A highly sensitive Anti-Müllerian hormone test as a promising tool for follicle growth prediction in primary ovarian insufficiency patients

Primary ovarian insufficiency (POI) patients often require prolonged stimulation for follicular growth. Anti-Müllerian hormone (AMH), produced by granulosa cells of early-stage follicles, is a potential a biomarker for predicting follicular development in POI patients undergoing ovarian stimulation. This retrospective study analyzed 165 patients undergoing 504 long controlled ovarian stimulation cycles. AMH levels were measured three weeks after stimulation initiation using a highly sensitive assay to guide decisions on extending stimulation beyond four weeks. Follicular development occurred in 9.7% of cycles among 41 patients, who had shorter amenorrhea durations and lower baseline follicle-stimulating hormone levels. Three-week AMH levels showed superior predictive ability for follicular development (area under the curve: 0.957; optimal threshold: 2.45 pg/ml) and were negatively correlated with time to follicular detection (R = - 0.326, P < 0.05). However, AMH levels did not significantly affect the precise time required for follicular development or show significant differences in oocyte yield or embryo quality. The study concludes that three-week AMH levels can predict follicular growth in POI patients. These findings suggest that a highly sensitive AMH assay could be a valuable tool for guiding ovarian stimulation in POI patients, potentially improving treatment outcomes.