The authors suggest that AMH testing is useful for individualization of stimulation protocols in oocyte donors to maximize egg yields and to prevent OHSS.
This conclusion makes great sense to me. Our goal in all IVF cycles (infertile and egg donors alike) is to maximize the number of quality eggs retrieved without causing complications such as OHSS. The number of eggs is not the real goal, the number of quality eggs is the goal. We believe that quality eggs come from quality stimulations, which means that if we under or over-dose the eggs with gonadotropin stimulation then the egg quality will suffer.
Certainly the delivery rates are a critical outcome measure of the treatment but having excess embryos fro freezing is an important secondary goal. We will freeze more embryos when we have more quality eggs (regardless of the total egg number). When we can freeze excess embryos then patients are more likely to consider eSET (elective single embryo transfer) and we (IVF team) are more comfortable suggesting eSET.
Our patients have significant expense with donor eggs cycles and the opportunity to freeze makes it possible to have related siblings etc.
I believe that this study offers important suggestions for all our patients to improve outcomes and avoid complications.
AMH allows individualization of stimulation protocols in egg donors
Dr Gary Nakhuda1,4, Dr Nataki Douglas2, Dr Melvin Thornton3, Dr Michael Guarnaccia3, Dr Rogerio Lobo3, Dr Mark Sauer3
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While the age of a donor is a fundamental factor to the success of donor IVF, no serum markers have been demonstrated to be useful in predicting variability of ovarian response in individual donors. Anti-Müllerian hormone (AMH) has been described as an accurate marker of ovarian response in patients undergoing IVF, but has not been applied to oocyte donors. AMH concentrations from 104 anonymous oocyte donors between the ages of 21–32 years were studied and IVF outcome parameters compared. AMH was correlated with several parameters, including the number of oocytes retrieved (r = 0.232, P = 0.024), the peak oestradiol concentrations (r = 0.235, P = 0.024) and the need to decrease gonadotrophin dose in order to avoid ovarian hyperstimulation syndrome (r = 0.274, P = 0.007). Receiver operating curve analysis was able to identify an AMH threshold that rendered about 70% sensitivity and 70% specificity for predicting the need to decrease gonadotrophin dosing. The clinical pregnancy rate was 77% per recipient and was not related to the donors’ AMH concentrations. For oocyte donors, measurement of AMH appears most useful for determining gonadotrophin sensitivity in order to mitigate symptoms consistent with ovarian hyperstimulation.
1Columbia University College of Physicians & Surgeons Division of Reproductive Endocrinology & Infertility Center for Womens Reproductive Care 1790 Broadway New York, NY 10019
2 Columbia University College of Physicians & Surgeons
3 Columbia University College of Physicians & Surgeons
4 Correspondence: firstname.lastname@example.org
Reproductive BioMedicine Online 2009 http://www.rbmonline.com/Article/3993 [e-pub ahead of print on 4 November 2009].