Live birth chances in women with extremely low-serum anti-Mullerian hormone levels

BACKGROUND: To determine whether women with extremely low-serum anti-Mullerian hormone (AMH) levels (<0.1-0.4 ng/ml) still demonstrate live birth potential with assisted reproduction and whether such potential is age dependent. METHODS: Between January 2006 and October 2009, 128 consecutive infertility patients with AMH <= 0.4 ng/ml were retrospectively evaluated for pregnancy chances and live birth rates after IVF. RESULTS: Patients presented at a mean (+/- SD) age of 40.8 +/- 4.1 years, with mean (+/- SD) baseline FSH of 15.7 +/- 11.1 mIU/ml and mean (+/- SD) AMH of 0.2 +/- 0.1 ng/ml. One hundred and twenty-eight women underwent a total of 254 IVF cycles. Twenty clinical pregnancies were recorded (7.9% per cycle start [95% confidence interval (CI): 4.9-11.9%]; 15.6% cumulative [CI: 9.8-23.1%]). These pregnancies resulted in 13 live births in 12 women (i.e. 11 singletons and a pair of twins) and 8 patients miscarried. Eight deliveries occurred after the first cycle (6.3% per cycle start) and four after subsequent IVF cycles (3.2%). When evaluated according to female age, 70 women <= 42 years presented with 16 clinical pregnancies that resulted in 10 deliveries (14.3%), while 58 patients >42 years presented with four clinical pregnancies that resulted in 2 deliveries (3.4%), representing a reduced pregnancy chance (P = 0.013) and delivery rate (P = 0.036) versus age <= 42 years. CONCLUSIONS: With extremely low-serum AMH levels, moderate, but reasonable pregnancy and live birth rates are still possible. Extremely low AMH levels do not seem to represent an appropriate marker for withholding fertility treatment.