EC Gynaecology

This study examines the impact of low Anti-Müllerian Hormone (AMH) levels (< 1 ng/mL) on fertility outcomes in assisted reproductive technologies (ART). AMH, a key biomarker of ovarian reserve, is more reliable than other hormonal indicators due to its stability. Women with low AMH often experience diminished ovarian reserve (DOR), leading to reduced ovarian response, lower oocyte yield, and decreased pregnancy success rates. The study analyzes correlations between AMH levels, fertilization rates, and pregnancy outcomes to provide evidence-based recommendations for clinical practice in ART. A study of 71 women (ages 23 - 48, mean 35.7) with low AMH undergoing ART analyzed variables including egg count, fertilization, and embryo quality. The average number of eggs retrieved was 4.21, with a fertilization rate of 70%. AMH levels ranged from 0.05 to 0.99 ng/mL (mean 0.55). AMH is a key marker of ovarian reserve, moderately correlating with egg count and weakly with mature eggs. However, it lacks strong ties to fertilization or embryo quality. Future research should explore additional biomarkers for better fertility prediction.

 Keywords: AMH; Assisted Reproductive Techniques; Egg Counts; Fertilization Rate

1. Moolhuijsen LME and Visser JA. “Anti-Müllerian hormone and ovarian reserve: update on assessing ovarian function”. The Journal of Clinical Endocrinology and Metabolism11 (2020): 3361-3373.
2. Practice Committee of the American Society for Reproductive Medicine. “Testing and interpreting measures of ovarian reserve: a committee opinion”. Fertility and Sterility6 (2020): 1151-1157.
3. La Marca A and Sunkara SK. “Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: from theory to practice”. Human Reproduction Update1 (2014): 124-140.
4. Nelson SM., et al. “Serum anti-Müllerian hormone and FSH: prediction of live birth and extremes of response in stimulated cycles—implications for individualization of therapy”. Human Reproduction9 (2007): 2414-2421.
5. Sunkara SK., et al. “Polycystic ovary syndrome and the risk of spontaneous abortion following assisted conception: a systematic review and meta-analysis of observational studies”. Human Reproduction Update 2011 17.6 (2001): 761-771.
6. Tal R and Seifer DB. “Ovarian reserve testing: a user’s guide”. American Journal of Obstetrics and Gynecology2 (2017): 129-140.
7. Zhang A and Zhang J. “Serum levels of anti-Müllerian hormone influence pregnancy outcomes of patients undergoing in vitro fertilization/intracytoplasmic sperm injection treatment”. Scientific Reports1 (2023): 28724.
8. Morin SJ., et al. “Diminished ovarian reserve and poor response to stimulation in patients under 38 years old: a quantitative but not qualitative reduction in performance”. Human Reproduction8 (2018): 1489-1498.
9. Wang Y., et al. “Analysis of cumulative outcomes and influencing factors of patients with low anti-Müllerian hormone levels undergoing IVF/ICSI”. Frontiers in Endocrinology 14 (2023): 1098131.
10. Alberto Revelli., et al. “IVF results in patients with very low serum AMH are significantly affected by chronological age”. Journal of Assisted Reproduction and Genetics5 (2016): 603-609.
11. Smith A., et al. “Age-related change in AMH in women seeking fertility preservation”. Journal of In Vitro Fertilization2 (2023): 75-80.
12. Yavuz Emre Şükür., et al. “Inter-cycle variability of anti-Müllerian hormone in women undergoing fertility treatment”. Journal of Ovarian Research1 (2023): 209.
13. Al-Inany HG. “Gonadotrophin-releasing hormone antagonists for assisted reproductive technology”. The Cochrane Database of Systematic Reviews 4 (2016): CD001750.
14. López M., et al. “Oocyte quality and fertilization rate as predictors of successful IVF outcomes”. Reproductive Biology and Endocrinology 19 (2021): 51.
15. Sjöblom T., et al. “Embryo quality and its association with IVF success”. Human Reproduction6 (2022): 1245-1253.
16. Murphy M., et al. “Influence of ovarian reserve markers on gonadotropin requirements in IVF cycles”. Fertility and Sterility4 (2022): 763-770.
17. Kovacs P., et al. “Ovarian reserve markers and their correlation with ovarian response and incidence of ovarian hyperstimulation syndrome (OHSS) in ART cycles”. Journal of Ovarian Research 14 (2021): 33.
18. Andrew Garth. “Analysing data using SPSS (A practical guide for those unfortunate enough to have to actually do it)”. Sheffield Hallam University (2008).
19. “How to Perform a Kolmogorov-Smirnov Test in SPSS by Zach Bobbitt” (2024).
20. Spearman's Rank Order Correlation using SPSS Statistics - A How-To Statistical Guide by Laerd Statistics.
21. Raadina Health. “Diminished ovarian reserve: causes, symptoms, and treatment”. Retrieved March 7, 2025 (n.d.).
22. Van Rooij IA., et al. “Anti-Müllerian hormone: Correlation with age and follicle number in women undergoing IVF”. Human Reproduction8 (2002): 2004-2012.
23. Mayo Clinic. “In vitro fertilization (IVF)”. Retrieved March 7, 2025 (n.d.).
24. To Doctor. “Anti-Müllerian hormone (AMH) and fertility assessment”. Retrieved March 7, 2025 (n.d.).
25. Jones H and Smith D. “Anti-Müllerian hormone as a marker of ovarian reserve and reproductive outcomes: a systematic review”. Human Reproduction Update3 (2023): 417-434.
26. Seifer DB., et al. “Age-specific serum anti-Müllerian hormone values for 17,120 women presenting to fertility centers within the United States”. Fertility and Sterility2 (2011): 747-750.
27. La Marca A., et al. “Anti-Müllerian hormone (AMH) as a predictive marker in assisted reproduction”. Human Reproduction Update2 (2010): 113-130.
28. Broer SL., et al. “Anti-Müllerian hormone and ovarian reserve: implications for ART”. Human Reproduction Update2 (2011): 222-229.
29. Sunkara SK., et al. “Anti-Müllerian hormone as a predictor of ovarian response in assisted reproduction: A systematic review and meta-analysis”. Human Reproduction7 (2011): 1768-1777.
30. Tremellen K., et al. “The role of anti-Müllerian hormone in predicting oocyte quality and IVF outcomes”. Fertility and Sterility3 (2017): 759-764.
31. Fiedler K., et al. “Anti-Müllerian hormone levels as a predictor of ovarian response in assisted reproduction: A population-based study”. Human Reproduction6 (2019): 1142-1149.
32. La Marca A., et al. “Anti-Müllerian hormone as a predictor of ovarian response in assisted reproduction: A systematic review”. Reproductive Biomedicine Online3 (2011): 251-259.
33. Nelson SM and Yates AP. “The evolution of ovarian reserve biomarkers: Insights into clinical utility and limitations”. Best Practice and Research Clinical Obstetrics and Gynaecology 81 (2022): 56-67.
34. Martins WP and Nastri CO. “Anti-Müllerian hormone and its integration into the ART pathway: A critical update”. Fertility and Sterility2 (2023): 319-330.