Transcript Slide 1

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
Material and Methods
Abstract
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.
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.
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.
Results
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.
Patients Characteristics
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%
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 Biology
2- The role of antimullerian hormone in prediction of outcome
after IVF: comparison with the antral follicle count. Fertility
Sterility
3- Anti-Mullerian hormone dynamics during controlled ovarian
hyperstimulation and optimal timing of measurement for
outcome prediction. Human Reproduction
4- 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