Researchers in a 2022 study compared IVF outcomes in women with low AMH and while there were differences in cancellation rates and number of eggs retrieved, there were no differences in clinical pregnancy or live birth rates.
Anti-Müllerian hormone (AMH) is a marker for ovarian reserve and low levels can predict a poor response to IVF treatment. Bologna and Poseidon criteria use 1.2 ng/ml as a cutoff for low AMH levels (Humaidan et al. 2016). It’s not clear what the IVF outcomes are for women with low or very low AMH.
Morcel et al. (2022), in their retrospective study, compared IVF outcomes for women with low AMH aged <38 doing their first IVF cycle between 2017 and 2021 at a single IVF center in France. Women had varying levels of AMH and were divided into three groups:
- <0.4 ng/ml (<2.9 pmol/l; 86 cycles)
- 0.4-0.8 ng/ml (2.9-5.7 pmol/l; 90 cycles)
- 0.8-1.2 ng/ml (5.7-8.8 pmol/l; 92 cycles)
The actual AMH levels were reported, and the averages were 0.2 ng/ml, 0.5 ng/ml and 1.0 ng/ml.
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Women with very low AMH had a higher cycle cancellation rate
Of the three groups, women with AMH <0.4 ng/ml had the highest rate of cancellation compared to the other two groups (52.3% vs 16.7% and 9.8%), and this was statistically significant. These were cancelations that occurred during ovarian stimulation, so presumably due to inadequate follicle recruitment.
There were also cancellations during the embryo culture stage, either as a result of no fertilization or no embryo cleavage. There were no differences among the groups (22.0%, 24.0% and 22.9%).
Worsened embryology outcomes with lower AMH
Women with AMH <0.8 ng/ml retrieved fewer eggs compared to the higher group (statistically significant).
There were no differences in fertilization rates between the groups (51.1%, 45.2% and 52.7%).
In this study, they only cultured embryos to day 2 or 3, as their policy is to transfer during the cleavage stage when there are <4 embryos obtained. Women with AMH <0.8 ng/ml had significantly fewer embryos that developed.
AMH levels have no impact on pregnancy outcomes
In this study they included women doing their first transfer, and all groups transferred about 1 embryo from day 2 or 3. When looking at the clinical pregnancy and live birth rates per transfer, there were no statistically significant differences between the groups.
A limitation of this study is the small number of transfers performed, particularly with the AMH <0.4 ng/ml group that had a high rate of cycle cancellations.
They also combined these groups as a single AMH <1.2 ng/ml group and compared live birth rates to another group with AMH ≥1.2 ng/ml. Although the low AMH group had a lower live birth rate (per transfer), this was not statistically significant (26.5% vs 34.4%).
Conclusions
In this study they found that women with the lowest AMH (<0.4 ng/ml) had the highest ovarian stimulation cancellation rate. Women with AMH <0.8 ng/ml had a lower number of retrieved eggs and day 3 embryos obtained. They found no differences in clinical pregnancy or live birth rates between the the three low AMH groups.
The main limitation of this study was its small sample size and that there were significant differences in age of women (34.7, 34.2 and 32.6) and men (35.6, 36.7 and 35.4) between the groups. A larger study is needed to confirm these results.
Reference
About Embryoman
Embryoman (Sean Lauber) is a former embryologist and the founder of Remembryo, an IVF research and fertility education website. After working in an IVF lab in the US, he returned to Canada and now focuses on making fertility research more accessible. He holds a Master’s in Immunology and launched Remembryo in 2018 to help patients and professionals make sense of IVF research. Sean shares weekly study updates on Facebook, Instagram, and Reddit regularly. He also answers questions on Reddit or in his private Facebook group.
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