The predictive value of anti-mullerian hormone on embryo quality, blastocyst development, and pregnancy rate following in vitro fertilization-embryo transfer (IVF-ET)

  • Wen-Qin Lin
  • Ling-Nv Yao
  • Dong-Xue Zhang
  • Wei Zhang
  • Xiao-Jing Yang
  • Rong Yu
ASSISTED REPRODUCTION TECHNOLOGIES

Abstract

Purpose

The objective of this study was to investigate the predictive value of anti-Mullerian hormone (AMH) on fertilization rate (FR), blastocyst development, embryo quality, the outcome of the pregnancy and the live birth rate (LBR) following in vitro fertilization-embryo transfer (IVF-ET)/intracytoplasmic sperm injection (ICSI).

Method

In this prospective study outcomes were followed in 83 women undergoing cycles of IVF/ICSI within a university hospital. Basal serum AMH, follicle stimulating hormone (FSH), luteinizing hormone (LH) and antral follicle count (AFC) were measured on Day 3. Serum AMH (Gn6 AMH ) level was measured on Day 6 after the administration of gonadotrophin (Gn). AMH was measured in follicle fluid (FF AMH) on the day of ovum pick-up (dOPU). The numbers of retrieved and fertilized oocytes, good quality embryos and blastocysts were counted. Secondary outcome variables included clinical pregnancy rate (CPR) and LBR.

Results

Spearman correlation analysis indicated that the numbers of oocytes, good quality embryos and blastocysts were associated with AMH (P < 0.05) and that LBR was correlated with FF AMH (r = 0.495, P < 0.05). No associations were found between FR and AMH (P > 0.05). Receiver operating characteristic analysis showed that the sensitivity of FF AMH at predicting CPR was 91.2 %; the specificity was 86.5 % and ROCAUC was 0.893 (P < 0.0001).

Conclusion

AMH parameters were correlated with good quality embryos and blastocysts, but only FF AMH showed a significant correlation with LBR and CPR.

Keywords

Anti-Mullerian hormone Fertilization Blastocyte Live birth rate Pregnancy 

References

  1. 1.
    Arabzadeh S, Hossein G, Rashidi BH, Hosseini MA, Zeraati H. Comparing serum basal and follicular fluid levels of anti-Mullerian hormone as a predictor of in vitro fertilization outcomes in patients with and without polycystic ovary syndrome. Ann Saudi Med. 2010;30(6):442–7. doi:10.4103/0256-4947.71063.PubMedGoogle Scholar
  2. 2.
    Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006;12(6):685–718. doi:10.1093/humupd/dml034.PubMedCrossRefGoogle Scholar
  3. 3.
    Broer SL, Mol BW, Hendriks D, Broekmans FJ. The role of antimullerian hormone in prediction of outcome after IVF: comparison with the antral follicle count. Fertil Steril. 2009;91(3):705–14. doi:10.1016/j.fertnstert.2007.12.013.PubMedCrossRefGoogle Scholar
  4. 4.
    Durlinger AL, Gruijters MJ, Kramer P, Karels B, Ingraham HA, Nachtigal MW, et al. Anti-Mullerian hormone inhibits initiation of primordial follicle growth in the mouse ovary. Endocrinology. 2002;143(3):1076–84.PubMedCrossRefGoogle Scholar
  5. 5.
    Ebner T, Sommergruber M, Moser M, Shebl O, Schreier-Lechner E, Tews G. Basal level of anti-Mullerian hormone is associated with oocyte quality in stimulated cycles. Hum Reprod. 2006;21(8):2022–6. doi:10.1093/humrep/del127.PubMedCrossRefGoogle Scholar
  6. 6.
    Eldar-Geva T, Ben-Chetrit A, Spitz IM, Rabinowitz R, Markowitz E, Mimoni T, et al. Dynamic assays of inhibin B, anti-Mullerian hormone and estradiol following FSH stimulation and ovarian ultrasonography as predictors of IVF outcome. Hum Reprod. 2005;20(11):3178–83. doi:10.1093/humrep/dei203.PubMedCrossRefGoogle Scholar
  7. 7.
    Fanchin R, Taieb J, Lozano DH, Ducot B, Frydman R, Bouyer J. High reproducibility of serum anti-Mullerian hormone measurements suggests a multi-staged follicular secretion and strengthens its role in the assessment of ovarian follicular status. Hum Reprod. 2005;20(4):923–927. doi:10.1093/humrep/deh688.Google Scholar
  8. 8.
    Fanchin R, Mendez Lozano DH, Frydman N, Gougeon A, di Clemente N, Frydman R, et al. Anti-Mullerian hormone concentrations in the follicular fluid of the preovulatory follicle are predictive of the implantation potential of the ensuing embryo obtained by in vitro fertilization. J Clin Endocrinol Metab. 2007;92(5):1796–802. doi:10.1210/jc.2006-1053.PubMedCrossRefGoogle Scholar
  9. 9.
    Gnoth C, Schuring AN, Friol K, Tigges J, Mallmann P, Godehardt E. Relevance of anti-Mullerian hormone measurement in a routine IVF program. Hum Reprod. 2008;23(6):1359–65. doi:10.1093/humrep/den108.PubMedCrossRefGoogle Scholar
  10. 10.
    Hazout A, Bouchard P, Seifer DB, Aussage P, Junca AM, Cohen-Bacrie P. Serum antimullerian hormone/mullerian-inhibiting substance appears to be a more discriminatory marker of assisted reproductive technology outcome than follicle-stimulating hormone, inhibin B, or estradiol. Fertil Steril. 2004;82(5):1323–9. doi:10.1016/j.fertnstert.2004.03.061.PubMedCrossRefGoogle Scholar
  11. 11.
    Honnma H, Baba T, Sasaki M, Hashiba Y, Oguri H, Fukunaga T, et al. Serum anti-Mullerian hormone levels affect the rate of ongoing pregnancy after in vitro fertilization. Reprod Sci. 2013;20(1):51–9. doi:10.1177/1933719112450329.PubMedCrossRefGoogle Scholar
  12. 12.
    Irez T, Ocal P, Guralp O, Cetin M, Aydogan B, Sahmay S. Different serum anti-Mullerian hormone concentrations are associated with oocyte quality, embryo development parameters and IVF-ICSI outcomes. Arch Gynecol Obstet. 2011;284(5):1295–301. doi:10.1007/s00404-011-1979-6.PubMedCrossRefGoogle Scholar
  13. 13.
    Jayaprakasan K, Campbell B, Hopkisson J, Johnson I, Raine-Fenning N. A prospective, comparative analysis of anti-Mullerian hormone, inhibin-B, and three-dimensional ultrasound determinants of ovarian reserve in the prediction of poor response to controlled ovarian stimulation. Fertil Steril. 2010;93(3):855–64. doi:10.1016/j.fertnstert.2008.10.042.PubMedCrossRefGoogle Scholar
  14. 14.
    Khader A, Lloyd SM, McConnachie A, Fleming R, Grisendi V, La Marca A, et al. External validation of anti-Mullerian hormone based prediction of live birth in assisted conception. J Ovarian Res. 2013;6(1):3. doi:10.1186/1757-2215-6-3.PubMedCrossRefGoogle Scholar
  15. 15.
    La Marca A, Nelson SM, Sighinolfi G, Manno M, Baraldi E, Roli L, et al. Anti-Mullerian hormone-based prediction model for a live birth in assisted reproduction. Reprod Biomed Online. 2011;22(4):341–9. doi:10.1016/j.rbmo.2010.11.005.PubMedCrossRefGoogle Scholar
  16. 16.
    Lekamge DN, Barry M, Kolo M, Lane M, Gilchrist RB, Tremellen KP. Anti-Mullerian hormone as a predictor of IVF outcome. Reprod Biomed Online. 2007;14(5):602–10.PubMedCrossRefGoogle Scholar
  17. 17.
    Liberty G, Ben-Chetrit A, Margalioth EJ, Hyman JH, Galoyan N, Eldar-Geva T. Does estrogen directly modulate anti-mullerian hormone secretion in women? Fertil Steril. 2010;94(6):2253–6. doi:10.1016/j.fertnstert.2010.01.018.PubMedCrossRefGoogle Scholar
  18. 18.
    Lie Fong S, Baart EB, Martini E, Schipper I, Visser JA, Themmen AP, et al. Anti-Mullerian hormone: a marker for oocyte quantity, oocyte quality and embryo quality? Reprod Biomed Online. 2008;16(5):664–70.PubMedCrossRefGoogle Scholar
  19. 19.
    Majumder K, Gelbaya TA, Laing I, Nardo LG. The use of anti-Mullerian hormone and antral follicle count to predict the potential of oocytes and embryos. Eur J Obstet Gynecol Reprod Biol. 2010;150(2):166–70. doi:10.1016/j.ejogrb.2010.02.029.PubMedCrossRefGoogle Scholar
  20. 20.
    Mashiach R, Amit A, Hasson J, Amzalzg S, Almog B, Ben-Yosef D, et al. Follicular fluid levels of anti-Mullerian hormone as a predictor of oocyte maturation, fertilization rate, and embryonic development in patients with polycystic ovary syndrome. Fertil Steril. 2010;93(7):2299–302. doi:10.1016/j.fertnstert.2009.01.125.PubMedCrossRefGoogle Scholar
  21. 21.
    McIlveen M, Skull JD, Ledger WL. Evaluation of the utility of multiple endocrine and ultrasound measures of ovarian reserve in the prediction of cycle cancellation in a high-risk IVF population. Hum Reprod. 2007;22(3):778–85. doi:10.1093/humrep/del435.PubMedCrossRefGoogle Scholar
  22. 22.
    Moghadam KK, Nett R, Robins JC, Thomas MA, Awadalla SG, Scheiber MD, et al. The motility of epididymal or testicular spermatozoa does not directly affect IVF/ICSI pregnancy outcomes. J Androl. 2005;26(5):619–23. doi:10.2164/jandrol.05018.PubMedCrossRefGoogle Scholar
  23. 23.
    Mulders AG, Laven JS, Eijkemans MJ, de Jong FH, Themmen AP, Fauser BC. Changes in anti-Mullerian hormone serum concentrations over time suggest delayed ovarian ageing in normogonadotrophic anovulatory infertility. Hum Reprod. 2004;19(9):2036–42. doi:10.1093/humrep/deh373.PubMedCrossRefGoogle Scholar
  24. 24.
    Nardo LG, Gelbaya TA, Wilkinson H, Roberts SA, Yates A, Pemberton P, et al. Circulating basal anti-Mullerian hormone levels as predictor of ovarian response in women undergoing ovarian stimulation for in vitro fertilization. Fertil Steril. 2009;92(5):1586–93. doi:10.1016/j.fertnstert.2008.08.127.PubMedCrossRefGoogle Scholar
  25. 25.
    Nelson SM, Yates RW, Fleming R. Serum anti-Mullerian hormone and FSH: prediction of live birth and extremes of response in stimulated cycles–implications for individualization of therapy. Hum Reprod. 2007;22(9):2414–21. doi:10.1093/humrep/dem204.PubMedCrossRefGoogle Scholar
  26. 26.
    Penarrubia J, Fabregues F, Manau D, Creus M, Casals G, Casamitjana R, et al. Basal and stimulation day 5 anti-Mullerian hormone serum concentrations as predictors of ovarian response and pregnancy in assisted reproductive technology cycles stimulated with gonadotropin-releasing hormone agonist--gonadotropin treatmen. Hum Reprod. 2005;20(4):915–22. doi:10.1093/humrep/deh718.PubMedCrossRefGoogle Scholar
  27. 27.
    Silberstein T, MacLaughlin DT, Shai I, Trimarchi JR, Lambert-Messerlian G, Seifer DB, et al. Mullerian inhibiting substance levels at the time of HCG administration in IVF cycles predict both ovarian reserve and embryo morphology. Hum Reprod. 2006;21(1):159–63. doi:10.1093/humrep/dei270.PubMedCrossRefGoogle Scholar
  28. 28.
    Sills ES, Collins GS, Brady AC, Walsh DJ, Marron KD, Peck AC, et al. Bivariate analysis of basal serum anti-Mullerian hormone measurements and human blastocyst development after IVF. Reprod Biol Endocrinol. 2011;9:153. doi:10.1186/1477-7827-9-153.PubMedCrossRefGoogle Scholar
  29. 29.
    Smeenk JM, Sweep FC, Zielhuis GA, Kremer JA, Thomas CM, Braat DD. Antimullerian hormone predicts ovarian responsiveness, but not embryo quality or pregnancy, after in vitro fertilization or intracyoplasmic sperm injection. Fertil Steril. 2007;87(1):223–6. doi:10.1016/j.fertnstert.2006.06.019.PubMedCrossRefGoogle Scholar
  30. 30.
    Takahashi C, Fujito A, Kazuka M, Sugiyama R, Ito H, Isaka K. Anti-Mullerian hormone substance from follicular fluid is positively associated with success in oocyte fertilization during in vitro fertilization. Fertil Steril. 2008;89(3):586–91. doi:10.1016/j.fertnstert.2007.03.080.PubMedCrossRefGoogle Scholar
  31. 31.
    Wunder DM, Guibourdenche J, Birkhauser MH, Bersinger NA. Anti-Mullerian hormone and inhibin B as predictors of pregnancy after treatment by in vitro fertilization/intracytoplasmic sperm injection. Fertil Steril. 2008;90(6):2203–10. doi:10.1016/j.fertnstert.2007.10.078.PubMedCrossRefGoogle Scholar
  32. 32.
    Yilmaz N, Uygur D, Dogan M, Ozgu E, Salman B, Mollamahmutoglu L. The effect of follicular antimullerian hormone levels of non-obese, non-hyperandrogenemic polycystic ovary syndrome patients on assisted reproduction outcome. Gynecol Endocrinol. 2012;28(3):162–5. doi:10.3109/09513590.2011.593667.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Wen-Qin Lin
    • 1
  • Ling-Nv Yao
    • 1
  • Dong-Xue Zhang
    • 1
  • Wei Zhang
    • 1
  • Xiao-Jing Yang
    • 2
  • Rong Yu
    • 2
  1. 1.Reproductive Medcine Centerthe First Affiliated Hospital of Zhejiang University, School of MedicineHangzhouChina
  2. 2.Reproductive Medcine Centerthe First Affiliated Hospital of Wenzhou Medical CollegeWenzhouChina

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