There has long been a desire in IVF treatment to reduce the amount of medication used while maintaining excellent success rates. A study at Bourn Hall Clinic Norwich has shown that this can be achieved by tailoring treatment according to levels of Anti-Mullerian Hormone (AMH).
Lead author Dr Athanasios (Thanos) Papathanasiou, Lead Clinician at Bourn-Hall Clinic Norwich, says the results are very interesting: “The study has shown that personalising IVF according to AMH levels – as we do at Bourn Hall – may improve live birth rates and minimise drug consumption, resulting in friendlier and more cost-effective IVF.”
AMH is considered one of the gold-standard ovarian reserve tests. It can provide an indication of the woman’s egg store – and therefore an indication of her fertility – and response to ovarian stimulation.
AMH testing has been gradually introduced into Bourn Hall Clinic Norwich over a two-year period. Over this time the medical team has been collating data to see if tailoring stimulation according to AMH levels has a beneficial impact on IVF outcomes.
The aim of controlled ovarian stimulation is to boost egg quantity without compromising egg quality and requires managing a fine balance between the pituitary gland-derived hormones, luteinizing hormone (LH) and follicle stimulating hormone (FSH).
The trial was non-randomised with a single blood test for AMH gradually introduced before the first treatment. The physician determined the choice of ovarian stimulation (rFSH dose, protocol used) based on female characteristics such as age, body weight and the AMH results if available.
The AMH and non-AMH groups were compared using regression analysis that was adjusted for age, BMI, cause of infertility and year of treatment.
Higher IVF success from use of AMH test
The aim of this study was to evaluate the benefit of AMH-based individualisation on performance within a typical IVF programme and the results showed that there are many benefits.
- AMH test can accurately predict the level of response to ovarian stimulation even during the first IVF cycle
- Higher live birth rate in the AMH group (36% vs. 30%)
- Fewer women had sub-optimal stimulation in AMH group
- More likely to have high-quality embryos available for cryopreservation
- Lower starting levels of rFSH were prescribed when AMH was available
- Less likely to choose antagonist protocol in AMH group (5% vs. 12%)
Dr Papathanasiou continues: “The results show that AMH-individualised ovarian stimulation can improve success of the IVF programme.
“In contrast with previous studies, where individualised stimulation promoted the use of the antagonist protocol for women at the low and high end of expected ovarian response, this is the first study to demonstrate the benefit of using low gonadotrophin starting doses.
“We think that the use of AMH to promote individualised ovarian stimulation warrants further study and application. Couples welcome personalised IVF treatment with less medication and there is also potential for reducing cost.”