P-581 Live birth rates in women under 38 years old with AMH level &lt; 1.2 ng/ml in in-vitro fertilization/intracytoplasmic sperm injection: arguments for care
Authors: Merviel P , Beauvillard D , Pertuisel D , Boue'e S , James P , Drapier H 
Published: June 2022

Abstract

Study question
To evaluate the clinical pregnancy and live birth rates in the first IVF/ICSI cycle in women under 38 years old with AMH level &lt; 1.2 ng/ml.

Summary answer
Our findings argue to propose IVF for those patients.

What is known already
Many studies failed to show a predictive impact of AMH levels on the chances of pregnancy, however acceptable pregnancy rates for young women with low AMH levels were observed in IVF/ICSI. The definition of early ovarian failure is based on two classifications, Bologna and Poseidon, where an AMH level of 1.2 ng/ml appears to be the threshold for determining ovarian failure. According to La Marca's curve, this level of 1.2 ng/ml corresponds to an ovarian reserve of a 38 year-old woman.

Study design, size, duration
The primary objective of this study was to compare the live birth rates between these three groups of women. The secondary objective was to compare the rate of positive βhCG level, clinical pregnancy rate and live birth rate in women under 38 years of age during the 1st cycle of IVF+/-ICSI, regardless of whether the AMH is &lt; 1.2 ng/ml or ≥ 1.2 ng/ml.

Participants/materials, setting, methods
We analyzed the first cycle of IVF/ICSI in women under 38 years old with AMH level &lt; 1.2 ng/ml under long GnRH agonist or GnRH antagonist protocols. We classified the women into three groups: group A: AMH &lt; 0.4 ng/ml; group B: AMH: 0.4 to 0.8 ng/ml; group C: AMH &gt; 0.8 ng/ml.

Main results and the role of chance
Between January 2017 and September 2020, we retained 227 cycles for analysis (group A: 50 cycles, B: 85 cycles and C: 92 cycles). No significant difference was found between the three groups for clinical pregnancy and live birth rates, either per stimulation cycle, oocyte puncture or embryo transfer. Thus, the birth rates per embryo transfer are 23.5% in group A, 25.4% in group B and 28.1% in group C. When we compared the two groups of women under 38 years of age during the 1st cycle of IVF+/-ICSI, according to AMH levels &lt; 1.2 ng/ml (n: 227) or ≥ 1.2 ng/ml (n: 325), the only significant difference was the positive βhCG level rate per oocyte puncture (p &lt; 0.01). Biochemical pregnancy rates were significantly different in women with AMH &lt; 1.2 ng/ml (40.8%) compared to those with AMH ≥ 1.2 ng/ml (16.6%; p &lt; 0.01), but the rate of first trimester miscarriage was identical in both groups (14.6% and 6.1% respectively).

Limitations, reasons for caution
Our retrospective study and the small sample size limited the level of scientific proof. The woman and male ages were significantly different between the AMH groups, but these data lead to reduce the impact of low AMHs on pregnancy rates.

Wider implications of the findings
The young age of the women (&lt; 38 y.o) reassures about the oocyte quality, but a low level of AMH may raise concerns about a lower quantitative oocyte yield, leading to accelerated management of the couple in IVF/ICSI.

Trial registration number
B2020CE.43