Anti-Müllerian Hormone Based Protocol Versus The Traditional Protocol For in-Vitro Fertilization/ Intracytoplasmic Sperm Injection: A Randomized Controlled Trial

Objectives: To compare the AMH based protocol and the traditional protocol in patients undergoing IVF/ICSI.
Study Design: Randomized controlled trial. 
Patients and Methods: Two hundred patients candidate for IVF/ICSI were randomized intro two group; AMH-based
protocol group (n = 100) and traditional protocol group (n = 100).
Results: There two groups were similar as regards the demographic features and baseline hormones. The antagonist
protocol was used more frequently in the AMH group compared to the traditional protocol group (62% vs. 19%, P = 0.03).
The duration of stimulation was shorter and the total dose of gonadotropins was lower in the AMH group (10.2 ± 2.8 vs.
11.7 ± 2.7, P = 0.05 and 2133.4 ± 432.5 vs. 2875.4 ± 465.7, P = 0.04, respectively). The clinical pregnancy rate (CPR)
and live birth rate were higher in the AMH group compared to the control group (49.5% vs.30.7%, P = 0.001 and 43.3%
vs.23.9%, P =0.001 respectively). In the AMH group, two cases were cancelled due to poor response and one case was
cancelled due to moderate ovarian hyperstimulation syndrome (OHSS) with freeze all embryos, while in the traditional
protocol group, five cases were cancelled due to poor response and seven cases were cancelled due to moderate / severe
OHSS (2% vs. 5%, P =0.002 and 1% vs. 7%, P = 0.001 respectively).
Conclusion: AMH based protocol was significantly associated with improvement of CPR and live birth rate while
reducing the adverse outcomes such as OHSS and cycle cancellation rate in patients undergoing IVF/ICSI.