How safe and effective is anti-Mullerian hormone-based ovarian stimulation?

This study investigated if anti-Mullerian hormone (AMH) measuring is useful in controlled ovarian stimulation (COS). 

They found that pregnancy rates with AMH-COS were similar to standard COS (sCOS).

Controlled ovarian stimulation (COS) is the first step in assisted reproduction (AR). COS is performed to retrieve eggs. Drugs are used to stimulate the growth of ovarian follicles (OFs). OFs mature and release oocytes (eggs). Oocytes can then be harvested for in vitro fertilization (IVF).

It is important to determine how well a woman will respond to COS. Overstimulation can lead to ovarian hyperstimulation syndrome (OHSS). This is a life-threatening complication of COS. There are two methods of determining the ovarian response. The standard method uses the antral follicle count (AFC). This represents the number of matured follicles. Another method uses anti-Mullerian hormone (AMH) levels. AMH indicates how many oocytes are in the ovaries. Some studies suggest AMH is a better predictor of ovarian response. Using AMH may also reduce the risk of OHSS. Most of these studies had low patient numbers. It is unclear if AMH-based COS (AMH-COS) is safe and effective compared to standard COS (sCOS).

This study included 4 clinical reports of COS. The authors analyzed data from these studies to determine the outcomes. 2052 patients were included in the analysis. The primary outcomes measured were ongoing pregnancy rate (OPR) and OHSS rates. 

OPR was similar in patients that underwent AMH-COS and sCOS. There was no difference in OHSS rates between the groups. Lower doses of follicle stimulating hormone (FSH) were administed in AMH-COS. AMH-COS protocol was shorter in duration. 

The authors concluded that pregnancy rates with AMH-COS were similar to sCOS.

The number of patients in this analysis was low. This means that it is difficult to detect meaningful differences between the groups. Larger controlled studies are needed.