Significance of serum AMH and antral follicle count discrepancy for the prediction of ovarian stimulation response in Poseidon criteria patients.

Purpose To determine the risk of not being a poor responder in ovarian stimulation (OS) for in vitro fertilization (IVF) when ovarian reserve markers are discordant—one falling within Poseidon’s criteria normal range (e.g., anti-Müllerian hormone (AMH) ≥ 1.2 ng/mL or antral follicle count (AFC) ≥ 5), and the other in the poor ovarian reserve range.

A tri-center retrospective cohort study (2015–2017) involving women with discordant AMH and AFC values undergoing their first IVF/ICSI cycle using conventional OS (cOS, ≥ 150 IU/day of follicle-stimulating hormone). Discordant serum AMH and AFC values were defined according to Poseidon’s criteria (AMH < 1.2 ng/mL and AFC ≥ 5 or AMH ≥ 1.2 ng/mL and AFC < 5). Poor ovarian response (POR) was < 4 retrieved oocytes. Receiver operating characteristic (ROC) curves were used to determine AMH and AFC cut-offs for non-POR. Logistic regression analysis evaluated factors associated with non-POR.

Out of 8797 patients who underwent assessment with both AMH and AFC, 1172 (13.3%) exhibited discordant values. Of these, 854 (72.9%) had ≥ 4 oocytes retrieved. Within this group, 726 (85.0%) had “low” AMH values, whereas 128 (15.0%) had “low” AFCs. An AFC of 6 had 77% sensitivity and 52% specificity (AUC = 0.700), while AMH of 1.19 ng/mL had 31% sensitivity and 85% specificity (AUC = 0.492) for non-POR. AFC and the use of recombinant gonadotropins were positive predictors of non-POR.

When serum AMH is < 1.19 ng/mL, but AFC is ≥ 6, there is a moderate likelihood of a non-POR during stimulation. Conversely, if AFC is < 5 but serum AMH is ≥ 1.19 ng/mL, the chances of non-POR are low. Among patients with discordant markers, AFC emerges as the primary predictor of oocyte yield. Similar content being viewed by others Data availability All data supporting the findings of this study are available within the paper.

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The study received ethical approval from the institutions’ ethics committees: Instituto Investiga, Brazil (CAAE 26429219.0.0000.5599); Hacettepe University, Turkey (KA-180070); and My Duc Hospital, Vietnam (05/18/DD-BVMD). Informed consent Informed consent was waived due to the retrospective design of the study. Competing interests MHD received unrestricted research grants from Merck Serono and Ferring. HY declares receipt of payment for lectures from Merck and Ferring. LNV receives speaker fees and conferences from Merck, Merck Sharp and Dohme (MSD), and Ferring and research grants from MSD and Ferring. SCE declares receipt of unrestricted research grants from Merck and lecture fees from Merck and MedEA. AH has no conflict of interest to declare. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Hochberg, A., Dahan, M.H., Yarali, H. et al. Significance of serum AMH and antral follicle count discrepancy for the prediction of ovarian stimulation response in Poseidon criteria patients. J Assist Reprod Genet 41, 717–726 (2024). https://doi.org/10.1007/s10815-024-03050-8 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s10815-024-03050-8