Anti-mullerian hormone as a predictive marker for the selection of women for oocyte in vitro maturation treatment

Abstract

Purpose In oocyte in-vitro maturation (IVM) treatments, the chances to achieve a pregnancy are critically dependent on the retrieval of a suitable number of oocytes. In this study, we assessed the ability of circulating levels of anti-mullerian hormone (AMH) to identify normo-ovulatory women suitable for IVM treatment on the basis of the number of retrieved oocytes. Method Serum AMH was quantified in normo-ovulatory women younger than 39 years undergoing IVM treatment. After immature oocyte retrieval and IVM, maximum 3 mature oocytes were used for treatment and all resulting embryos were transferred, as established by law. From 177 cycles, 991 oocytes were recovered. Following IVM, 484 mature oocytes were obtained (50.1%). Results The overall pregnancy rate per embryo transfer was 16.6% (25/151) and the implantation rate was 10.9% (30/ 278). Linear regression and receiver operating characteristic (ROC) analyses were applied to identify independent variables and quantify a cut-off AMH value able to identify patients suitable for IVM treatment. An AMH value of 1.28 ng/ml was identified as a threshold for the prediction of the retrieval of at least 5 oocytes, with a sensitivity of 93.4% and a specificity of 33.8%. Positive and negative predictive values were 67.6% and 75.0%, respectively. Conclusions AMH can be adopted to identify women candidate for an IVM treatment from whom a suitable number of oocytes may be retrieved. This is of crucial significance during a non-stimulated cycle, in order to prevent an insufficient oocyte collection and rescue the treatment by implementing a conventional controlled ovarian stimulation.

What is the optimal threshold of serum Anti-Müllerian hormone (AMH) necessary for IVM treatments?

“…Our findings are in agreement with Fadini et al [8] who also showed a correlation between AMH levels and the number of oocytes harvested, The final number of matured oocytes suitable for fertilization is dependent not only on their quantity but also upon their quality and maturation potential in in vitro culture systems. In this respect, our study reports for the first time to the best of our knowledge the association between AMH levels and the maturational status of oocytes, where on the day of the OPU, we did not detect any correlation.…”

“…Other studies have also shown that in IVM cycles, the number of available oocytes is the single most important factor correlating with a successful procedural outcome in NO patients [5,8,9]. Our findings are in agreement with Fadini et al [8] who also showed a correlation between AMH levels and the number of oocytes harvested, The final number of matured oocytes suitable for fertilization is dependent not only on their quantity but also upon their quality and maturation potential in in vitro culture systems.…”

“…It has been suggested that AMH levels may effectively represent the ovarian follicular pool where recently, several large prospective studies have reported that its measurement may have potential clinical application in the prediction of the quantitative and qualitative ovarian response during assisted reproductive technologies [7,11,14,15,21,23,25]. As a result, AMH is currently being used as a novel clinical marker of ovarian reserve as well as a guide to the response to gonadotropin [8]. Our recent data would suggest that AMH expression by granulosa cells and its secretion level within the follicular fluid of small-and medium-sized follicles is strongly correlated with the serum AMH (unpublished results).…”

“…In spite of the large number of studies investigating the role of AMH as a marker of ovarian reserve and response during IVF, there are limited data concerning its role in IVM, where recently, Fadini et al have suggested that it may be used to identify suitable normo-ovulatory (NO) IVM candidates with sufficient oocyte retrieval [8]. As far as we are aware, there are no available data concerning the measurement of serum AMH levels in those women with PCOS undergoing IVM treatment.…”

Clinical outcomes from mature oocytes derived from preovulatory and antral follicles: reflections on follicle physiology and oocyte competence

“…Motivated by the experience gained over years of clinical practice in IVM [10][11][12][13], in the present study we aimed to compare not IVM with standard IVF-COS as clinical approaches, but rather to evaluate the relative competence of oocytes matured in vivo recovered from follicles of different developmental stages. Pursuing this objective, oocytes matured in vivo retrieved from antral follicles in IVM cycles were analyzed together with oocytes normally recovered from preovulatory follicles following conventional IVF-COS in order to assess comparatively their ability of establishing a viable pregnancy.…”