The Significance of Low Anti-Mullerian Hormone Levels in Young Women Undergoing in Vitro Fertilization

OBJECTIVE: To determine if young women (aged <= 35 years) with low anti-Mullerian 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.