Low circulating anti-Mullerian hormone and normal follicle stimulating hormone levels: Which prognosis in an IVF program?

Objective. - To evaluate the results of controlled ovarian hyperstimulation (COH) for IVF in patients with low anti-Mullerian hormone (AMH) and normal basal follicle stimulating hormone (FSH) and Estradiol levels (<= 50 pg/mL). Patients and methods. - A retrospective cohort study including 704 patients for whom AMH and FSH levels (measured between days 3 and 5 of the menstrual cycle) were available, is performed in the IVF center at the Sevres Hospital (France). Three groups are designed and analyzed: group 1 with AMH less or equal to 2 ng/mL and FSH less or equal to 10 mUl/mL (study group), Group 2 with AMH greater than 2 ng/mL and FSH less or equal to 10 mUl/mL (control group) and Group 3 with AMH less or equal to 2 ng/mL and FSH greater than 10 mUl/mL (group with decreased ovarian reserve). Results. - IVF outcome for patients from the study group is significantly worse than that of the second but not than that of the third group. In the first group, the number of retrieved oocytes, the number of total obtained embryos, the clinical pregnancy rate and the live birth rate are significantly lower than in the second group; moreover, there are more cancelled cycles because of poor response in the first group. There is no difference with the third group. Discussion and conclusions. - This study shows that women with a low baseline AMH have a similar response to COH to the poor responders patients with a decreased ovarian reserve revealed by an elevated FSH level. Thus, when a woman undergoing IVF cycle presents a low AMH, she might be considered as a poor responder patient regardless of the FSH level and, although the clinical pregnancy rate is not so disappointing (18%), the couple should be informed of a higher risk of cycle cancellation. (c) 2012 Elsevier Masson SAS. All rights reserved.