Serum antimüllerian hormone/müllerian-inhibiting substance appears to be a more discriminatory marker of assisted reproductive technology outcome than follicle-stimulating hormone, inhibin B, or estradiol

Purpose To investigate whether serum Anti-Müllerian hormone (AMH) on day 3 could predict controlled ovarian stimulation and reproductive outcomes in women with polycystic ovary syndrome. Methods A total of 164 PCOS patients undergoing their first IVF treatment cycle were prospectively included. Serum AMH levels on cycle day 3 was measured. The controlled ovarian stimulation and clinical outcomes for the study population were divided according to the <25th, 25 to 75th, or >75th percentile of serum day-3 AMH. Results Estradiol levels on hCG day and the number of retrieved oocytes significantly increased with increasing serum AMH levels, while total consumption of gonadotropin dose showed a significant decrease (P<0.05). Fertilization rate and the number of good quality embryos were comparable among the low, average and high groups (P>0.05). Embryo implantation rates in the high AMH group was significantly inferior to those with low and average AMH concentration (27 versus 48.8 and 50%, P<0.01). Clinical pregnancy rates was lower in the high AMH group than that of the low and average group (45.9 versus 65 and 66.7%, P00.09), but this difference was only close to statistical significance. In addition, ordinal regression analysis indicated that LH level was the only independent predictor of embryo implantation rates (P00.017). Conclusions In PCOS women, AMH levels on day 3 of the IVF stimulation cycle positively predict ovarian response to gonadotrophins. However, the women with high AMH levels had a significantly decreased IR, which may be due to remarkably increased LH concentrations.Keywords Anti-Müllerian hormone . Assisted reproduction . Polycystic ovary syndrome . Serum AMH Anti-Müllerian hormone (AMH), also known as Müllerian inhibiting substance (MIS), is producted specifically by granulose cells of early developing pre-antral and small antral follicles in the ovary, and declines with advancing age. AMH has therefore been proposed as a novel clinical marker of ovarian reserve [1]. Another major reason for the interest in AMH is the fact that serum AMH levels are increased significantly in women with polycystic ovary syndrome (PCOS) when compared with normoovulatory women [2,3].PCOS is the most frequent cause of anovulatory infertility and hyperandrogenism in young women [4]. Women with this syndrome are characterized by an excessive number of small antral follicles (2-3 fold that of normal ovaries) [5]. As an exclusively granulosa cell product, it was initially proposed that the rise in serum AMH in PCOS was a consequence of the increased small antral follicle number in these ovaries [6]. The Capsule In PCOS women, high AMH levels on day 3 of the IVF stimulation cycle predict high ovarian response to gonadotrophins, but low embryo implantation rates.

Section: Discussionmentioning

confidence: 99%

“…Recently, several studies demonstrated that day 3 AMH concentrations accurately predicted ovarian response to gonadotrophins and the chance of pregnancy during in vitro fertilization (IVF) [12][13][14][15][16]. However, majority of these studies have not focused on women with PCOS.…”

mentioning

confidence: 99%

Correlation of serum Anti-Müllerian hormone concentrations on day 3 of the in vitro fertilization stimulation cycle with assisted reproduction outcome in polycystic ovary syndrome patients

Wei

Gong

2012

“…The presence of a reduced ovarian reserve is believed to be variably related to the deterioration of oocyte quality to the extent that it can alter embryo development and reduce the chances of a possible term pregnancy [13][14][15][16][17]. In clinical practice, when a woman is defined as poor responder on the sole basis of ovarian assessment, reproductive prognosis is not easy to determine.…”

Section: Introductionmentioning

confidence: 99%

Live birth rates in the different combinations of the Bologna criteria poor ovarian responders: a validation study

Marca

Grisendi

Giulini

et al. 2015

Purpose to compare the baseline characteristics and chance of live birth in the different categories of poor responders identified by the combinations of the Bologna criteria and establish whether these groups comprise a homogenous population. Methods database containing clinical and laboratory information on IVF treatment cycles carried out at the Mother-Infant Department of the University Hospital of Modena between year 2007 and 2011 was analysed. This data was collected prospectively and recorded in the registered database of the fertility centre. Eight hundred and thirty women fulfilled the inclusion/ exclusion criteria of the study and 210 women fulfilled the Bologna criteria definition for poor ovarian response (POR). Five categories of poor responders were identified by different combinations of the Bologna criteria. Results There were no significant differences in female age, AFC, AMH, cycle cancellation rate and number of retrieved oocytes between the five groups. The live birth rate ranged between 5.5 and 7.4 % and was not statistically different in the five different categories of women defined as poor responders according to the Bologna criteria. Conclusion The study demonstrates that the different groups of poor responders based on the Bologna criteria have similar IVF outcomes. This information validates the Bologna criteria definition as women having a uniform poor prognosis and also demonstrates that the Bologna criteria poor responders in the various subgroups represent a homogenous population with similar pre-clinical and clinical outcomes.

“…Several research groups have confirmed that low serum AMH levels are predictive of a poor response to COH [10][11][12][13][14][15][16][17][18][19][20][21]. Therefore, it is possible that by using serum AMH assessment of ovarian reserve, clinicians may be able to identify women with early diminished reserve and place them on a maximal dose of FSH in their first cycle of IVF, thereby maximizing the number of retrieved oocytes without placing patients at risk of OHSS.…”

Section: Introductionmentioning

confidence: 99%

Increased gonadotrophin stimulation does not improve IVF outcomes in patients with predicted poor ovarian reserve

Lekamge

Lane

Gilchrist³

et al. 2008

Purpose This retrospective study was carried out to evaluate whether increasing the starting dose of FSH stimulation above the standard dose of 150 IU/day in patients with low predicted ovarian reserve can improve IVF outcomes. Method A total of 122 women aged less than 36 years in their first cycle of IVF were identified as having likely low ovarian reserve based on a serum AMH measurement below 14 pmol/l. Thirty five women were administered the standard dose of 150 IU/day FSH, while the remaining 87 received a higher starting dose (200-300 IU/day FSH). There were no significant differences in age, BMI, antral follicle count, serum AMH, FSH or aetiology of infertility between the two dose groups.Results No significant improvement in oocyte and embryo yield or pregnancy rates was observed following an upward adjustment of FSH starting dose. While increasing the dose of FSH above 150 IU/day did not produce any adverse events such as OHSS, it did consume an extra 1,100 IU of FSH per IVF cycle. ConclusionThe upward FSH dose adjustment in anticipation of low ovarian reserve can not be advocated as it is both expensive and of no proven clinical value.