Prediction of Reproductive Outcomes According to Different Serum Anti-Müllerian Hormone Levels in Females Undergoing Intracystoplasmic Sperm Injection

Abstract

Background and aim of the studySerum anti-Müllerian hormone (AMH) is a reliable marker of ovarian reserve, and it has been shown to be correlated with reproductive outcomes in grouped analyses. However, practical data is scarce for the physician and the patients to predict these outcomes in an individual couple according to serum AMH measured prior to assisted reproduction technology (ART) procedures.Study DesignTo address this question, we performed an analytic observational study including 145 females undergoing intracytoplasmic sperm injection (ICSI) in a single center. Results were analyzed according to serum AMH; subgroup analyses were performed by grouping patients according to patient’s age and FSH levels.ResultsThe risk of cycle cancelation decreased from 64% in patients with serum AMH ≤3 pmol/L (0.42 ng/mL) to 21% with AMH ≥15 pmol/L (2.10 ng/mL). Cycle cancelation occurred in approximately two-thirds of the patients with AMH ≤ 3 pmol/L irrespective of the FSH level. However, with higher AMH values the risk of cycle cancelation decreased more significantly in patients with normal FSH. The rate of good response increased from almost null in patients with AMH ≤3 pmol/L to 61% in those with AMH ≥15 pmol/L. The positive correlation between good response and AMH was also significant, but with lower absolute rates, when patients were grouped according to their age or FSH levels. Pregnancy rate increased moderately, but significantly, from 31% with AMH ≤3 pmol/L to 35% with AMH ≥15 pmol/L.ConclusionsWe provide estimates of reproductive outcomes according to individualized values of serum AMH, in general and in subgroups according to patient’s age or serum FSH, which are helpful for the clinician and the couple in their decision making about starting an assisted reproductive treatment.

In Vitro Fertilisation and Intracytoplasmic Sperm Injection predictive factors: A review of the effect of female age, ovarian reserve, male age, and male factor on IVF/ICSI treatment outcomes

“…Currently, a variety of biochemical and sonographic tests allow this evaluation (Nelson et al, 2007;Lee et al, 2009). Serum levels of FSH and anti-Müllerian hormone (AMH), and the antral follicle count (AFC), are considered baseline factors predicting the ovarian reserve (Nelson et al, 2007;Lee et al, 2009;Fridén et al, 2011;Brugo Olmedo et al, 2013;Li et al, 2016;Yin et al, 2019). The third criterion of the Bologna ESHRE consensus group defines diminished ovarian reserve (DOR) as women presenting either an AFC ≤ 5-7 or an AMH assay ≤ 0.5-1 ng/mL (Ferraretti et al, 2011).…”

“…In the recent years AMH has been shown to represent a reliable marker of ovarian reserve and ovarian stimulation response (Fridén et al, 2011;Brugo Olmedo et al, 2013). Although knowledge of the physiologic role of AMH remains limited, various studies have demonstrated its importance as regulator of ovarian activity (Azizi et al, 2019).…”

“…Although knowledge of the physiologic role of AMH remains limited, various studies have demonstrated its importance as regulator of ovarian activity (Azizi et al, 2019). AMH, a member of the transforming growth factor-β family, has the primary role of regression of the Müllerian duct in the male fetus during early testis differentiation, persisting after completion of the male reproductive system, and commencing in females in early fetal life, produced by ovarian granulosa cells (Nelson et al, 2007;Brugo Olmedo et al, 2013) of pre-antral and small antral follicles (Nelson et al, 2007;Lee et al, 2009;Fridén et al, 2011;Brugo Olmedo et al, 2013;La Marca et al, 2017). Thus, AMH can be directly indicative of the pool of such follicles, the ovarian reserve (Fridén et al, 2011).…”

“…Besides predicting the ovarian reserve, AMH may be a potential predictor of the ovarian response to FSH, as AMH expression declines as antral follicles increase in size (FSH-dependent final stages of follicular growth) and is absent from atretic follicles, suggesting that the basal levels of AMH may represent the total developing follicular cohort (Nelson et al, 2007). Moreover, unlike basal follicle-stimulating hormone (bFSH), AMH has an insignificant variation during the menstrual cycle and therefore no restriction of measurement to a particular stage of the cycle (Nelson et al, 2007;Fridén et al, 2011;Brugo Olmedo et al, 2013).…”

“…The primary value of ovarian reserve markers is to provide a more accurate estimate of potential treatment success for patients, allowing optimization and individualization of therapy prior to the commencement of treatment. It is not only important to predict those who can expect low outcomes, warning poor responders and modifying stimulation approaches, but also to identify high responding patients at risk for ovarian hyperstimulation syndrome (Nelson et al, 2007;Lee et al, 2009;Brodin et al, 2013;Brugo Olmedo et al, 2013;Li et al, 2016;Liao et al, 2016;Reijnders et al, 2016). On one hand, studies have shown that markers of ovarian reserve are useful in the individualization of stimulation, but on the other, further association with clinical pregnancy rate (CPR) and live birth rate (LBR) have varied and been disputed (Lee et al, 2009;Brodin et al, 2013;Amsiejiene et al, 2017;Azizi et al, 2019).…”