Follicle Stimulating Hormone and Anti-Müllerian Hormone per Oocyte in Predicting in vitro Fertilization Pregnancy in High Responders: A Cohort Study

Abstract

BackgroundFollicle stimulating hormone (FSH) and Anti-Müllerian hormone (AMH) are utilized to differentiate between good and poor response to controlled ovarian hyperstimulation. Their respective roles in defining functional ovarian reserve remain, however, to be elucidated. To better understand those we investigated AMH and FSH per oocyte retrieved (AMHo and FSHo).Methodology/Principal FindingsThree-hundred and ninety-six women, undergoing first in vitro fertilization cycles, were retrospectively evaluated. Women with oocyte yields >75th percentile for their age group were identified as high responders. In a series of logistic regression analyses, AMHo and FSHo levels were then evaluated as predictive factors for pregnancy potential in high responders. Patients presented with a mean age of 38.0±5.0 years, mean baseline FSH of 11.8±8.7 mIU/mL and mean AMH of 1.6±2.1 ng/mL. Those 88 women, who qualified as high responders, showed mean FSH of 9.7±6.5 mIU/mL, AMH of 3.1±3.1 ng/mL and oocyte yields of 15.8±7.1. Baseline FSH and AMH did not predict pregnancy in high responders. However, a statistically significant association between FSHo and pregnancy was observed in high responders, both after univariate regression (p = 0.02) and when adjusted for age, percentage of usable embryos, and number of embryos transferred (p = 0.03). Rate of useable embryos also significantly affected pregnancy outcome independently of FSHo (p = 0.01). AMHo was also associated with clinical pregnancy chances in high responders (p = 0.03) and remained significant when adjusted for usable embryos and number of embryos transferred (p = 0.04).ConclusionsAMHo and FSHo are predictive of pregnancy potential in high responders, but likely reflect different responsibilities in recruitment and maturation of growing follicle cohorts.

Ongoing Pregnancy Rates in Women with Low and Extremely Low AMH Levels. A Multivariate Analysis of 769 Cycles

“…Our data indicates that in its lower range, AMH remains a good quantitative marker of the ovarian follicular pool but is a poor qualitative marker. This is consistent with previous reports [19] – [25] where in the group of patients with very low ovarian reserve age has a major impact on the chance of pregnancy. This most probably reflects the quality of the oocyte.…”

Twenty years’ experience with the Swiss data registry for assisted reproductive medicine: outcomes, key trends and recommendations for improved practice

“…As the potency of an individual woman's ovaries to respond to the ovarian stimulation regimen is highly variable, the panel focused on methods to predict the outcome of controlled ovarian hyperstimulation. Among all available measurements of ovarian reserve, such as the antral follicle count (AFC), the basal FSH concentration and early follicular phase inhibin B concentration, the serum concentration of the anti-Muellerian hormone (AMH) has been shown to correlate best with the number of retrieved oocytes [12][13][14][15][16]. In addition, the AMH serum levels are also helpful for the prediction of low ovarian response as well as of the risk of OHSS [17][18].…”