Although the efficacy of anti-Müllerian hormone (AMH) as a marker in IVF cycles has been established in various studies, there is insufficient evidence about its usefulness in oocyte donors. Now, a study has reported that AMH assessment in oocyte donors has the potential to ascertain the gonadotropin sensitivity and reduce/prevent the occurrence of ovarian hyperstimulation syndrome (OHSS). The findings, indicating the benefits of testing AMH for individualizing stimulation protocols, have been published in the online issue of the journal, Reproductive BioMedicine Online.

Gary S Nakhuda and colleagues from the Columbia University College of Physicians and Surgeons, Center for Women’s Reproductive Care, New York, compared IVF outcomes and analyzed the levels of AMH in 104 anonymous oocyte donors, aged between 21 and 32 years. The scientists correlated AMH concentrations with the following parameters:
• Number of retrieved oocytes (P=0.024)
• Need for reducing gonadotropin dose to avert ovarian hyperstimulation syndrome (P=0.007)
• Peak estradiol levels (P=0.024)

Using receiver operating curve analysis, the researchers identified an AMH threshold that helped to predict the need for lowering gonadotropin dosing with a sensitivity and specificity of 70%. It was also noted that the AMH levels of the donors were not associated with clinical pregnancy rates of the recipients (77% per recipient). The researchers concluded that AMH testing helps to customize the stimulation protocol by assessing the gonadotropin sensitivity.

Similarly, Riggs et al, in an earlier study, reported the association between AMH and the total number of mature oocytes retrieved and peak levels of estradiol, thereby suggesting the potential of the hormone as a predictor in fertile subjects. The findings that were presented at the 24^th Annual Meeting of the ESHRE are touted to provide the first evidence of AMH use in fertile population, and also its indication for screening oocyte donors.

Earlier studies have investigated the role of AMH as a marker of ovarian reserve and dysfunction in ART cycles. In one such review, Visser et al (Reproduction, 2006) suggested various probable uses of AMH measurement:
• Initial follicle recruitment and dominant follicle selection
• Marker for ovarian aging, responsiveness, and pathophysiology
• Diagnosis of polycystic ovary syndrome

Many potential benefits of AMH assessment have been suggested in ART cycles including the increased understanding of the ovarian pathophysiology and the directing of clinical management of various conditions. However, in a recent review, La Marca et al, on behalf of ESHRE Special Interest Group for Reproductive Endocrinology – AMH Round Table, emphasized that vital questions on the basic AMH physiology and its clinical applications need to be addressed.

References

1. Nakhuda G, Douglas N, Thornton M, Guarnaccia M, Lobo R, Sauer M. Anti-Müllerian hormone testing is useful for individualization of stimulation protocols in oocyte donors. RBM Online. January 2010;20(1) 42-47.

2. Riggs R, Bocca S, Yin L, et al. Anti-mullerian hormone serum levels predict response to controlled ovarian hyperstimulation in oocyte donors. Paper presented at: 24^th Annual Meeting of the European Society of Human Reproduction and Embryology;July 7-9, 2008;Barcelona, Spain.

3. Visser JA, de Jong FH, Laven JS, Themmen AP. Anti-Müllerian hormone: a new marker for ovarian function. Reproduction. 2006 Jan;131(1):1-9.

4. La Marca A, Broekmans FJ, Volpe A, Fauser BC, Macklon NS; ESHRE Special Interest Group for Reproductive Endocrinology–AMH Round Table. Anti-Mullerian hormone (AMH): what do we still need to know? Hum Reprod. 2009 Sep;24(9):2264-75.