Differential response of AMH to GnRH agonist among individuals: the effect on ovarian stimulation outcomes

Cai, Jiali; Liu, Lanlan; Zheng, Jianhua; Zhang, Ling; Jiang, Xiaoming; Li, Ping; Sha, Aihua; Ren, Jianzhi

doi:10.1007/s10815-017-1095-z

Cited by 10 publications

(7 citation statements)

References 28 publications

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“…Second, the majority of blood samples were obtained during downregulation with a GnRH agonist, which may have slightly affected serum AMH levels (Wang et al ., 2007; Jayaprakasan et al ., 2008; Su et al ., 2013). However, as such a change most likely reflects a change in the follicle number and follicle size distribution, the accuracy to predict the ovarian response is unlikely to be compromised, as was confirmed by a previous study (Wang et al ., 2007; Cai et al ., 2018). In the POSEIDON classification, AMH is used as an ovarian response predictor to categorize women into expected and unexpected poor responders.…”

Section: Discussionmentioning

confidence: 99%

Cumulative live birth rates in low-prognosis women

et al. 2019

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STUDY QUESTION Do cumulative live birth rates (CLBRs) over multiple IVF/ICSI cycles confirm the low prognosis in women stratified according to the POSEIDON criteria? SUMMARY ANSWER The CLBR of low-prognosis women is ~56% over 18 months of IVF/ICSI treatment and varies between the POSEIDON groups, which is primarily attributable to the impact of female age. WHAT IS KNOWN ALREADY The POSEIDON group recently proposed a new stratification for low-prognosis women in IVF/ICSI treatment, with the aim to define more homogenous populations for clinical trials and stimulate a patient-tailored therapeutic approach. These new criteria combine qualitative and quantitative parameters to create four groups of low-prognosis women with supposedly similar biologic characteristics. STUDY DESIGN, SIZE, DURATION This study analyzed the data of a Dutch multicenter observational cohort study including 551 low-prognosis women, aged <44 years, who initiated IVF/ICSI treatment between 2011 and 2014 and were treated with a fixed FSH dose of 150 IU/day in the first treatment cycle. PARTICIPANTS/MATERIALS, SETTING, METHODS Low-prognosis women were categorized into one of the POSEIDON groups based on their age (younger or older than 35 years), anti-Müllerian hormone (AMH) level (above or below 0.96 ng/ml), and the ovarian response (poor or suboptimal) in their first cycle of standard stimulation. The primary outcome was the CLBR over multiple complete IVF/ICSI cycles, including all subsequent fresh and frozen-thawed embryo transfers, within 18 months of treatment. Cumulative incidence curves were obtained using an optimistic and a conservative analytic approach. MAIN RESULTS AND THE ROLE OF CHANCE The CLBR of the low-prognosis women was on average ~56% over 18 months of IVF/ICSI treatment. Younger unexpected poor ( n = 38) and suboptimal ( n = 179) responders had a CLBR of ~65% and ~68%, respectively, and younger expected poor responders ( n = 65) had a CLBR of ~59%. The CLBR of older unexpected poor ( n = 41) and suboptimal responders ( n = 102) was ~42% and ~54%, respectively, and of older expected poor responders ( n = 126) ~39%. For comparison, the CLBR of younger ( n = 164) and older ( n = 78) normal responders with an adequate ovarian reserve was ~72% and ~58% over 18 months of treatment, respectively. No large differences were observed in the number of fresh treatment cycles between the POSEIDON groups, with an average of two fresh cycles per woman within 18 months of follow-up. LIMITATIONS, REASONS FOR CAUTION Small numbers in some (sub)groups reduced the precision of the estimates. However, our findings provide the f...

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Section: Discussionmentioning

confidence: 99%

Cumulative live birth rates in low-prognosis women

et al. 2019

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“…Different dosages and formulations of GnRH-a were devised. It has been noted that clinical pregnancy rate might increase when patients are given a period of artificial amenorrhea caused by GnRH-a (Cai et al, 2018; Liao et al, 2015; Martínez et al, 2014; Ren et al, 2014). One full-dose depot of long-acting GnRH-a per COH cycle would be more convenient for women than short-acting GnRH-a injections because there are fewer injections, leading to greater compliance as well as fewer incidences of infection (Cheon et al, 2008; Gao et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Prolonged pituitary down-regulation with full-dose of gonadotropin-releasing hormone agonist in different menstrual cycles: a retrospective cohort study

Ying¹,

Yang²,

Zhang³

et al. 2019

PeerJ

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Background The efficiency of prolonged down-regulation caused by a full-dose of gonadotropin-releasing hormone agonist (GnRH-a) injected during different menstrual phases has not yet been researched. Our goal was to evaluate the effects of GnRH-a, which was used in different phases of the menstrual cycle in patients undergoing in vitro fertilization and embryo transfer. Methods This was a retrospective cohort study. A total of 320 patients received a prolonged pituitary down-regulated full-dose (3.75 mg) of triptorelin in the early follicular phase, and 160 patients received the same full-dose of triptorelin during the mid-luteal phase. Clinical and laboratory outcomes were compared between the two groups. Results The basic characteristics of the two groups were comparable. The mean number of retrieved oocytes, fertilized oocytes, cleavage oocytes and good quality embryos were comparable between the two groups. Although there was a higher antral follicle count, cyst formation rate, fertilization rate and cleavage rate in the follicular phase group, no statistically significant effects were seen on implantation rate (41.15% vs. 45.91%), clinical pregnancy rate (60.38% vs. 61.36%), ongoing pregnancy rate (57.74% vs. 57.58%), live birth rate (56.23% vs. 57.58%) or early abortion rate (2.64% vs. 3.79%) per fresh transfer cycle. Moreover, severe ovarian hyperstimulation syndrome rates at the early stage (1.89% vs. 2.27%) were low in both groups. Conclusions Prolonged pituitary down-regulation achieved by utilizing a full-dose of GnRH-a administrated in either phase of the menstrual cycle can have a positive effect on ongoing pregnancy rate and live-birth rate per fresh embryo transfer cycle. Ovarian cyst formation rate was higher in the follicular phase group, but this did not have any adverse impact on clinical results.

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“… 33 These data indicate that the timing of the AMH measurement affects the type of difference in serum AMH concentration following GnRH-a treatment, but individual variation may also contribute to this. 34 A limitation of the present study was that we only recruited relatively young patients, who have ovaries that would be more sensitive to GnRH-a. Thus, basal AMH concentration may not be a reliable marker of the ovarian response to long-term administration of such agonists.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting the accuracy and reliability of the measurement of anti-Müllerian hormone concentration in the clinic

Wang²,

et al. 2021

J Int Med Res

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Objective We aimed to identify the factors that influence serum anti-Müllerian hormone (AMH) concentration measurements. Methods We collected serum samples between May and September 2018 and compared the effect on AMH concentration measured by ELISA of conditions including venepuncture, storage time, storage temperature, locations of the reaction microplate, and the use of the oral contraceptive pill and gonadotrophin-releasing hormone (GnRH). Results AMH concentration was not affected by food intake but was affected by haemolysis. It was also much higher in samples on the edge of the ELISA microtitre plate. AMH concentration increased after incubation at room temperature for 1 day, 4°C for 3 days, −20°C for 1 month and −40°C for 4 months, but no change occurred during storage at −80°C for 9 months. AMH concentration was high in patients following GnRH agonist treatment but was not affected by oral contraceptives. Conclusions No fasting is required prior to AMH measurement. Placement of serum samples on the edge of microtitre plates affects the results of the AMH ELISA. If serum samples cannot be assayed immediately, it is best to store them at −80°C. Basal AMH concentration cannot be used as a measure of ovarian reserve after GnRH agonist treatment.

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Differential response of AMH to GnRH agonist among individuals: the effect on ovarian stimulation outcomes

Abstract: AMH change in response to GnRH agonist varies among individuals; for those undergoing significant changes in AMH following GnRH agonist treatment, basal AMH may not be a reliable marker for ovarian response in long agonist protocol.

Cited by 10 publications

References 28 publications

Cumulative live birth rates in low-prognosis women

Cumulative live birth rates in low-prognosis women

Prolonged pituitary down-regulation with full-dose of gonadotropin-releasing hormone agonist in different menstrual cycles: a retrospective cohort study

Factors affecting the accuracy and reliability of the measurement of anti-Müllerian hormone concentration in the clinic

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