Predictive factors of ovarian response to GnRH antagonist stimulation protocol: AMH and age are potential candidates

Abstract

Background Prediction of ovarian response prior to the ovarian stimulation cycle is useful in determining the optimal starting dose of recombinant follicle-stimulating hormone (r-FSH). This study was designed to (I) evaluate which of the following parameters (age, AMH, and FSH) can be used as a predictor of ovarian response to GnRH antagonist stimulation protocol, (II) determine the cutoff value of AMH and age for predicting poor and high ovarian response, and (III) investigate the relationship between age, AMH level, and other clinical parameters. It is a retrospective study. A total of 318 women with a mean age of 28.2 ± 5.9 years old were included in this study. Hormone levels (FSH, LH, PRL, E2, and AMH) and the number of collected oocytes were determined. Based on the number of retrieved oocytes, the participants were divided into three groups: poor response (oocytes < 4, n= 51), normal response (oocytes 4–14, n= 192), and high response (oocytes > 14, n= 75). Results A significant increase has been found in AMH level and number of retrieved oocytes and mature oocytes from low to normal and high ovarian response group (P < 0.001). Also, the age in the poor ovarian response group was significantly greater than normal and high ovarian response groups (P < 0.001). A significant positive correlation has been found between the number of retrieved oocytes and mature oocytes and level of AMH (P < 0.001). The receiver operating characteristic (ROC) curves showed that both AMH and age had the highest accuracy in the prediction of poor ovarian response with a cutoff value < 1.45 and > 31.5 years, respectively. Additionally, the ROC analysis has shown that the AMH had the highest accuracy, followed by age in the prediction of high ovarian response with a cutoff value > 3.55 and < 27.5 years, respectively. Conclusions This study demonstrates that AMH level and women’s age may be used as potential predictors of ovarian response to GnRH antagonist stimulation protocol.

High-Risk genotypes associated with poor response to controlled ovarian stimulation in Indian women

“…Even though advancing age is considered a marker for declined response to ovarian stimulation, it does not affect all women equally. [ 9 ] In the present study, we did not find any significant difference between the PR and GR groups for patient parameters – age and BMI. The mean age of the GR and PR groups is 31.4 and 31.7 years, respectively.…”

Comparison of anti-Müllerian hormone and antral follicle count in the prediction of ovarian response: a systematic review and meta-analysis

“…However, these factors have limited predictive value. Therefore, emerging studies reported that the multivariate models predicted ovarian response, and found the model could improve the predictive power [ 17 , 59 - 61 ]. For example, Honnma et al [ 60 ] thought that serum AMH in combination with age is a better indicator than AMH alone.…”

Role of anti-Mullerian hormone in polycystic ovary syndrome

“…Thus, circulating AMH level appears to indicate the size of the standing pool of primordial follicle as seen in different studies [46][47][48][49]. Nevertheless, there are no such clear evidences regarding the correlation between AMH level and oocyte quality, whereas the age-related declination of follicular pool was observed to be an explanation of diminished oocyte quality [50,51]. Along with the number of primordial follicles, some endocrine parameters like FSH, estradiol, and inhibin B and ultrasonographic parameters like count of antral follicles and determination of ovarian volume are also considered as markers of ovarian reserve.…”