Pregnancy prognosis in women with anti-Mullerian hormone below the tenth percentile

Although serum anti-Mullerian hormone (AMH) is considered a good predictor of ovarian response during in vitro fertilisation (IVF), pregnancies have been reported with low values, questioning its usefulness as a predictor of treatment outcome. A retrospective study was therefore carried out to assess the IVF treatment outcomes in women with AMH below the tenth percentile of the study population. In all, 134 women with AMH <= 3 pmol/L underwent 180 IVF cycles. The mean age at the time of treatment was 37 +/- 5 years. Fifty-three (29.4%) cycles were abandoned because of poor response to gonadotrophins, 12 (6.7%) due to absence of eggs at oocyte retrieval and 18 (10%) due to fertilisation failure. Seven (3.8%) had a biochemical pregnancy, 4 (2.2%) had a missed miscarriage and 8 (4.4%) had a live birth. When stratified by age, women older than 42 years had less number of follicles (p<0.05) and those older than 39 years had less oocytes (p<0.01) compared to those 35 years and younger. Live births declined with increasing age, when age was assessed as a continuous variable (p=0.023). Women with low AMH levels have a high probability of treatment cancellation, failure to proceed to embryo transfer and a low chance of achieving a viable pregnancy.