AMH at Advanced Reproductive Age can Identify a Subset of Patients who have Comparable Iui and IVF Outcomes

Advanced reproductive age (ARA) is associated with decreased probability of pregnancy after IUI, IVF. AMH is a indicator of ovarian reserve. However, there is a variation in ovarian reserve among women of ARA. AMH represents ovary biological age, however, it was suggested that chronological age is more important. Studies reported that women above the age of 40 and low AMH levels have poor IVF outcome. It is unclear whether high AMH at ARA is correlated with better pregnancy outcomes and can predict IUI and IVF outcomes at ARA?

Design: Retrospective case series analysis from a single center.

Methods: AMH and pregnancy outcomes were available for 384 patients. 281 patients underwent 1163 IUI cycles and 93 patients underwent 145 IVF cycles. Clinical pregnancy rates were compared among different age groups and between different AMH levels among the age groups.

Results: Women over the age of 40 with a serum AMH level above 15 pmol ⁄L had 10.2% chance of achieving clinical pregnancy after IUI and 14.3% after IVF (p=0.54). In the same age group women with AMH level 8 to 15 pmol ⁄L had 4.76% for clinical pregnancy by IUI and 13.6% by IVF (p=0.042). Women over the age of 35 with AMH levels greater than 15 pmol ⁄L had 17.36% chance for clinical pregnancy after IUI and 31.94% after IVF (p=0.006). In the same age group women with AMH level 8 to 15 pmol ⁄L had 8.48% for clinical pregnancy by IUI and 23.3% by IVF (p=0.001).

Summary: IUI and IVF have similar outcomes among women above 40 years old with higher AMH levels. Women with lower AMH should be referred to IVF.