P-684 Anti-müllerian hormone predictive value for cumulative pregnancy rate in non-infertile women following four intrauterine insemination with donor sperm
Authors: Gayete-Lafuente S , Moreno J  A , Sánchez-Álvarez J , Checa M  A , Espinos J  J 
Published: July 2024

Abstract

Study question
Are anti-Müllerian hormone (AMH) levels predictive of cumulative pregnancy rate in non-infertile women undergoing intrauterine insemination with donor sperm (ds-IUI)?

Summary answer
AMH has limited predictive value for clinical pregnancy after 4 cycles of ds-IUI in non-infertile women. Decreased AMH concentration does not necessarily reduce pregnancy rates.

What is known already
Physiologically, pregnancy rates decline due to oocyte quality deterioration upon advancing maternal age. AMH is a widely-used marker of ovarian reserve and follicular response but not an infertility test, despite being sometimes referred to as such. This misconception can lead to unnecessary complex ART treatments only based on low AMH. Indeed, the predictive value of AMH for natural conception and IUI remains uncertain and highly controversial in the literature.

Study design, size, duration
This multicenter prospective observational study evaluated the correlation between AMH levels and pregnancy rates in 182 non-infertile women undergoing ds-IUI. Participants were recruited from June 2020 to December 2022 from three centers: Hospital del Mar in Barcelona (Spain), Fertty Clinic in Barcelona (Spain) and Clinica de la Mujer in Viña del Mar (Chile).

Participants/materials, setting, methods
The study included women aged 25-39 years, normal BMI, regular periods, and without ovarian pathology or endometriosis, who were undergoing ds-IUI for severe oligoasthenoteratozoospermia, female partner, or single status. Baseline AMH and antral follicle count (AFC) by TVUS was registered. Reproductive outcomes were compared between women with AMH &gt;1.1 and AMH ≤1.1 ng/mL. The main outcome was the cumulative clinical pregnancy rate after up to 4 ds-IUIs in a 3-year frame.

Main results and the role of chance
Kaplan Meier’s analysis did not show cumulative pregnancy rate superiority in women with AMH &gt;1.1 ng/mL vs &lt; 1.1 ng/mL (log rank Mentel Cox 1,502; p-value 0.46; ROC curve analysis predictor for clinical pregnancy, AUC=0.586). AMH and AFC were found to be significantly correlated (Pearson’s coefficient r = 0.632, p-value &lt;0.001). Additionally, women who achieved pregnancy were found to be significantly younger (p-value &lt;0.05) versus women who did not. However, no differences in AMH levels were found between them (p-value 0.33).

Limitations, reasons for caution
Limitations of the study include interpretation of results in extreme concentrations of AMH, potential impact of polycystic ovary syndrome (PCOS) in women with high AMH values, lower representation of patients with low AMH levels, and variability in ovulation induction regimens prior to ds-IUI (exposure to different rFSH dosages).

Wider implications of the findings
AMH is not a reliable predictor for pregnancy in ds-IUI. Even women with extremely low AMH levels can achieve successful outcomes, which are associated with age. The results of this multicenter study support that low AMH should not be used as an exclusion criterion for non-infertile women seeking ds-IUI.

Trial registration number
IRB Protocol ID 2020/9445