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The predictive value of anti-Müllerian hormone for natural conception leading to live birth in subfertile couples

Published:November 28, 2021DOI:https://doi.org/10.1016/j.rbmo.2021.11.018

      Abstract

      Research question

      What is the predictive value of serum anti-Müllerian hormone (AMH) level for natural conception and its clinical effect on subfertile couples?

      Design

      A retrospective cohort of ovulatory women seeking fertility consultation in a private fertility clinic. Couples who had an immediate indication for IVF were excluded. All natural conceptions leading to live birth before the start of assisted reproductive technology were followed within 12 months of the initial consultation. A prediction model was developed by updating the Hunault model with serum AMH to predict the probabilities of achieving a natural conception leading to live birth.

      Results

      A total of 325 couples were included in the final analysis. The estimated cumulative proability of achieving natural conception leading to live birth within 12 months was 20.9% (95% CI 12.9% to 28.2%). The categorical net reclassification improvement of AMH is 7.6%. For couples with a predicted chance of natural conception changed from poor (<30%) by the reference model to good (≥30%) by the updated model, the cumulative natural conception rate leading to live birth was 52.0%. For couples who had predicted chance of natural conception changed from good to poor by the updated model, the rate was 18.9%.

      Conclusions

      The addition of serum AMH to the routine fertility work-up may improve prognosis-based treatment policy and help to prevent unnecessary costs and stress for couples. Prospective validation of the updated model with AMH is required before clinical application.

      KEYWORDS

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      Biography

      Ben Mol is Professor of Obstetrics and Gynaecology at Monash University, Victoria, Australia. He studied medicine at the University of Amsterdam and trained as a gynaecologist at the University Medical Centre in Utrecht (1997–2003). He is involved in multi-centric evaluative research in obstetrics, gynaecology and fertility.
      Key message
      Serum anti-Müllerian hormone can be used in infertility work-up in combination with other predictors to improve the prediction of natural conception for subfertile couples. This may improve prognosis-based treatment selection. Prospective validation of the updated model with anti-Müllerian hormone is required before clinical application.