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To determine whether antim€ ullerian hormone (AMH) predicts good quality supernumerary blastocyst cryopreservation.DESIGN: Retrospective study. MATERIALS AND METHODS: First, fresh IVF cycles (n¼247) from two fertility ceneters, grouped as follows: women < 35 years with AMH < 1 ng/mL (n¼40) or AMH R 1 ng/mL (n¼77); women R 35 years with AMH < 1 ng/mL (n¼62) or AMH R 1 ng/mL (n¼68). AMH level was measured prior to IVF. Ovarian stimulation protocols based on patient age and AMH level included short Gonadotropin Releasing Hormone (GnRH) agonist, GnRH antagonist, or GnRH agonist microdose flare. Supernumerary good quality blastocysts were cryopreserved on days 5 or 6 post-retrieval. Primary outcomes measure was supernumerary good quality blastocyst cryopreservation in relation to AMH levels. Logistic regression was used for statistical analyses.RESULTS: Among women < 35 years of age, there was a significant difference in supernumerary good quality blastocyst cryopreservation between groups of AMH < 1 ng/mL and AMH R 1 ng/mL (30.0 % vs 58.4 %) when adjusted for age. Among women R 35 years of age, there was a significant difference in supernumerary good quality blastocyst cryopreservation between groups of AMH < 1 ng/mL and AMH R 1 ng/mL (16.1 % vs 42.6 %), when adjusted for age.CONCLUSIONS: Low AMH levels are associated with a significantly lower likelihood of blastocyst cryopreservation as compared to higher AMH levels. This effect was seen among women < 35 years of age and those R 35 years of age. Patient counseling should include realistic expectations for the probability of good quality supernumerary blastocyst cryopreservation.

number of fair to good quality blastocysts and utilization rates of blastocysts. This study is unique from prior studies in that 96.4% of study patients underwent antagonist stimulation cycles with GnRH agonist trigger.DESIGN: Prospective cohort study. MATERIALS AND METHODS: All patients underwent IVF / ICSI between August 2016 and February 2017 at a tertiary academic fertility centre. All patients included were normal responders with > 8 mature follicles (> 17 mm) at retrieval. All patients were assigned to alternate ovarian (left or right) flushing on an alternating day allocation. Each patient was used as their own control comparing the ovary with the aspirated and flushed follicles to the contralateral ovary with follicles which were retrieved using standard aspiration without flushing. Because of this study design, statistical analysis was carried out using paired T-tests for comparison of flushed and non-flushed ovaries.RESULTS: 111 patients were included with no statistical difference in any outcome if either the left or right ovary was allocated to be flushed. The mean number of oocytes retrieved from the flushed ovary was 9.5 compared to 8.8 in the unflushed ovary (P ¼ 0.13). Mean mature (M2) oocytes retrieved was 7.5 from the flushed ovary, compared to 6.9 from the unflushed ovary (P ¼ 0.12). Blastocysts of good quality obtained from the flushed and unflushed ovaries were 2.5 and 2.1 (P ¼ 0.17). Blastocyst utilization rates from the flushed and unflushed ovaries were 56% and 51% (P ¼ 0.17).CONCLUSIONS: All outcomes studied showed no statistically significant difference between the flushed and unflushed ovary. This is concordant with published studies showing no difference with follicular flushing. This study adds to the literature as uniquely 96.4% of IVF / ICSI cycles included had used GnRH antagonist stimulation and GnRH agonist trigger. This study suggests that follicular flushing does not provide any clinical benefits in patients who are good responders when using an antagonist stimulation cycle with GnRH agonist trigger.

AH, Hill MJ. Progesterone luteal support after ovulation induction and intrauterine insemination: an updated systemic review and meta-analysis. Fertil Steril 2017 Apr;107(4):924-933.