Differential response of AMH to GnRH agonist among individuals: the effect on ovarian stimulation outcomes
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The purpose of this study is to investigate whether individual response of anti-Mullerian hormone (AMH) to gonadotropin-releasing hormone (GnRH) treatment is associated with difference in ovarian stimulation outcomes.
The retrospective study included 1058 non-polycystic ovary syndrome (PCOS) women undergoing long agonist protocol in a single in vitro fertilization unit from January 1, 2016, through December 31, 2016. Patients were grouped according to AMH changes from day 3 to the day of stimulation (group 1, change < 1 ng/ml, n = 714; group 2, decrease ≥ 1 ng/ml, n = 143; group 3, increase ≥ 1 ng/ml, n = 201). A generalized linear model including Poisson distribution and log link function was used to evaluate the association between AMH response and the number of oocytes retrieved.
Group 2 was characterized by higher basal AMH level and increased AMH to AFC ratio in comparison with two other groups. However, the number of oocytes and ovarian sensitivity index in group 2 was significantly lower than group 3. Adjusted for age, BMI, ovarian reserve markers, and stimulation parameters, the population marginal means (95% confidence interval) of oocyte number in groups 1 through 3 were 9.51 (9.17, 9.86), 8.04 (7.54, 8.58), and 10.65 (10.15, 11.18), respectively. For patients from group 2 and group 3, basal AMH is no longer significantly associated with oocyte yield.
AMH change in response to GnRH agonist varies among individuals; for those undergoing significant changes in AMH following GnRH agonist treatment, basal AMH may not be a reliable marker for ovarian response in long agonist protocol.
KeywordsControlled ovarian hyperstimulation Anti-Mullerian hormone GnRH agonist Pituitary downregulation Long agonist protocol
The authors would like to thank all the staff, nurses, and physicians at the Reproductive Medicine Center for their support in generating this manuscript. This work was supported by the National Natural Science Foundation of China [grant number 81302454], the Science and Technology Project funding in Xiamen City [grant number 3502Z20144039], and the Natural Science Foundation of Fujian Province [grant numbers 2016D025 and 2015D016].
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
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