P-663 Serum anti-Müllerian hormone level to predict the chance of live birth after spontaneous or assisted conception: a systematic review and meta-analysis
Authors: Bernard V , Peigné M , Dijols L , Creux H , Robin G , Hocké C , Grynberg M , Dewailly D , Sonigo C 
Published: June 2023

Abstract

Study question
Is Serum anti-Müllerian hormone (AMH) level predictive of cumulative live birth (CLB) rate after assisted reproductive technologies (ART) or in women trying to conceive naturally?

Summary answer
Serum AMH level is linked to CLB after IVF/ICSI but data are lacking after intrauterine insemination (IUI) or in women trying to conceive without ART.

What is known already
Serum AMH level is a marker of ovarian reserve and a good predictor of ovarian response after controlled ovarian hyperstimulation. Literature is unclear whether its measurement can predict CLB in spontaneous or assisted conception.

Study design, size, duration
A systematic review and meta-analysis, following PRISMA guidelines, was undertaken to assess whether serum AMH level may predict chances of CLB in infertile women undergoing IVF/ICSI or IUI and/or chances of live birth in women having conceived naturally.

Participants/materials, setting, methods
A systematic review and meta-analysis was performed using the following keywords: “AMH”, “Anti-Müllerian Hormone”, “Live-Birth”, “Cumulative live birth”. Searches were conducted from January 2004 to May 2021 on PubMed and Embase. Two independent reviewers carried out study selection, quality assessment and bias assessment with QUIPS tool scale and data extraction. Odds ratio were estimated using random-effect model. Pre-specified sensitivity analyses and subgroup analyses were performed. The primary outcome was CLB.

Main results and the role of chance
A total of 32 studies were included in the meta-analysis. After IVF-ICSI, only 4 studies reported CLB rate according to AMH level. No statistically significant differences in mean serum AMH levels was shown between patients with and without CLB, but with a high heterogeneity [Difference in Means (95% CI) = 0.97 (-0.25;2.19) ng/mL; I² = 99%; p = 0.12; n = 4]. After exclusion of 2 studies with high risks of bias, there were no more heterogeneity [I²=0%] and the mean AMH level was statistically significantly higher in women with CLB [Difference in Means (95% CI)=0.86 (0.53;1.19) ng/mL; p &lt; 0.00001; n = 2]. Overall, 27 articles were included in the meta-analysis of the relationship between AMH and CLB or AMH and LB after IVF/ICSI. A non-linear positive relationship was found in both cases. A polynomial fraction was the best model to describe it but no discriminant AMH threshold was shown. There were not enough articles/data to assess the ability of AMH to predict CLB rate or find an AMH threshold after IUI or in women without history of infertility trying to conceive without ART.

Limitations, reasons for caution
Systematic review and meta-analysis have some limitations due to the limits and bias of the studies included. In the present meta-analysis, heterogeneity may have been caused by different baseline characteristics in study participants, different stimulating protocols for ART, different serum AMH level threshold used and various assays of serum AMH.

Wider implications of the findings
Serum AMH level is linked to CLB rate after IVF/ICSI but no discriminating threshold can be established. Data are lacking concerning its predictive value after IUI or in women trying to conceive without ART. Our findings may be helpful to counsel candidate couples to IVF-ICSI.

Trial registration number
not applicable