Abstract

Study question

Can AMH levels detected by serial high-sensitivity AMH testing predict potential for reaching oocyte retrieval in POI patients with AMH previously undetectable with conventional assays?

Summary answer

In POI, AMH is often undetectable even with high-sensitivity assays. Serial testing can detect sporadic rises, identifying patients who are likely to reach oocyte retrieval.

What is known already

In most patients with POI, serum AMH is undetectable by conventional assays, making it difficult to assess residual ovarian activity or anticipate treatment options. Therefore, oocyte donation is widely considered as a reasonable treatment. However, in clinical practice, some POI patients show sporadic follicular growth, suggesting that oocyte retrieval may be achievable with ovarian stimulation.

Study design, size, duration

In this single-center retrospective study, 83 patients who were diagnosed with POI and visited Rose Ladies Clinic (May 2022–December 2023) for ART were followed until December 2025. We analyzed 1,659 serum AMH measurements (pg/mL) obtained by a high-sensitivity ELISA (LoD 1.3 pg/mL; LoQ 3.2 pg/mL) to see the levels of their AMH and if there is any time to time changes.

Participants/materials, setting, methods

AMH levels measured by high-sensitivity assays were categorized as (a) undetectable (<1.3 pg/mL), (b) detectable, but not quantifiable (1.3–<3.2), or (c) quantifiable (≥3.2).All ovarian stimulation cycles started within 45 days of AMH measurement were included. A spike was defined as a rise from <3.2 to ≥ 3.2. Oocyte retrieval rates were compared by spike status. Logistic regression was used to model spike occurrence as a function of age and duration of amenorrhea.

Main results and the role of chance

Of the 1,659 high-sensitivity AMH measurements, 67.1% (1,114/1,659) were classified as category (a), indicating that most values remained undetectable even with high-sensitivity testing. 55.4% (46/83) of patients showed at least one spike. Oocyte retrieval was achieved in 89.1% (41/46) of spike-positive patients, which is significantly higher compared to that of spike-negative patients (54.4% (19/37)) (p < 0.01). Serial high-sensitivity AMH profiles revealed heterogeneous patterns: some patients showed multiple spikes during the follow-up while others showed persistently low or undetectable throughout the measurement period. We evaluated 388 stimulation cycles that started within 45 days of an AMH measurement regardless of whether AMH had risen at that test and 25.5% (99/388) of the cycles resulted in oocyte retrieval. Retrieval rates per cycle by AMH category were 9.6% (17/178) in (a), 26.9% (25/93) in (b), and 48.7% (57/117) in (c) indicating higher success when stimulation was initiated after AMH entered the quantifiable range. Shorter duration of amenorrhea was associated with higher spike occurrence while the age at the time of their first visit was not associated with spike occurrence.

Limitations, reasons for caution

This retrospective, single-center study is limited by non-uniform AMH testing intervals. Future work should incorporate POI etiology and other clinically relevant covariates.

Wider implications of the findings

Serial high-sensitivity AMH testing may capture unexpected residual ovarian activities in POI and help identify when stimulation is more likely to lead to oocyte retrieval. Such information may help individualized counseling and can lead to more efficient treatment planning for patients pursuing autologous oocytes.

Trial registration number

No