High serum Antimullerian hormone levels are associated with lower live birth rates in women with polycystic ovarian syndrome undergoing assisted reproductive technology

Abstract

Introduction: Antimullerian hormone (AMH) strongly correlates with ovarian reserve and response to controlled ovarian stimulation. Emerging data suggests that serum AMH level may also predict ART outcomes. However, AMH is characteristically elevated in PCOS women and it is unknown whether it may predict live birth outcomes in this population. Methods: This was a retrospective cohort study of 184 PCOS women (Rotterdam criteria) who underwent their first fresh IVF/ICSI cycle. Women were divided into 3 groups according to the <25th (low), 25 to 75th (average), or > 75th (high) percentile of serum AMH concentration. Cycle stimulation parameters and reproductive outcomes were compared between groups. Results: Women in the low serum AMH group were older than those in the average or high AMH (p < 0.05), and required greater gonadotropin dose for stimulation compared to the high AMH group (p < 0.05). Women with high AMH had greater testosterone level compared to women in the low or average AMH groups. No differences were noted between groups in terms of maximal E2, oocytes retrieved and fertilization rate. However, low serum AMH women had significantly greater live birth rates (p < 0.05) and showed a trend towards greater clinical pregnancy rates compared to women in the average and high AMH groups (p = 0.09). The significant association of AMH with live birth rate remained after adjusting for age, BMI, day of transfer and number of embryos transferred. Conclusions: In PCOS women, elevated AMH concentrations are associated with hyperandrogenism and lower live birth rates.

High Serum Anti-Müllerian Hormone Concentrations Are Associated With Poor Pregnancy Outcome in Fresh IVF/ICSI Cycle but Not Cumulative Live Birth Rate in PCOS Patients

“…There have been four studies published that explore the relationship between baseline serum AMH level and pregnancy outcome following IVF/ICSI treatment in PCOS women (15)(16)(17)(18). Our results contrast to these earliest studies (15), in which they enrolled 60 PCOS patients and reported fresh CPR and FR were significantly increased with AMH levels on day 3 of the stimulations cycle.…”

“…In agreement with previous studies ( 4 , 38 – 41 ), the number of total oocytes, metaphase II oocytes, and >14 mm follicles were statistically different in groups in our study, verifying the positive predictive value of baseline AMH levels on the ovarian response to stimulation regimen. The total consumption of gonadotrophins progressively decreased from low to high baseline in the AMH group, which is consistent with previous data indicating that baseline AMH levels positively predict ovarian responsiveness to gonadotrophin in PCOS ( 15 , 17 , 18 , 42 ). The estradiol (E2) level on the day of hCG administration was significantly positively correlated with serum AMH levels in this cohort.…”

“…On the contrary, Xi et al (18) found the lowest CPR in PCOS women with high AMH levels, although this difference was not significant. Interestingly, the study by Tal et al in 2014 (16) showed that increased AMH levels were correlated with greater ovarian stimulation and higher fresh CPR, but a recent study by Tal et al (17) suggested that higher serum AMH levels have poorer LBR in a fresh cycle, which agrees with our study. No statistically significant correlation between CPR, FR, and AMH level was reported, possibly due to the limitation of sample size (17).…”

“…In addition, studies have found a possible relationship between AMH levels and the severity of PCOS (12)(13)(14), which may confuse the predictive value of AMH on ovarian reserve and pregnancy outcomes in PCOS women undergoing ART. The few studies that have evaluated the relationship have reported inconsistent results, with some showing a positive relationship between the AMH concentrations and reproductive outcomes in PCOS patients (15,16), and others suggesting the opposite results (17,18). Other studies have tried to assess the association based on different PCOS phenotypes (19)(20)(21), but there was no consistent conclusion.…”

“…Other studies have tried to assess the association based on different PCOS phenotypes (19)(20)(21), but there was no consistent conclusion. Furthermore, the sample size of these studies (15)(16)(17)(18)(19)(20)(21) was limited. With the extensive use of highly efficient embryo cryopreservation technology, cumulative live birth rate (CLBR) encompassing live birth outcomes in the fresh and subsequent frozen embryo transfer (FET) following a single ovarian stimulation cycle is progressively regarded as a significant indicator for assessing the success of ART but so far, no study has directly explored the relationship of CLBR and baseline AMH level in PCOS patients.…”