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Older Women with Low AMH Still Have Chance for Pregnancy
by Leigh Ann Woodruff, June 11, 2012
Women with extremely low ovarian reserve may be told that their only hope for a successful pregnancy and birth is by using a donor egg; however, sometimes this is not the option they want to choose. There can be, however, other options for these women. In fact, the Center for Human Reproduction (CHR) in New York recently earned international recognition for its paper analyzing IVF success rates in women with low Anti-Müllerian hormone (AMH) levels. The paper received the Austrian Hugo Husslein Prize, which is awarded biannually by the Austrian Society of Obstetrics and Gynecology.
"Women with poor ovarian reserve are, often, too early told that donor eggs are their only chance because, after all, they can do donor eggs at any time," says Norbert Gleicher, M.D., Medical Director and Chief Scientist of CHR. "But the time for using their own eggs is usually 'now or never.'"
According to the research, the doctors at CHR demonstrated that there were reasonable live birth chances in women with extremely low ovarian reserve, which was demonstrated by either completely undetectable or very AMH levels. AMH is a substance secreted by the granulosa cells in the developing ovarian follicles and the amount of AMH in the blood decreases as a woman ages. The researchers retrospectively evaluated 128 infertility patients from between January 2006 and October 2009, who had AMH levels of ≤0.4 ng/ml, looking at their pregnancy chances and live birth rates after in vitro fertilization (IVF). The women in the study also had a mean age approaching 41,
Despite the poor prognosis, the CHR fertility doctors had established clinical pregnancies in 15.6 percent of these women. When evaluated according to age, 70 women less than or equal to 42 years old presented with 16 clinical pregnancies that resulted in 10 deliveries (14.3 percent), while 58 patients older than 42 years presented with four clinical pregnancies that resulted in two deliveries (3.4 percent). The women in the study did receive DHEA supplementation prior to starting their IVF cycles.
That study, which was published in the journal Human Reproduction, and other CHR studies bring hope to women who want to achieve pregnancy after age 40 with their own eggs. “This really echoes our philosophy at CHR,” says Dr. Gleicher. “We never turn away patients who fully understand their limited chances, and our entire clinical team literally fights for every egg and every embryo.”
DHEA is a mild male hormone that is produced by both men and women. CHR has been treating patients with the hormone since 2004 and has published papers showing that the treatment improves spontaneous pregnancy rates, as well as increasing the number of eggs retrieved for IVF.
"I cannot overemphasize the importance of using DHEA supplementation in these women," Dr. Gleicher says. "Without DHEA, their chances would have been much lower. On the other hand, since patients we reported in this paper in a high percentage came to CHR after they had failed, often multiple cycles, elsewhere, they were really very adversely selected. The easier cases, of course, had gotten pregnant. This means that in a less adveresly selected patient population, even of advanced ages, chances of pregnancy may be even higher."