Can anti-Müllerian hormone concentrations be used to determine gonadotrophin dose and treatment protocol for ovarian stimulation?

R. Fleming, Fj Broekmans, C. Calhaz-Jorge, L. Dracea, H. Alexander, Anders Nyboe Andersen, C. Blockeel, J. Jenkins, Bruno Lunenfeld, Peter Platteau, Johan Smitz, D. De Ziegler

Onderzoeksoutput: Articlepeer review

50 Citaten (Scopus)

Samenvatting

The ability to predict the response potential of women to ovarian stimulation may allow the development of individualized ovarian stimulation protocols. This tailored approach to ovarian stimulation could reduce the incidence of ovarian hyperstimulation syndrome in women predicted to have an excessive response to stimulation or could improve pregnancy outcomes in women classed as poor responders. Namely, variation of the type of gonadotrophin-releasing hormone (GnRH) analogue or the form and dosage of gonadotrophin used for stimulation could be adjusted according to an individual's response potential. The serum concentration of anti-Müllerian hormone (AMH) is established as a reliable marker of ovarian reserve, with decreasing concentrations correlated with reduced response potential. This review examines the current evidence evaluating individualized ovarian stimulation protocols using AMH concentration as a predictive marker of ovarian response. The rationale behind why specific treatment protocols based on individual response potential may be more suitable is also discussed. Based on current evidence, it appears that the use of AMH serum concentrations to predict ovarian response and optimize treatment strategies is a promising approach for improving pregnancy outcomes in women undergoing ovarian stimulation. However, prospective randomized controlled trials evaluating this approach are needed before any firm conclusions can be drawn. Optimizing treatment protocols for individual patients undergoing assisted reproduction treatment has been the focus of much research in recent years. Individual patients will respond differently to stimulation of the ovaries with gonadotrophins such as recombinant FSH or human menopausal gonadotrophin, meaning that certain treatments could be more appropriate for specific patients. Being able to predict how women will respond to treatment with gonadotrophins could allow clinicians to make appropriate dose adjustments or vary the type of gonadotrophin-releasing hormone (GnRH) analogue used. For example, women classed as excessive responders may benefit from milder forms of ovarian stimulation, which could prevent the incidence of ovarian hyperstimulation syndrome (OHSS) and the need to cancel treatment due to the risk of developing this condition. Alternatively, in poor responders, higher doses of gonadotrophins may improve pregnancy outcomes. The concentration of anti-Müllerian hormone (AMH) circulating in the blood is a good indicator of how women will respond to ovarian stimulation with gonadotrophins. There is now evidence to suggest that using the AMH concentration to optimize individual treatment protocols could be an effective approach to improve both pregnancy and safety outcomes for women undergoing ovarian stimulation. However more clinical trials are needed to fully evaluate this individualized approach to ovarian stimulation in larger numbers of patients.
Originele taal-2English
Pagina's (van-tot)431-439
Aantal pagina's9
TijdschriftReproductive BioMedicine Online
Volume26
StatusPublished - 2013

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