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• W2076457632 abstract "To the Editor: We read with interest the articles published in Fertility and Sterility by Fraisse et al. (1Fraisse T. Ibecheole V. Streuli I. Bischof P. de Ziegler D. Undetectable serum anti-müllerian hormone levels and occurrence of ongoing pregnancy.Fertil Steril. 2008; 89 (723.e9–11)Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar) and Tocci et al. (2Tocci A. Ferrero S. Iacobelli M. Greco E. Negligible serum anti-müllerian hormone: pregnancy and birth after a 1-month course of an oral contraceptive, ovarian hyperstimulation, and intracytoplasmic sperm injection.Fertil Steril. 2009; 92 (395.e9–12)Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar) who reported on a total of three pregnancies that occurred in the presence of undetectable levels of serum antimüllerian hormone (AMH). We would like to bring a similar case to the attention of our colleagues. A 40-year-old woman with a 2-year history of secondary infertility presented at our department. In 2004, her gynecologist had made the definite diagnosis of premature ovarian failure based on the patient's undetectable AMH levels; however, this patient conceived shortly thereafter via timed intercourse during the first cycle of clomiphene citrate treatment. In 2009, when the patient presented at our department, she had already tried to conceive for 2 years but had oligomenorrhea and elevated levels of follicle-stimulating hormone (FSH) at 26.0 mIU/mL. Her serum AMH level measured by active müllerian inhibiting substance (MIS)/AMH enzyme-linked immunosorbent assay (ELISA; Beckman Coulter, Fullerton, CA) was below the detection limit (<3.6 pmol/L or <0.05 ng/mL). The antral follicle count in the early follicular phase was two. In a first-treatment trial, the patient was administered 50 mg of clomiphene citrate, as had been performed previously (resulting in the live birth in 2005), but her estradiol levels remained low (peak level: 18 pg/mL), and no follicular development was observed. A second treatment cycle was performed with 75 IU daily of menopausal gonadotropin stimulation. Two follicles developed at a preovulatory estradiol level of 174 pg/mL, and ovulation induction was performed with 5,000 IU of human chorionic gonadotropin (hCG) on cycle day 10. The couple had timed intercourse that resulted in a pregnancy, which is ongoing in the third trimester at the time of writing. Although AMH levels may indeed provide an accurate assessment of the size of the follicular pool in hypergonadotropic women with cycle disturbances who do not fulfill the diagnostic criteria for premature ovarian failure (3Knauff EA, Eijkemans MJ, Lambalk CB, ten Kate-Booij MJ, Hoek A, Beerendonk CC, et al. Anti-müllerian hormone, inhibin B, and antral follicle count in young women with ovarian failure [published correction appears in J Clin Endocrinol Metab 2010;95:465]. Dutch Premature Ovarian Failure Consortium. J Clin Endocrinol Metab 2009;94:786–792.Google Scholar) and thus may provide a good measure of the response to ovarian stimulation, it is important to acknowledge that AMH cannot reliably predict current fecundity. This, together with a recent report on the relative insufficiency of AMH levels to predict pregnancy in intrauterine insemination cycles (4Li HW, Biu Yeung WS, Lan Lau EY, Ho PC, Ng EH. Evaluating the performance of serum antimullerian hormone concentration in predicting the live birth rate of controlled ovarian stimulation and intrauterine insemination. Fertil Steril. Published online February 18, 2010.Google Scholar), casts doubt on the usefulness of AMH measurements for fast-tracking aging patients to in vitro fertilization rather than to low-intervention treatment options. Undetectable serum anti-Müllerian hormone levels and occurrence of ongoing pregnancyFertility and SterilityVol. 89Issue 3PreviewTo discuss, on the basis of the experience of two clinical cases and extensive literature review, the significance of extremely low levels of anti-Müllerian hormone (AMH), also known as Müllerian-inhibiting substance, in infertile women. Full-Text PDF Negligible serum anti-müllerian hormone: pregnancy and birth after a 1-month course of an oral contraceptive, ovarian hyperstimulation, and intracytoplasmic sperm injectionFertility and SterilityVol. 92Issue 1PreviewTo describe a patient with isolated negligible (<0.5 ng/mL or <3.6 pmol/L) anti-müllerian hormone (AMH) levels who underwent intracytoplasmic sperm injection (ICSI) for severe oligoasthenoteratozoospermia, displayed ovarian hyperstimulation after a 1-month course of an oral contraceptive (OC), had a singleton pregnancy and delivered a healthy boy. Full-Text PDF Reply of the Authors: Ongoing pregnancy after human menopausal gonadotropin stimulation and timed intercourse in a 40-year-old woman with undetectable antimüllerian hormone levelsFertility and SterilityVol. 94Issue 4PreviewWe thank Dr. Cordes and colleagues for their interest in our paper (1). They present a case of a 40-year-old hypergonadotropic woman with secondary infertility who achieved pregnancy by slight controlled ovarian hyperstimulation (COH) and timed intercourse in the presence of undetectable levels of antimüllerian hormone (AMH). In the opinion of Cordes et al., their case corroborates the hypotheses that undetectable AMH levels cannot predict fecundity and should not imply the use of in vitro fertilization (IVF) as a first option. Full-Text PDF" @default.
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• W2076457632 title "Ongoing pregnancy after human menopausal gonadotropin stimulation and timed intercourse in a 40-year-old woman with undetectable antimüllerian hormone levels" @default.
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