Gonadotropin Dose in Young IVF Population With Low Anti-müllerian Hormone Level: A SART Data Study [23A]. (May 2020) - Sarkar, Papri
Abstract : INTRODUCTION: One of the most common causes of infertility is diminished ovarian reserve (DOR). AMH plays a role in determining ovarian reserve and levels <1.05 ng/mL is associated with DOR. Young IVF population even with DOR have modest clinical outcome, however information on the stimulation regimen is limited. The aim of this study was to evaluate the gonadotropin dose required in young IVF patients with low AMH to achieve optimal clinical response. METHODS: A retrospective cohort study based on SART database between 2012–2016. The study population included 23, 001 fresh autologous IVF cycles in women <35 years old with AMH level <1.05 ng/mL. Based on AMH level, women were stratified into 3 groups: low (<1.05–0.4 ng/mL), very low (<0.4–0.16 ng/mL) and ultralow (<0.16 ng/mL). Student t-test was used to compare continuous variables and chi-squared test to compare clinical outcomes. RESULTS: The mean age was 32.4±2.4 and BMI was 25±5.9. Women with ultralow AMH had lowest number of oocytes retrieved (5.2±0.4), followed by very low (6.1±0.1) and low AMH group (9.4± 0.07), P <.001. The total gonadotropin dose required was less in the low AMH group (4, 086±13.9 IU) than very low (4, 446.5±28.3 IU) and ultralow (4, 319.34±66.6 IU) AMH groups ( P <.001). Live birth rate was significantly higher in the low AMH (4, 735/16, 290; 29.1%), followed by very low (1, 131/5, 375; 21%) and ultralow AMH (159/1, 336; 11.9%) groups. CONCLUSION: AMH is an independent predictor of live birth during IVF and can be used as a guide to estimate gonadotropin dose in young IVF population with DOR to optimize ovarian stimulation and response.