Ovarian Reserve Assessment for Patient Tailored Management
Ovarian reserve is a term that is used to determine the capacity of the ovary to provide egg cells that are capable of fertilization resulting in a healthy and successful pregnancy. This ovarian reserve declines dramatically with age which decreases fertility and rate of decline varies between individuals.
Assessment of a woman’s ovarian reserve includes measurement of:
AMH is secreted by pre-antral and antral follicles and regulates follicle recruitment for the cycle. Lately, it is considered as one of the best indicators of ovarian reserve. Overcoming the variations of intra / inter cycle variability and test restrictions to specific menstrual days, serum levels of AMH can be measured at any point during the menstrual cycle, increasing its clinical utility.
The last three decades have seen a steady evolution in AMH assay technology, in tandem with shift to automation. Development of automated AMH assay systems has been driven by the need for greater precision & consistency in measurement of AMH levels. The first fully automated AMH assay was developed by Roche Diagnostics.
At Suburban we employ the Roche platform and the Roche Elecsys assay to ensure maximum accuracy, precision and consistency in AMH assessment.
Roche Elecsys AMH is the first fully automated FDA approved assay. Developed in 2014 the assay offers better precision and consistency in reporting with the elimination of complement interferences which are a major interfering element in AMH assessment.
More non-zero results because every patient counts
The superior assay design and the above mentioned features of Roche Elecsys Assay makes it an ideal test to access the ovarian reserve and design AMH-tailored COS protocols.
Roche Elecsys AMH aids in generating a patient tailored management protocol by assessing the eligibility of the couple to enter in an IVF cycle and also provides AMH/AFC agreement which helps in the stimulation protocol selection.
|AFC 0-7||AFC 8-15||AFC >15||N|
|Poor||AMH ≤ 0.681 ng/mL||63.2%||32.4%||4.45%||68|
|Normal||0.681ng/mL <AMH≤ 2.27ng/mL||12.0%||56.9%||31.1%||167|
Elecsys AMH results and AFC subgroup, in a multi-centre evaluation, three AFC groups were defined based on two cut-offs (7 and 15), corresponding topoor, normal and high values.
Poor response to COS affects 2 – 30% of patients and affects the success of Assisted Reproductive Technology (ART). Predicted poor response could be used to assess eligibility and potentially refrain couples from entering a cycle, thus reducing cancellations rates, avoiding disappointment and reducing costs.
Patient-tailored stimulation protocols may help reduce cancellations due to excessive response, potentially increasing pregnancy prospects and reducing clinical risk costs
Mild to moderate Ovarian Hyperstimulation Syndrome (OHSS) occurs in 15-20% of all cases of ovarian stimulation, requiring careful observation. Severe OHSS occurs in 1-3% of all cases of ovarian stimulation, requiring hospitalization and intensive care due to its potentially life threatening nature. Complete prevention of OHSS is still not possible, but with early identification of potential risk factors and careful clinical management of patients undergoing COS, the incidence of OHSS can be significantly reduced, leading to better outcomes and reduced health care costs.
With Elecsys assay AMH was determined in 149 women undergoing an antagonist treatment protocol in the course of their first cycle of COS and among this population hyper response was observed in 16women.The clinical performance of Roche Elecsys AMH to predict hyper-response to COS was evaluated by ROC analysis, applying a pre specified cut off of 15 pmol/L (2.1ng/ml)
|AMH cutoff||15.0 pmol/L (2.1o ng/m)|
|Point estimate||95% CI|
AMH-tailored stimulation protocols seem to be effective in improving I VF outcomes, thereby justifying their introduction into routine IVF practice. As a consequence, the average cost per patient and cycle was reduced by 31%.