volpe A.
        Serum anti-Mullerian hormone throughout the human menstrual cycle.
        Hum Reprod. 2006; 21: 3103-3107
        • Tsepelidis S.
        • Devreker F.
        • Demeestere I.
        • Flahaut A.
        • Gervy Ch
        • Englert Y.
        Stable serum levels of anti-Müllerian hormone during the menstrual cycle: a prospective study in normo-ovulatory women.
        Hum Reprod. 2007; 22: 1837-1840
        • La Marca A.
        • Giulini S.
        • Tirelli A.
        • et al.
        Anti-Müllerian hormone measurement on any day of the menstrual cycle strongly predicts ovarian response in assisted reproductive technology.
        Hum Reprod. 2007; 22: 766-771
        • La Marca A.
        • Malmusi S.
        • Giulini S.
        • et al.
        Anti-Müllerian hormone plasma levels in spontaneous menstrual cycle and during treatment with FSH to induce ovulation.
        Hum Reprod. 2004; 19: 2738-2741
        • Seifer D.B.
        • Maclaughlin D.T.
        Mullerian inhibiting substance is an ovarian growth factor of emerging clinical significance.
        Fertil Steril. 2007; 88: 539-546
        • La Marca A.
        • Giulini S.
        • Orvieto R.
        • De Leo V.
        • Volpe A.
        Anti-Müllerian hormone concentrations in maternal serum during pregnancy.
        Hum Reprod. 2005; 20: 1569-1572
        • Fanchin R.
        • Taieb J.
        • Lozano D.H.
        • Ducot B.
        • Frydman R.
        • Bouyer J.
        High reproducibility of serum anti-Mullerian hormone measurements suggests a multi-staged follicular secretion and strengthens its role in the assessment of ovarian follicular status.
        Hum Reprod. 2005; 20: 923-927
        • Pesce L.L.
        • Metz C.E.
        Reliable and computationally efficient maximum-likelihood estimation of “proper” binormal ROC curves.
        Acad Radiol. 2007; 14: 814-829
        • Metz C.E.
        • Herman B.A.
        • Shen J.H.
        Maximum likelihood estimation of receiver operating characteristic (ROC) curves from continuously-distributed data.
        Stat Med. 1998; 17: 1033-1053
      1. Labroc4.
        (Accessed December 2007)
        • Seifer D.B.
        • MacLaughlin D.T.
        • Christian B.P.
        • Feng B.
        • Shelden R.M.
        Early follicular serum mullerian-inhibiting substance levels are associated with ovarian response during assisted reproductive technology cycles.
        Fertil Steril. 2002; 77: 468-471
        • de Vet A.
        • Laven J.S.
        • de Jong F.H.
        • Themmen A.P.
        • Fauser B.C.
        Anti-Müllerian hormone serum levels: a putative marker for ovarian aging.
        Fertil Steril. 2002; 77: 357-362
        • van Rooij I.A.
        • Broekmans F.J.
        • te Velde E.R.
        • et al.
        Serum anti-Müllerian hormone levels: a novel measure of ovarian reserve.
        Hum Reprod. 2002; 17: 3065-3071
        • Tremellen K.P.
        • Kolo M.
        • Gilmore A.
        • Lekamge D.N.
        Anti-Mullerian hormone as a marker of ovarian reserve.
        Aust N Z J Obstet Gynaecol. 2005; 45: 20-24
        • Eldar-Geva T.
        • Ben-Chetrit A.
        • Spitz I.M.
        • et al.
        Dynamic assays of inhibin B, anti-Mullerian hormone and estradiol following FSH stimulation and ovarian ultrasonography as predictors of IVF outcome.
        Hum Reprod. 2005; 20: 3178-3183
        • Muttukrishna S.
        • McGarrigle H.
        • Wakim R.
        • Khadum I.
        • Ranieri D.M.
        • Serhal P.
        Antral follicle count, anti-Mullerian hormone and inhibin B: predictors of ovarian response in assisted reproductive technology?.
        BJOG. 2005; 112: 1384-1390
        • Nelson S.M.
        • Yates R.W.
        • Fleming R.
        Serum anti-Müllerian hormone and FSH: prediction of live birth and extremes of response in stimulated cycles-implications for individualization of therapy.
        Hum Reprod. 2007; 22: 2414-2421
        • Kwee J.
        • Schats R.
        • McDonnell J.
        • Themmen A.
        • de Jong F.
        • Lambalk C.
        Evaluation of anti-Müllerian hormone as a test for the prediction of ovarian reserve.
        Fertil Steril. 2007; (Epub ahead of print)
        • Peñarrubia J.
        • Fábregues F.
        • Manau D.
        • et al.
        Basal and stimulation day 5 anti-Mullerian hormone serum concentrations as predictors of ovarian response and pregnancy in assisted reproductive technology cycles stimulated with gonadotropin-releasing hormone agonist–gonadotropin treatment.
        Hum Reprod. 2005; 20: 915-922