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The impact of anti-Müllerian hormone on endometrial thickness in gonadotropin stimulation/intrauterine insemination cycles: is there an effect on pregnancy outcomes?

  • Assisted Reproduction Technologies
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Abstract

Purpose

To study the association, if any, between anti-Müllerian hormone (AMH) and pre-ovulatory endometrial thickness (ET) in gonadotropin/intrauterine insemination (IUI) cycles.

Methods

This retrospective cohort study included a total of 964 patients undergoing 1926 gonadotropin/IUI cycles at an academic fertility center. Primary outcome measure was the association between serum AMH and measured ET on the day of and the day before human chorionic gonadotropin hormone (hCG) ovulation trigger. The effect of a model combining AMH and ET on early pregnancy outcomes was a secondary measure.

Results

In 52.8% of cycles, ET was last assessed and recorded on the day of hCG administration, while in the remaining 47.2% on the day prior to trigger. In unadjusted regression models, AMH was weakly correlated with ET on hCG trigger day [bAMH (95%CI) = 0.032 (− 0.008, 0.070), p = 0.015]. When adjusting for potential confounders, the positive correlation became significant [0.051 (0.006, 0.102), p = 0.047]. Similar findings were observed when assessing the correlation between AMH and ET on the day prior to hCG trigger. ET was non-significantly associated with the odds of clinical pregnancy, when adjusting for potential confounders, except for when restricting the analysis to couples with idiopathic infertility [OR (95%CI), p-value: 0.787 (0.623, 0.993), 0.044].

Conclusion

Our findings support an effect of serum AMH on endometrial development in gonadotropin induced cycles, even when adjusting for the diagnosis of PCOS. ET was not associated with the odds of achieving a clinical pregnancy, except for couples with idiopathic infertility.

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References

  1. Group ECW. Intrauterine insemination. Hum Reprod Update. 2009;15(3):265–77. https://doi.org/10.1093/humupd/dmp003.

    Article  Google Scholar 

  2. Starosta A, Gordon CE, Hornstein MD. Predictive factors for intrauterine insemination outcomes: a review. Fertil Res Pract. 2020;6(1):23. https://doi.org/10.1186/s40738-020-00092-1.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hansen KR, Peck JD, Coward RM, Wild RA, Trussell JC, Krawetz SA, et al. Intrauterine insemination performance characteristics and post-processing total motile sperm count in relation to live birth for couples with unexplained infertility in a randomised, multicentre clinical trial. Hum Reprod. 2020;35(6):1296–305. https://doi.org/10.1093/humrep/deaa027.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bakkensen JB, Christou G, Dimitriadis I, James K, Souter I. The effect of follicular phase length on cycle outcomes and endometrial development in gonadotrophin ovarian stimulation/intrauterine insemination cycles. Reprod Biomed Online. 2020;40(3):362–8. https://doi.org/10.1016/j.rbmo.2019.12.007.

    Article  CAS  PubMed  Google Scholar 

  5. Weiss NS, van Vliet MN, Limpens J, Hompes PGA, Lambalk CB, Mochtar MH, et al. Endometrial thickness in women undergoing IUI with ovarian stimulation. How thick is too thin? A systematic review and meta-analysis. Hum Reprod. 2017;32(5):1009–18. https://doi.org/10.1093/humrep/dex035.

    Article  CAS  PubMed  Google Scholar 

  6. Quaas AM, Gavrizi SZ, Peck JD, Diamond MP, Legro RS, Robinson RD, et al. Endometrial thickness after ovarian stimulation with gonadotropin, clomiphene, or letrozole for unexplained infertility, and association with treatment outcomes. Fertil Steril. 2021;115(1):213–20. https://doi.org/10.1016/j.fertnstert.2020.07.030.

    Article  CAS  PubMed  Google Scholar 

  7. Gao G, Cui X, Li S, Ding P, Zhang S, Zhang Y. Endometrial thickness and IVF cycle outcomes: a meta-analysis. Reprod Biomed Online. 2020;40(1):124–33. https://doi.org/10.1016/j.rbmo.2019.09.005.

    Article  PubMed  Google Scholar 

  8. Iatrakis G, Tsionis C, Adonakis G, Stoikidou M, Anthouli-Anagnostopoulou F, Parava M, et al. Polycystic ovarian syndrome, insulin resistance and thickness of the endometrium. Eur J Obstet Gynecol Reprod Biol. 2006;127(2):218–21. https://doi.org/10.1016/j.ejogrb.2006.01.023.

    Article  CAS  PubMed  Google Scholar 

  9. Dehbashi S, Parsanezhad ME, Alborzi S, Zarei A. Effect of clomiphene citrate on endometrium thickness and echogenic patterns. Int J Gynaecol Obstet. 2003;80(1):49–53. https://doi.org/10.1016/s0020-7292(02)00341-7.

    Article  CAS  PubMed  Google Scholar 

  10. Souter I, Dimitriadis I, Baltagi LM, Meeker JD, Petrozza JC. Elevated day 3 follicle-stimulating hormone in younger women: is gonadotropin stimulation/intrauterine insemination a good option? Am J Obstet Gynecol. 2014;211(1):62.e1-8. https://doi.org/10.1016/j.ajog.2014.01.031.

    Article  CAS  PubMed  Google Scholar 

  11. Wang L, Lv S, Mao W, Bai E, Yang X. Fecundity disorders in older women: declines in follicular development and endometrial receptivity. BMC Womens Health. 2020;20(1):115. https://doi.org/10.1186/s12905-020-00979-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Gaba A, Horath S, Hager M, Marculescu R, Ott J. Basal anti Mullerian hormone levels and endometrial thickness at midcycle can predict the outcome after clomiphene citrate stimulation in anovulatory women with PCOS, a retrospective study. Arch Gynecol Obstet. 2019;300(6):1751–7. https://doi.org/10.1007/s00404-019-05359-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Sacha CR, Chavarro JE, Williams PL, Ford J, Zhang L, Donahoe PK, et al. Follicular fluid anti-Mullerian hormone (AMH) concentrations and outcomes of in vitro fertilization cycles with fresh embryo transfer among women at a fertility center. J Assist Reprod Genet. 2020;37(11):2757–66. https://doi.org/10.1007/s10815-020-01956-7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Souter I, Baltagi LM, Kuleta D, Meeker JD, Petrozza JC. Women, weight, and fertility: the effect of body mass index on the outcome of superovulation/intrauterine insemination cycles. Fertil Steril. 2011;95(3):1042–7. https://doi.org/10.1016/j.fertnstert.2010.11.062.

    Article  PubMed  Google Scholar 

  15. Ferguson JM, Pepin D, Duru C, Matejtschuk P, Donahoe PK, Burns CJ. Towards international standardization of immunoassays for Mullerian inhibiting substance/anti-Mullerian hormone. Reprod Biomed Online. 2018;37(5):631–40. https://doi.org/10.1016/j.rbmo.2018.08.012.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Li Q, Zhu M, Deng Z, Wang L, Huang Y, Ruan L, et al. Effect of gonadotropins and endometrial thickness on pregnancy outcome in patients with unexplained infertility or polycystic ovarian syndrome undergoing intrauterine insemination. J Int Med Res. 2020;48(10):300060520966538. https://doi.org/10.1177/0300060520966538.

    Article  CAS  PubMed  Google Scholar 

  17. Li HW, Anderson RA, Yeung WS, Ho PC, Ng EH. Evaluation of serum antimullerian hormone and inhibin B concentrations in the differential diagnosis of secondary oligoamenorrhea. Fertil Steril. 2011;96(3):774–9. https://doi.org/10.1016/j.fertnstert.2011.06.016.

    Article  CAS  PubMed  Google Scholar 

  18. Dewailly D, Andersen CY, Balen A, Broekmans F, Dilaver N, Fanchin R, et al. The physiology and clinical utility of anti-Mullerian hormone in women. Hum Reprod Update. 2014;20(3):370–85. https://doi.org/10.1093/humupd/dmt062.

    Article  PubMed  Google Scholar 

  19. Garg D, Tal R. The role of AMH in the pathophysiology of polycystic ovarian syndrome. Reprod Biomed Online. 2016;33(1):15–28. https://doi.org/10.1016/j.rbmo.2016.04.007.

    Article  CAS  PubMed  Google Scholar 

  20. Vagios S, James KE, Sacha CR, Hsu JY, Dimitriadis I, Bormann CL, et al. A patient-specific model combining antimullerian hormone and body mass index as a predictor of polycystic ovary syndrome and other oligo-anovulation disorders. Fertil Steril. 2021;115(1):229–37. https://doi.org/10.1016/j.fertnstert.2020.07.023.

    Article  CAS  PubMed  Google Scholar 

  21. Wang J, Dicken C, Lustbader JW, Tortoriello DV. Evidence for a Mullerian-inhibiting substance autocrine/paracrine system in adult human endometrium. Fertil Steril. 2009;91(4):1195–203. https://doi.org/10.1016/j.fertnstert.2008.01.028.

    Article  CAS  PubMed  Google Scholar 

  22. Paulson M, Sahlin L, Hirschberg AL. Endometrial expression of anti-Mullerian hormone and its type II receptor in women with polycystic ovary syndrome. Reprod Biomed Online. 2020;41(1):128–37. https://doi.org/10.1016/j.rbmo.2020.01.032.

    Article  CAS  PubMed  Google Scholar 

  23. Renaud EJ, MacLaughlin DT, Oliva E, Rueda BR, Donahoe PK. Endometrial cancer is a receptor-mediated target for Mullerian Inhibiting Substance. Proc Natl Acad Sci U S A. 2005;102(1):111–6. https://doi.org/10.1073/pnas.0407772101.

    Article  CAS  PubMed  Google Scholar 

  24. Hsu JY, James KE, Bormann CL, Donahoe PK, Pepin D, Sabatini ME. Mullerian-inhibiting substance/anti-mullerian hormone as a predictor of preterm birth in polycystic ovary syndrome. J Clin Endocrinol Metab. 2018;103(11):4187–96. https://doi.org/10.1210/jc.2018-01320.

    Article  PubMed  Google Scholar 

  25. Vagios S, Hsu JY, Sacha CR, Dimitriadis I, Christou G, James KE, et al. Pretreatment antimullerian hormone levels and outcomes of ovarian stimulation with gonadotropins/intrauterine insemination cycles. Fertil Steril. 2021;116(2):422–30. https://doi.org/10.1016/j.fertnstert.2021.02.047.

    Article  CAS  PubMed  Google Scholar 

  26. Weissman A, Gotlieb L, Casper RF. The detrimental effect of increased endometrial thickness on implantation and pregnancy rates and outcome in an in vitro fertilization program. Fertil Steril. 1999;71(1):147–9. https://doi.org/10.1016/s0015-0282(98)00413-0.

    Article  CAS  PubMed  Google Scholar 

  27. Liu Y, Ye XY, Chan C. The association between endometrial thickness and pregnancy outcome in gonadotropin-stimulated intrauterine insemination cycles. Reprod Biol Endocrinol. 2019;17(1):14. https://doi.org/10.1186/s12958-019-0455-1.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Massachusetts General Hospital Fertility Center, Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Stylianos Vagios, Caitlin R. Sacha, Karissa C. Hammer, Victoria W. Fitz, Irene Dimitriadis, Charles L. Bormann & Irene Souter

  2. Department of Obstetrics and Gynecology, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA

    Stylianos Vagios

  3. Deborah Kelly Center for Outcomes Research, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Kaitlyn E. James

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  1. Stylianos Vagios
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Correspondence to Stylianos Vagios.

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Vagios, S., Sacha, C.R., James, K.E. et al. The impact of anti-Müllerian hormone on endometrial thickness in gonadotropin stimulation/intrauterine insemination cycles: is there an effect on pregnancy outcomes?. J Assist Reprod Genet 40, 845–850 (2023). https://doi.org/10.1007/s10815-023-02736-9

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