To the Editor:
We read with great interest the paper “Antimüllerian hormone in gonadotropin releasing-hormone antagonist cycles: prediction of ovarian response and cumulative treatment outcome in good-prognosis patients” (1) by Arce et al. In that paper the authors make a secondary analysis of the MEGASET study, concluding that antimüllerian hormone (AMH) can predict oocyte yield, categories of ovarian response, and live birth from IVF, and that AMH was associated with these outcomes, irrespective of the type of gonadotropin used. Moreover, as Nelson pointed out in the same issue of the journal (2), in Arce and colleagues’ analysis it was observed that the antral follicle count (AFC) was not associated with any of these outcomes.
There are two aspects that we would like to comment on. First, as already mentioned by Nelson, previous studies have observed that AMH and AFC were essentially equivalent in ovarian response prediction. We recently analyzed our population of oocyte donors (3) that presented similar inclusion criteria to that of the study by Arce (1): normal ovarian reserve (OR) by AFC and basal follicle-stimulating hormone (FSH). In this population treated with antagonists, AMH levels (analyzed by the Gen 2 ELISA) correlated significantly with the number of metaphase II oocytes (MII) retrieved. The AMH cutoff to predict a retrieval <6 MII was 2.31 ng/ml. AMH showed a mild capacity to discriminate poor response (AUC 0.675). We carried out a multiple regression analysis including age, AFC, and FSH in order to obtain a poor ovarian response prediction model and the AUC was 0.668 (95 % CI 0.540-0.796); if AMH was added to the model, the AUC was 0.713 (95% CI 0.596-0.830), slightly improving the prediction capacity. According to our results, measuring AMH is not an advantage for those reproductive medicine centers with easy access to AFC and FSH. In Arce’s paper, blood samples were analyzed at a central laboratory, whereas the AFC was performed at each investigational site by different observers, and a sonographer-dependent variability has been suggested. Read the rest of this entry »