Objectives. - In Assisted Reproductive Technologies (ART), impaired ovarian reserve represents a therapeutic challenge. The Anti-Mullerian Hormone (AMH) serum level would be a good marker of ovarian reserve and a predictor of response to stimulation. The objective of this study is to assess into a population of infertile couples where the woman has at least one patent tube and where the man has sperm parameters compatible with insemination, whether AMH level less than 12 pmol/L can be used to establish a strategy supporting the couple's infertility by comparing their chances of pregnancy after Intra-uterine insemination (IUD or in vitro fertilization (IVF). Materials and methods. - This single-center retrospective study of 1012 patients over 28 months compared the pregnancy rates of 2011 ART attempts (1385 IUI and 626 IVF, ICSI excluded) according to the value of serum AMH, either reduced if <= 12 prnol/L or non-reduced if greater. Results. - In IVF, a tow AMH reduced pregnancy rate (18.4% vs. 32.9% in the normal AMH group, P < 0.0001). Conversely, the AMH value did not influence the success in IUI cycles (14.2% vs. 14.5%, respectively, NS). In cases with low AMH, the pregnancy rate per initiated cycle in IVF (18.4%) was not significantly greater than in 1L11 cycles (14.2%). Converting an IVF attempt in 1U1 did not impair the pregnancy rate (13.5% vs. 14.5% after immediate IUI, NS). Conclusion. - When the serum AMH level is less than 12 pmol/L, ILA may be an interesting option in case of IVF failure. However, its place remains to be defined: converting IVF in IUI, IUI in relay of failed IVF, or even as first line therapy when the chances with IVF appear to be minimal. (C) 2014 Elsevier Masson SAS. All rights reserved.
