Role of Anti-Mullerian hormone in prediction of Assisted Reproductive Technology outcomes

Leili Safdarian M.D. Khadigeh Khosravi M.D. Marzieh Agha Hosseini M.D. Ashraf Aleyasin M.D. Fateme Sarvi M.D. Parvin Fallahi M.L.D.Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences

Abstract

Background:

Anti-Mullerian hormone (AMH) is identified as a member of the transforming growth factor β and is produced by the granulose cells of preantral and small antral follicles. AMH is undetectable in neonates but increases gradually during puberty and remains stable throughout the reproductive ages. It is believed that decline in serum levels of AMH, is the first indication of a decreased ovarian reserve. AMH has been suggested as a marker of ovarian reserve and predictor of ovarian response to controlled ovarian hyper stimulation. The aim of this study is to determine the role of AMH in prediction of success ART cycles in patients with normal FSH serum levels.

The aim of this study is to determine the role of AMH in prediction of success ART cycles in patients with normal FSH serum levels. This prospective cohort study included 80 infertile women under 4o years, who candidates for assisted reproductive technique. Serum AMH levels on cycle day 3 were measured and all the patients underwent controlled ovarian hyper stimulation and ART. The relationship between serum AMH and ART outcomes, including oocytes number, matured oocytes, fertilization rate, implantation rate, high quality embryo, free zed embryo and biochemical and clinical pregnancy rates were evaluated. Cut-off for level of AMH in this level pregnancy is high, determined. Serum basal AMH levels showed positive correlation with number of oocytes retrieved, mature oocytes, number of embryos transferred and biochemical and clinical pregnancy. Cut-off for serum AMH with and without clinical pregnancy was 3.9.This study showed that in pregnant women undergoing ART, AMH serum levels were higher than non pregnant women.

Key words: Anti-Mullerian hormone, Assisted reproductive technology, outcomes, Follicle stimulating factor.

Results

Material and Methods

This prospective cohort study included 80 infertile women under 4o years, who candidates for assisted reproductive technique. Serum AMH levels on cycle day 3 were measured and all the patients underwent controlled ovarian hyper stimulation and ART. Patients were on the long protocol for ART, down regulation was achieved with GnRH agonist (buserelin) and stimulation was initiated with hMG and Gonal-f. In all patients, when matured follicle reached a diameter of 18 mm, 10000 IU of hCG was injected. Oocyte retrieved was carries out transvaginally 36h after hCG administration. The relationship between serum AMH and ART outcomes, including oocytes number, matured oocytes, fertilization rate, implantation rate, high quality embryo, free zed embryo and biochemical and clinical pregnancy rates were evaluated. Cut-off for level of AMH in this level pregnancy is high, determined.

Serum basal AMH levels showed positive correlation with number of oocytes retrieved, mature oocytes, number of embryos transferred and biochemical and clinical pregnancy. There is positive and significant relationship between serum basal AMH levels and total oocytes retrieved and matured oocytes. Serum AMH levels were positively and significantly correlated with clinical pregnancy. Cut-off for serum AMH with and without clinical pregnancy was 3.9, with 75% sensitivity and 55% specifity.

Conclusion

This study showed that in pregnant women undergoing ART, AMH serum levels were higher than non pregnant women. The results suggest that a serum basal AMH level is prediction of oocytes quantity and quality.

Age (years) 29.48±4.24

Duration of infertility (years) 7.23±4.18

BMI (kg/m2) 25.84±3.84

FSH (IU/L) 6.01±1.83

AMH (ng/ml) 4.44±2.68

Total oocytes retrieved (no) 11.35±5.77

Matured oocytes (no) 6.68±3.76

Fertilization rate (%) 77±19

Chemical pregnancy rates 31.1%

Clinical pregnancy rates 25%

Severe OHSS 8.7%

Cycle cancelation 16.3%

Patients Characteristics

References

1- The use of anti-Mullerian hormone and antral follicle count the potential of oocytes and embryos. European Journal of Obstetrics & Gynecology and Reproductive Biology2- The role of antimullerian hormone in prediction of outcome after IVF: comparison with the antral follicle count. Fertility Sterility3- Anti-Mullerian hormone dynamics during controlled ovarian hyperstimulation and optimal timing of measurement for outcome prediction. Human Reproduction4- Serum antimullerian hormone concentrations on day 3 of the in vitro fertilization stimulation cycle are predictive of the fertilization, implantation, and pregnancy in polycystic ovary syndrome patients undergoing assisted reproduction. Fertility Sterility