Basal serum anti-Mullerian hormone (AMH) is a promising test in prediction of occurrence of pregnancy rate in infertile women undergoing ICSI cycles.

BACKGROUND

The aim of this study was to evaluate the predictive value of basal serum AMH for prediction of quality of the embryos, and pregnancy rate in infertile patients undergoing intracytoplasmic sperm injection (ICSI) cycles.

METHODS

This prospective study included 110 patients. All were subjected to the following on the first 3 days of the cycle prior to starting induction program; full history taken, systematic and local pelvic examination, routine investigations such as CBC, liver and kidney function tests, transvaginal ultrasound scan to assess the uterus, ovaries and to exclude any pelvic pathology. Venous blood samples were taken for quantitative FSH and AMH on day 3 of the cycle. All samples were centrifuged within 2 hours after withdrawal and serum was stored at -70°C until time of assay. A standard long step-down protocol was used for controlled ovarian hyperstimulation. Embryo transfer of maximum three good embryos was done on day three after oocyte retrieval using the Cook catheter. Vaginal progesterone pessaries (Cyclogest 400 mg twice daily) were used to support the luteal phase until the day of β-hCG assay.

RESULTS

Patients were classified according to their response to controlled ovarian hyperstimulation into 2 main groups; good responders group (group 1) including 75 patients (68.2%) and poor responders group (group 2) including 35 patients (31.8%). There were statistically significant differences between good and poor responding groups as regards age, types of infertility, duration and causes of infertility, BMI, and serum levels of AMH. There were statistically significant differences between good and poor responding groups regarding duration of stimulation, number of HMG ampoules, number of eggs retrieved, number of metaphase II eggs, fertilization rate, quality of the embryos, and both chemical and clinical pregnancy rate. Serum AMH level at a cut-off value of 2.8 μg/L is more sensitive, specific, and predictive of the good quality of the embryos and occurrence of either chemical or clinical pregnancy.

CONCLUSIONS

Simple measuring of the basal serum AMH level represents an ideal promising test in prediction of ovarian reserve, good quality of retrieved eggs and fertilized embryos, and, for the first time to our knowledge, in prediction of occurrence of pregnancy rate.