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Antimüllerian hormone (AMH) and age as predictors of preimplantation genetic testing for aneuploidies (PGT-A) cycle outcomes and blastocyst quality on day 5 in women undergoing in vitro fertilization (IVF)

  • Assisted Reproduction Technologies
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Abstract

Purpose

The objective of this study was to investigate whether women with diminished ovarian reserve who planned for PGT-A exhibit a lower number of blastocysts for biopsy, ploidy outcomes, and blastocyst quality on day 5, regardless of age.

Methods

A retrospective analysis was performed between March 2017 and July 2020 at ART Fertility Clinics Abu Dhabi, including couples that were triggered for final oocyte maturation in an ovarian stimulated cycle planned for PGT-A. Patients were stratified into four AMH groups: < 0.65 ng/ml, 0.65–1.29 ng/ml, 1.3–6.25 ng/ml, and > 6.25 ng/ml; four age categories: ≤ 30, 31–35, 36–40, and > 40 years.

Main results and the role of chance

A total of 1410 couples with a mean maternal age of 35.2 ± 6.4 years and AMH of 2.7 ± 2.6 ng/ml were included. In a multivariate logistic regression analysis, controlling for age, the chance of having at least one blastocyst biopsied/stimulated cycle (1156/1410), the chance of having at least one euploid blastocyst/stimulated cycle (880/1410), and the chance of having one euploid blastocyst once biopsy was performed (880/1156) were affected in all patients with AMH < 0.65 ng/ml [AdjOR 0.18[0.11–0.31] p = 0.008)], [AdjOR 0.18 [0.11–0.29] p < 0.001], and [AdjOR 0.34 [0.19–0.61] p = 0.015] as well as in patients with AMH 0.65–1.29 ng/ml (AdjOR 0.52 [0.32–0.84] p < 0.001), (AdjOR 0.49 [0.33–0.72] p < 0.001), and (AdjOR 0.57 [0.36–0.90] p < 0.001), respectively. In a multivariate linear regression analysis, AMH values did not affect blastocyst quality (− 0.72 [− 1.03 to − 0.41] p < 0.001).

Conclusion

Irrespective of age, patients with diminished ovarian reserve (AMH < 1.3 ng/ml) have a lower chance of having at least one blastocyst biopsied and lower chance of having at least one euploid blastocyst per ovarian stimulated cycle. Blastocyst quality was not affected by AMH values.

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Data Availability

All data supporting the findings of this study are available within the paper and its Supplementary Information.

References

  1. Dewailly D, Andersen CY, Balen A, Broekmans F, Dilaver N, Fanchin R, et al. The physiology and clinical utility of anti-Müllerian hormone in women. Hum Reprod Update. 2014;20(3):370–85.

    Article  PubMed  Google Scholar 

  2. Durlinger A, Visser J, Themmen A. Regulation of ovarian function: the role of anti-Mullerian hormone. Reproduction. 2002;1:601–9.

    Article  Google Scholar 

  3. Visser JA, Themmen APN. Anti-Müllerian hormone and folliculogenesis. Mol Cell Endocrinol. 2005;234(1–2):81–6.

    Article  CAS  PubMed  Google Scholar 

  4. Jeppesen JV, Anderson RA, Kelsey TW, Christiansen SL, Kristensen SG, Jayaprakasan K, et al. Which follicles make the most anti-Mullerian hormone in humans? Evidence for an abrupt decline in AMH production at the time of follicle selection. Mol Hum Reprod. 2013;19(8):519–27.

    Article  CAS  PubMed  Google Scholar 

  5. Weenen C. Anti-Mullerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment. Mol Hum Reprod. 2004;10(2):77–83.

    Article  CAS  PubMed  Google Scholar 

  6. Zec I, Tislaric-Medenjak D, Bukovec Megla Z, Kucak I. Anti-Müllerian hormone: a unique biochemical marker of gonadal development and fertility in humans. Biochem Medica. 2011;219–30.

  7. La Marca A, Sighinolfi G, Radi D, Argento C, Baraldi E, Artenisio AC, et al. Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update. 2010;16(2):113–30.

    Article  PubMed  Google Scholar 

  8. de Vet A, Laven JSE, de Jong FH, Themmen APN, Fauser BCJM. Antimüllerian hormone serum levels: a putative marker for ovarian aging. Fertil Steril. 2002;77(2):357–62.

    Article  PubMed  Google Scholar 

  9. Fleming R, Seifer DB, Frattarelli JL, Ruman J. Assessing ovarian response: antral follicle count versus anti-Müllerian hormone. Reprod Biomed Online. 2015;31(4):486–96.

    Article  CAS  PubMed  Google Scholar 

  10. van Rooij IAJ. Serum anti-Mullerian hormone levels: a novel measure of ovarian reserve. Hum Reprod. 2002;17(12):3065–71.

    Article  PubMed  Google Scholar 

  11. Tal R, Seifer DB. Ovarian reserve testing: a user’s guide. Am J Obstet Gynecol. 2017;217(2):129–40.

    Article  PubMed  Google Scholar 

  12. Arvis P, Rongières C, Pirrello O, Lehert P. Reliability of AMH and AFC measurements and their correlation: a large multicenter study. J Assist Reprod Genet. 2022;39(5):1045–53.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Melado L, Lawrenz B, Sibal J, Abu E, Coughlan C, Navarro AT, et al. Anti-müllerian hormone during natural cycle presents significant intra and intercycle variations when measured with fully automated assay. Front Endocrinol. 2018;9:686.

    Article  Google Scholar 

  14. Nelson SM, Klein BM, Arce JC. Comparison of antimüllerian hormone levels and antral follicle count as predictor of ovarian response to controlled ovarian stimulation in good-prognosis patients at individual fertility clinics in two multicenter trials. Fertil Steril. 2015;103(4):923-930.e1.

    Article  CAS  PubMed  Google Scholar 

  15. Borges E, Braga DPAF, Setti A, de Figueira RC, Iaconelli A. The predictive value of serum concentrations of anti-Müllerian hormone for oocyte quality, fertilization, and implantation. JBRA Assist Reprod. 2017;21(3):176–82.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ebner T, Sommergruber M, Moser M, Shebl O, Schreier-Lechner E, Tews G. Basal level of anti-Müllerian hormone is associated with oocyte quality in stimulated cycles. Hum Reprod. 2006;21(8):2022–6.

    Article  CAS  PubMed  Google Scholar 

  17. Lin WQ, Yao LN, Zhang DX, Zhang W, Yang XJ, Yu R. The predictive value of anti-Mullerian hormone on embryo quality, blastocyst development, and pregnancy rate following in vitro fertilization-embryo transfer (IVF-ET). J Assist Reprod Genet. 2013;30(5):649–55.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Scheffer JB, de Carvalho RF, de Aguiar APS, Machado IJM, Franca JB, Lozano DM, et al. Which ovarian reserve marker relates to embryo quality on day 3 and blastocyst; age, AFC, AMH? JBRA Assist Reprod. 2021;25(1):109–14.

    PubMed  PubMed Central  Google Scholar 

  19. Hazout A, Bouchard P, Seifer DB, Aussage P, Junca AM, Cohen-Bacrie P. Serum antimüllerian hormone/müllerian-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.

    Article  CAS  PubMed  Google Scholar 

  20. Silberstein T, MacLaughlin DT, Shai I, Trimarchi JR, Lambert-Messerlian G, Seifer DB, et al. Müllerian 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.

    Article  CAS  PubMed  Google Scholar 

  21. Conto ED, Genro VK, da Silva DS, de Chapon RCB, Cunha Filho JSL. AMH as a prognostic factor for blastocyst development. JBRA Assist Reprod. 2015;19(3):131–4.

    Article  PubMed  Google Scholar 

  22. Kavoussi SK, Odenwald KC, Boehnlein LM, Summers-Colquitt RB, Pool TB, Swain JE, et al. Antimüllerian hormone as a predictor of good-quality supernumerary blastocyst cryopreservation among women with levels <1 ng/mL versus 1–4 ng/mL. Fertil Steril. 2015;104(3):633–6.

    Article  CAS  PubMed  Google Scholar 

  23. Bhide P, Escriba M, Srikantharajah A, Joshi H, Gudi A, Shah A, et al. Anti-Mullerian hormone (AMH) and embryo quality assessed by time-lapse imaging (TLI): a cross-sectional observational study. Arch Gynecol Obstet. 2017;296(3):583–7.

    Article  CAS  PubMed  Google Scholar 

  24. Dai X, Wang Y, Yang H, Gao T, Yu C, Cao F, et al. AMH has no role in predicting oocyte quality in women with advanced age undergoing IVF/ICSI cycles. Sci Rep. 2020;10(1):19750.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Morin SJ, Patounakis G, Juneau CR, Neal SA, Scott RT, Seli E. Diminished ovarian reserve and poor response to stimulation in patients <38 years old: a quantitative but not qualitative reduction in performance. Hum Reprod. 2018;33(8):1489–98.

    Article  CAS  PubMed  Google Scholar 

  26. Riggs R, Kimble T, Oehninger S, Bocca S, Zhao Y, Leader B, et al. Anti-Müllerian hormone serum levels predict response to controlled ovarian hyperstimulation but not embryo quality or pregnancy outcome in oocyte donation. Fertil Steril. 2011;95(1):410–2.

    Article  CAS  PubMed  Google Scholar 

  27. Fong SL, Baart E, Martini E, Schipper I, Visser J, Themmen A, et al. Anti-Müllerian hormone: a marker for oocyte quantity, oocyte quality and embryo quality? Reprod Biomed Online. 2008;16(5):664–70.

    Article  CAS  Google Scholar 

  28. Smeenk J, Sweep F, Zielhuis G, Kremer J, Thomas C, Braat D. Antimüllerian 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.

    Article  CAS  PubMed  Google Scholar 

  29. Kelsey TW, Wright P, Nelson SM, Anderson RA, Wallace WHB. A validated model of serum anti-Müllerian hormone from conception to menopause. Vitzthum VJ, editor. Plos One. 2011;6(7):e22024.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Zheng Z, Zhao X, Xu B, Yao N. What should we focus on before preimplantation genetic diagnosis/screening? Arch Med Sci. 2018;14(5):1119–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. La Marca A, Minasi MG, Sighinolfi G, Greco P, Argento C, Grisendi V, et al. Female age, serum antimüllerian hormone level, and number of oocytes affect the rate and number of euploid blastocysts in in vitro fertilization/intracytoplasmic sperm injection cycles. Fertil Steril. 2017;108(5):777-783.e2.

    Article  PubMed  Google Scholar 

  32. Gat I, AlKudmani B, Wong K, Zohni K, Weizman NF, Librach C, et al. Significant correlation between anti-Müllerian hormone and embryo euploidy in a subpopulation of infertile patients. Reprod Biomed Online. 2017;35(5):602–8.

    Article  CAS  PubMed  Google Scholar 

  33. Jiang X, Yan J, Sheng Y, Sun M, Cui L, Chen ZJ. Low anti-Müllerian hormone concentration is associated with increased risk of embryonic aneuploidy in women of advanced age. Reprod Biomed Online. 2018;37(2):178–83.

    Article  CAS  PubMed  Google Scholar 

  34. Steiner AZ, Pritchard D, Stanczyk FZ, Kesner JS, Meadows JW, Herring AH, et al. Association between biomarkers of ovarian reserve and infertility among older women of reproductive age. JAMA. 2017;318(14):1367.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Pipari A, Guillen A, Cruz M, Pacheco A, Garcia-Velasco JA. Serum anti-Müllerian hormone levels are not associated with aneuploidy rates in human blastocysts. Reprod Biomed Online. 2021;42(6):1211–8.

    Article  CAS  PubMed  Google Scholar 

  36. Baldi E, Gallagher MT, Krasnyak S, Kirkman-brown J, Apolikhin O, Barratt CLR, et al. Extended semen examinations in the sixth edition of the WHO Laboratory Manual for the examination and processing of human semen contributing to the understanding of the function of the male reproductive system. Fertil Steril. 2022;117(2):252–7.

    Article  PubMed  Google Scholar 

  37. Lee SY, Koo YJ, Lee DH. Classification of endometriosis. Yeungnam Univ J Med. 2021;38(1):10–8.

    Article  PubMed  Google Scholar 

  38. Abali K, Lawrenz B, Tegedor AL, Ruiz FR, El-Damen A, Khatib IE, et al. P–663 The ratio of serum progesterone (P4) to the number of follicles (P4/Follicle) is a more objective parameter for euploidy rate as compared to systemic progesterone. Hum Reprod. 2021;36(1):deab130.662.

    Article  Google Scholar 

  39. Vanni VS, Somigliana E, Reschini M, Pagliardini L, Marotta E, Faulisi S, et al. Top quality blastocyst formation rates in relation to progesterone levels on the day of oocyte maturation in GnRH antagonist IVF/ICSI cycles. Kim S, editor. Plos One. 2017;12(5):e0176482.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. La Marca A, Sunkara SK. Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: from theory to practice. Hum Reprod Update. 2014;20(1):124–40.

    Article  PubMed  Google Scholar 

  41. Palermo G. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. The Lancet. 1992;340(8810):17–8.

    Article  CAS  Google Scholar 

  42. Cuevas Saiz I, Carme Pons Gatell M, Vargas MC, Delgado Mendive A, Rives Enedáguila N, MoragasSolanes M, et al. The embryology interest group: updating ASEBIR’s morphological scoring system for early embryos, morulae and blastocysts. Med Reprod Embriología Clínica. 2018;5(1):42–54.

    Article  Google Scholar 

  43. Kung A, Munné S, Bankowski B, Coates A, Wells D. Validation of next-generation sequencing for comprehensive chromosome screening of embryos. Reprod Biomed Online. 2015;31(6):760–9.

    Article  CAS  PubMed  Google Scholar 

  44. Wells D, Kaur K, Grifo J, Glassner M, Taylor JC, Fragouli E, et al. Clinical utilisation of a rapid low-pass whole genome sequencing technique for the diagnosis of aneuploidy in human embryos prior to implantation. J Med Genet. 2014;51(8):553–62.

    Article  CAS  PubMed  Google Scholar 

  45. Broer SL, Mol BWJ, Hendriks D, Broekmans FJM. The role of antimullerian hormone in prediction of outcome after IVF: comparison with the antral follicle count. Fertil Steril. 2009;91(3):705–14.

    Article  CAS  PubMed  Google Scholar 

  46. Kotlyar A, Seifer DB. Anti-Müllerian hormone as a qualitative marker – or just quantity? Curr Opin Obstet Gynecol. 2020;32(3):219–26.

    Article  PubMed  Google Scholar 

  47. Katz-Jaffe MG, Surrey ES, Minjarez DA, Gustofson RL, Stevens JM, Schoolcraft WB. Association of abnormal ovarian reserve parameters with a higher incidence of aneuploid blastocysts: Obstet Gynecol. 2013;121(1):71–7.

    Article  PubMed  Google Scholar 

  48. Tarasconi B, Tadros T, Ayoubi JM, Belloc S, de Ziegler D, Fanchin R. Serum antimüllerian hormone levels are independently related to miscarriage rates after in vitro fertilization–embryo transfer. Fertil Steril. 2017;108(3):518–24.

    Article  CAS  PubMed  Google Scholar 

  49. Harris BS, Acharya KS, Weber JM, Truong T, Eaton JL. Can high antimüllerian hormone mitigate some of the age-related decline in live birth rates? The association between antimüllerian hormone and live birth among women over 40 undergoing in vitro fertilization. FS Rep. 2021;2(4):440–7.

    Google Scholar 

  50. O’Brien Y, Wingfield M, O’Shea LC. Anti-Müllerian hormone and progesterone levels in human follicular fluid are predictors of embryonic development. Reprod Biol Endocrinol. 2019;17(1):47.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Ciepiela P, Dulęba AJ, Kario A, Chełstowski K, Branecka-Woźniak D, Kurzawa R. Oocyte matched follicular fluid anti-Müllerian hormone is an excellent predictor of live birth after fresh single embryo transfer. Hum Reprod. 2019;14:dez186.

    Article  Google Scholar 

  52. Cecchino GN, García-Velasco JA, Rial E. Reproductive senescence impairs the energy metabolism of human luteinized granulosa cells. Reprod Biomed Online. 2021;43(5):779–87.

    Article  CAS  PubMed  Google Scholar 

  53. Kastora SL, Triantafyllidou O, Kolovos G, Kastoras A, Sigalos G, Vlahos N. Combinational approach of retrospective clinical evidence and transcriptomics highlight AMH superiority to FSH, as successful ICSI outcome predictor. J Assist Reprod Genet. 2020;37(7):1623–35.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Tadros T, Tarasconi B, Nassar J, Benhaim JL, Taieb J, Fanchin R. New automated antimüllerian hormone assays are more reliable than the manual assay in patients with reduced antral follicle count. Fertil Steril. 2016;106(7):1800–6.

    Article  CAS  PubMed  Google Scholar 

  55. Najafi K, Gholami S, Moshtagh A, Bazrgar M, Sadatian N, Abbasi G, et al. Chromosomal aberrations in pregnancy and fetal loss: insight on the effect of consanguinity, review of 1625 cases. Mol Genet Genomic Med [Internet]. 2019 Aug [cited 2022 May 12];7(8). Available from: https://doi.org/10.1002/mgg3.820

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Acknowledgements

We would like to thank Victor Lozoya for his initial support with data extraction and initial statistical evaluation.

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Authors and Affiliations

  1. ART Fertility Clinics Abu Dhabi and Dubai, Embryology Lab and IVF Clinic, Dubai, United Arab Emirates

    A. Arnanz, A. Bayram, I. Elkhatib, A. Abdala, A. El-Damen, R. Patel, B. Lawrenz, L. Melado & H. Fatemi

  2. Biomedicine and Biotechnology Department, University of Alcalá de Henares, Madrid, Spain

    A. Arnanz

  3. Embryology Lab, IVIRMA, Madrid, Spain

    A. Arnanz

  4. Obstetrical Department, Women’s University Hospital Tuebingen, Tuebingen, Germany

    B. Lawrenz

  5. UZ Brussels, Jette, Belgium

    N. De Munck

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  1. A. Arnanz
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Contributions

AA, ND, HF: conception and design of the study; AA, ND, AAb, AD, AB, IE, LM, BL, HF: oocyte retrieval; AA, ND, AAb, AD, AB, IE: IVF and ICSI procedure and embryo scoring; AA, ND, AAb, AD, AB, IE: blastocyst biopsy, tubing and vitrification procedure; AA, ND, RP: construction of the data base and data interpretation; AA: drafting of the manuscript; RP: statistical analysis; AA, ND, AAb, AD, AB, IE, LM, BL, HF: critical review and final approval of the manuscript.

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Correspondence to A. Arnanz.

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This study was approved by the local Ethical Committee of ART Fertility Clinics, Abu Dhabi (REFA020b).

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Arnanz, A., Bayram, A., Elkhatib, I. et al. Antimüllerian hormone (AMH) and age as predictors of preimplantation genetic testing for aneuploidies (PGT-A) cycle outcomes and blastocyst quality on day 5 in women undergoing in vitro fertilization (IVF). J Assist Reprod Genet 40, 1467–1477 (2023). https://doi.org/10.1007/s10815-023-02805-z

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