Anti-Mullerian hormone as marker for poor response to ovarian stimulation

Individualised protocols of controlled ovarian stimulation in assisted reproductive technologies (ART) based on the prediction of ovarian response, increase positive results, reduce the cycle cancelation risk and costs related to ineffective treatments. Recently it has been observed that anti-Mullerian hormone (AMH), a marker for ovarian reserve, is also a reliable index of ovarian response and therefore could be utilased to establish personalized treatments in ART. The aim of this study is to evaluate the usefulness of serum AMH levels as marker of ovarian response to stimulation. The study involved 145 women, who attended the clinical laboratory of Presidio Ospedaliero Macedonio Melloni in Milan (Italy), for a number of preliminary tests required by the fertility centre of the same hospital before undergoing ovarian stimulation. According to the obtained results, the AMH value correlates with the ovarian response better than age and follicle-stimulatin hormone (FSH) concentration. We also investigated the ability of AMH concentration in discriminating between poor and normal responsive patients. We compared the results with those obtained from age and other ovarian reserve markers; AMH showed a capacity to identify poor-responsive patients similar to the one showed by the antral follicle count and superior to those of age and FSH serum concentration. In conclusion, the determination of serum AMH to establish individualised ovarian stimulation protocols, could be recommended in order to reduce the cycle cancelation risk because of poor-response, to decrease costs and the psychological stress experienced by patients in case of failure of the procedure.