The predictive value of anti-Müllerian hormone for natural conception leading to live birth in subfertile couples

Research question What is the predictive value of serum anti-Mullerian hormone (AMH) level for natural conception and its clinical impact on subfertile couples? Design This is a retrospective cohort of ovulatory women seeking fertility consultation in a private fertility clinic. Couples who had an immediate indication for in vitro fertilisation (IVF) were excluded. All natural conceptions leading to live birth before the start of assisted reproduction technology (ART) were followed within 12 months since initial consultation. A prediction model was developed by updating the Hunault model with serum AMH to predict the probabilities of achieving a natural conception leading to live birth. Results There were 325 couples included in the final analysis. The cumulative natural conception rate leading to live birth within 12 months was 20.9% (95% Confidence Interval (CI): 12.9% - 28.2%). The categorical net reclassification improvement (NRI) of AMH is 7.6%. For couples with a predicted chance of natural conception changed from poor ( 30%) by the reference model to good ( ≥ 30%) by the updated model, the cumulative natural conception rate leading to live birth was 52.0%. For couples who had predicted chance of natural conception changed from good to poor by the updated model, the rate was 18.9%. Conclusions Adding serum AMH to the routine fertility work-up may improve prognosis-based treatment policy and help to prevent unnecessary costs and stress for couples. Prospective validation of the updated model with AMH is required before clinical application.