Analysis of cumulative live birth rate and perinatal outcomes in young patients with low anti-müllerian hormone levels using two ovulation promotion protocols: A cohort study

Abstract

ObjectiveTo compare cumulative live birth rates and perinatal outcomes of young IVF/ICSI patients with low anti-Mullerian hormone (AMH) levels on a gonadotropin-releasing hormone antagonist (GnRH-ant) regimen with those on a high progesterone state of ovulation (PPOS) regimen.MethodsWe retrospectively analyzed 798 patients who underwent in vitro fertilization (IVF) or intracytoplasmic sperm microinjection (ICSI) between January 2015 and December 2020 at the Third Affiliated Hospital of Zhengzhou University. A total of 798 cycles of complete clinical data from patients who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) at the Reproductive Medicine Center of Zhengzhou University Hospital between January 2015 and December 2020 and were eligible for AMH < 1.2 ng/ml at age < 35 years, Group A1: very low AMH levels (AMH < 0.5 ng/mL) and GnRH antagonist regimen; Group A2, very low AMH level (AMH < 0.5 ng/mL) and PPOS regimen; Group B1, low AMH level (0.5 ng/mL ≤ AMH < 1.2 ng/mL) and GnRH antagonist regimen; and Group B2, low AMH level (0.5 ng/mL ≤ AMH < 1.2 ng/mL), and the PPOS regimen.ResultsAt very low levels of AMH (< 0.5 ng/mL), the CLBR of the GnRH antagonist regimen was not significantly different from that of the PPOS regimen (P > 0.05), at 0.5 ng/mL ≤ AMH < 1.2 ng/mL. Statistics showed that the CLBR of the GnRH antagonist regimen was significantly higher than that of the PPOS regimen (49.7% vs. 35.7%, P=0.002). Logistic regression analysis showed that in Group A: the younger the female partner, the higher the CLBR (OR = 0.972, 95% CI = 0.923–1.042, P = 0.022), and the more the AFC, the higher the CLBR (OR = 1.166, 95% CI = 1.091–1.336, P < 0.001). Group B: the higher the number of good-quality embryos, the higher the CLBR (OR = 2.227, 95% CI = 1.869–2.654, P < 0.001). Compared with PPOS regimens, the antagonist regimen was able to increase the CLBR. The analysis of Group A showed that the antagonist regimen had a shorter TTP than the PPOS regimen (P < 0.001); however, the PPOS regimen had a lower cost of ovulation (4311.91 vs. 4903.81, P = 0.023). The antagonist regimen in Group B had a shorter TTP than the PPOS regimen, and there was no significant difference in the cost of ovulation. In the analysis of perinatal outcomes, there were no statistically significant differences in preterm birth, low birth weight, very low birth weight, and pregnancy complications among the four groups.ConclusionYoung patients with very low AMH levels (< 0. 5 ng/mL), the GnRH antagonist regimen was comparable to the PPOS regimen in CLBR outcomes; the antagonist regimen shortens the time to clinical pregnancy, and the PPOS regimen is more cost-effective. In young patients with low AMH levels of 0.5 ng/mL and <1.2 ng/mL, the GnRH antagonist regimen can more appropriate to improve CLBR, and the perinatal outcomes were similar for both regimens.

The comparison between fixed versus degressive doses of medroxyprogesterone acetate combined with letrozole in patients of progestin-primed ovarian stimulation protocol: a propensity score-matched study

“…In women with PCOS, LH levels ranged from 1.62 to 2.52 IU/L ( 40 – 43 ), while in infertile women with normal ovarian reserve, LH levels were between 1.56 and 3.54 IU/L ( 12 , 14 , 44 – 46 ). Poor responders showed LH levels in the range of 2.4 to 5.55 IU/L ( 6 , 47 – 49 ). Moreover, research indicated that the LH level at the hCG trigger was 3.68 ± 2.69 IU/L for patients younger than 35 years and 4.77 ± 3.10 IU/L for patients older than 35 years ( 49 ).…”

Impaired embryo development potential associated with thyroid autoimmunity in euthyroid infertile women with diminished ovarian reserve

“…A tailored ovarian stimulation regimen was designed, taking into account each patient’s age, body mass index (BMI), and ovarian reserve. Specifically, for women with DOR, milder stimulation protocols and GnRH-ant protocols were more commonly used ( 22 ). Regardless of the protocol employed, routine monitoring of serum hormone levels, such as luteinizing hormone (LH), estradiol (E2), and progesterone (P), was conducted during the stimulation process.…”

A Quadruplex Ultrasensitive Immunoassay for Simultaneous Assessment of Human Reproductive Hormone Proteins in Multiple Biofluid Samples

“…It is one of the hormones used to measure the ovarian reserve or the number of eggs remaining in the ovaries. , Serum levels of AMH can be used to predict the response to fertility treatments and can be used to diagnose conditions such as polycystic ovary syndrome (PCOS) and POI . Low levels of AMH indicate poor ovarian reserve and a high risk of poor outcomes from fertility treatments . High levels of AMH can indicate PCOS, where the ovaries produce excess hormones and produce cysts on the ovaries .…”

“…37 Low levels of AMH indicate poor ovarian reserve and a high risk of poor outcomes from fertility treatments. 38 High levels of AMH can indicate PCOS, where the ovaries produce excess hormones and produce cysts on the ovaries. 39 In fact, the previous studies have shown that the combination of FSH, LH, PRL, and AMH is more informative than the assessment of each hormone alone.…”