With the fast-paced lifestyle nowadays, late marriage and late childbearing have become a common trend. With that, the quality and quantity of our oocytes are getting worse day by day. AMH(Anti-Müllerian hormone) can evaluate a female's ovarian function and reserve. It is secreted by granulosa cells in the early follicles stage, and the concentration in the blood is relatively stable, not affected by the menstrual cycle. Different from FSH (Follicle-stimulating hormone), which will vary with the menstrual cycle. 

In addition to being an indicator of ovarian reserve, AMH can also be used to predict the response to ovulation stimulation treatment, which can then be used to select the appropriate ovulation stimulation treatment according to the level of AMH. Thus it can help us to avoid OHSS(Ovarian hyperstimulation syndrome). A retrospective statistical analysis was conducted by the University of Manchester and St Mary's Hospital to compare the differences in clinical outcomes and medical costs between conventional age- and FSH-based stimulation and newer AMH-based stimulation.

Research design : 

1. Conventional treatment group: Review the treatment records of 346 cases from September 1, 2007 to September 31, 2008 and different ovulation stimulation methods were selected according to FSH values and age.

2. AMH treatment group: The research records of 423 cases from December 1, 2008 to December 31, 2009. Based on the average of AMH value in 3 months, choose the methods of stimulating ovulation accordingly. (Note: The commonly used AMH concentration unit for unit is [ng/ml], which is different from the concentration unit [pmol/l] in this article. The conversion formula is [pmol/l] = 7.14 x [ng/ml])

Figure 1. Ovulation stimulation protocol of conventional and AMH treatment groups

Results: 

1. The basic data of the study cohorts are shown in Table I. There were no significant differences in age and previous pregnancy history, except for male factor and unexplained reasons for difficult pregnancy and use of ICSI or standard IVF in the two groups.

Table I. Patient and treatment characteristics

2. The overall clinical outcomes are shown in Table II. Although the number of oocytes retrieved in the AMH group was less than that in the conventional group (10.6±6.9 vs 12.4±7.8), the cancellation rate of the AMH treatment course was lower (2.3% vs 6.9%). The implantation rate (87.5% vs 78.9%), pregnancy rate (27.7% vs 17.9%) and live birth rate (23.9% vs 15.9%) were all higher.

Table 2. Clinical outcomes

3. The difference in the cost of ovulation injections for different protocols is shown in Table 3. The AMH protocol can save about 317 EUR (29%) of the injection each time compared with the conventional protocol. If OHSS occurs afterward, the medical cost of subsequent is counted in, then AMH protocol can save about 371 EUR (31%) per cycle. (Note: One Euro is approximately equivalent to 38 NTD).

Table 3. The cost of ovulation injection for different protocols

Discussion

Personalized medicine is the future trend in medicine. More and more clinical and research evidence shows that a fixed treatment method is not suitable for every patient. In addition to better treatment results, personalized medicine can also reduce costs by avoiding inadequate or excessive medical practices and reducing complications in the treatment process. Using AMH as a foundation for stimulating ovulation may not be a perfect way, but at least it's a start, showing that the medical community is moving in a patient-friendly direction. I believe that with time, an injection, an oocyte, and a good blastocyst will bring a healthy baby.

Reference：

• Taiwanese Society for Reproductive Medicine Annual Meeting, August 25-26, 2012.

• A.P. Yates, et al. Anti-Müllerian hormone-tailored stimulation protocols improve outcomes whilst reducing adverse effects and costs of IVF. Hum. Reprod. (2011) 26(9): 2353-2362.