SALT LAKE CITY – Low serum levels of anti-Müllerian hormone predicted miscarriage after in vitro fertilization and embryo transfer, according to a single-center prospective study of more than 2,000 women.
This relationship remained statistically significant after the study controlled for age and response to controlled ovarian hyperstimulation, which suggests that AMH is a marker of the reproductive potential of oocytes, not just of oocyte quantity, Bruno Tarasconi, MD, said at the annual meeting of the American Society for Reproductive Medicine.
“Low” serum AMH was defined as less than 1.61 ng per mL, but specific levels vary by test type, so “this is not a definite cutoff,” Dr. Tarasconi emphasized. “What we need to know is that patients with low AMH are probably experiencing some problems in the ovary that affect oocyte quality.”
The study comprised 2,365 women undergoing 2,688 IVF cycles with fresh oocytes. Levels of AMH were measured by ELISA (AMH Gen II, Beckman Coulter) within 12 months before IVF on cycle days 2 and 4, said Dr. Tarasconi of University of Paris Ouest in France.
Women younger than 34 years old, women 34-36 years old, and women 37 years and older had the highest rates of miscarriage when they had low serum AMH levels. For the two older age groups, low AMH was associated with about a 33% miscarriage rate – about twice the rate of miscarriage among women whose AMH measured at least 5.6 ng per mL. This difference reached statistical significance for both age groups (P less than .05).
Among women younger than 34 years, low serum AMH was associated with a 22% rate of miscarriage, compared with about 13% among women with higher AMH levels. This difference did not reach significance because of a lack of power, Dr. Tarasconi said. “However, binary logistic regression of the whole population confirmed the association between low serum AMH and miscarriage, independent of patient’s age and oocyte yield, with the P value less than .001.”
Low circulating AMH can reflect an above-average prevalence of oocyte abnormalities, which are linked to miscarriage, Dr. Tarasconi noted. “The fact that oocyte yield failed to alter the relationship between AMH and miscarriage suggests that altered per-follicle AMH production, not oocyte or embryo availability, fosters pregnancy loss,” he added. However, the researchers did not test either preimplantation embryos or the expelled gestational sacs to directly link miscarriages to abnormalities such as aneuploidy, he noted.
Low AMH levels also were associated with lower rates of pregnancy after IVF, regardless of age, as has been previously reported. Patients in the study were of normal karyotype, with no history of recurrent pregnancy loss, uterine abnormalities, or family history of genetic or congenital disorders, Dr. Tarasconi noted.
He reported having no financial disclosures.