Anti-müllerian hormone as a predictor of IVF outcome

Human egg Investigators at Brown University have reported that the serum concentration of a hormone made by the ovaries can predict the success of in vitro fertilization (IVF). Specifically, the higher amounts of the hormone were correlated to a greater number of eggs retrieved and the probability of achieving pregnancy.

The study measured blood concentrations of anti-müllerian hormone, or AMH. This is a rather interesting hormone. It plays an important role in both males and females but at different stages of human development.

  • In fetal development, AMH is synthesized by the testes of a male fetus and it functions to suppress the transformation of the müllerian ducts into the uterus and fallopian tubes. In the absence of AMH (i.e. a female fetus), the wolffian ducts fail to develop into ejaculatory ducts of the male reproductive system while the müllerian ducts complete their development.
  • AMH is synthesized by the female ovary but only after birth when it does not affect the development or maturation of the female reproductive tract. It increases slightly at puberty because of it functions to regulate the formation of ovarian follicles (eggs) by opposing the action of another hormone, follicle-stimulating hormone (FSH).

Because of its role in follicle development, AMH can be useful as a marker of ovarian function. In particular it seems to be a good indicator of the growing pool of follicles in the ovary and so reflects the number of eggs in the ovary. That’s exactly what the scientists at Brown University reported.

In 190 women undergoing IVF to achieve pregnancy, the concentration of AMH in a blood sample collected on the first day of ovarian stimulation with FSH was a strong predictor of favorable outcome. Women with the lowest concentrations of AMH had fewer eggs retrieved than those with higher concentrations. Also, the probability of achieving pregnancy was 2.5 times greater in the women with the higher AMH concentrations.

What might these results mean from a practical perspective? The authors of the study comment that IVF patients could be better counseled and IVF management strategies modified by the AMH results. IVF is expensive. Women who seek to achieve a pregnancy by this route are highly motivated to obtain a positive outcome and so they may undergo several IVF cycles in an effort to become pregnant. Those with a low AMH concentration may opt for only a single IVF cycle or seek adoption or other routes of parenthood rather than invest thousands of dollars into what may be an unachievable biological goal.

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