Effect of follicular fluid levels of AMH on IVF/ICSI outcomes among normo ovulatory women during different controlled hyperstimulation protocols

Abstract

Abstract:

Introduction: Anti-Müllerian hormone (AMH) plays a pivotal role in the regulation of ovarian folliculogenesis. However, the data link between its follicular fluid levels (FF AMH) and the IVF/ICSI outcomes in normo ovulatory women are limited, contradicted, and mainly obtained from Long-GnRH agonist cycles. Thus, we conducted this study to compare the correlations between the FF AMH levels and the IVF/ICSI outcomes in normo ovulatory women during different controlled hyperstimulation protocols.

Methods: A total of 83 normo ovulatory women (GnRH agonist group, n=50; GnRH antagonist group, n=33) who were referred to the Assisted Reproductive Unit of Orient Hospital, Damascus, Syrian Arab Republic, from December 2019 to August 2021 were included in this prospective trial. Follicular fluid samples were collected on the retrieval day, and the FF AMH levels were measured using ELISA Kits. In addition, the embryological and clinical IVF/ICSI outcomes were detected. Spearman rank correlation coefficients were computed to assess the correlations among the studied parameters. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the accuracy of FF AMH levels in predicting pregnancy rates among participants.

Results: The patients’ baseline characteristics were comparable between the studied groups. FF AMH levels were negatively correlated with the total FSH dose in both groups (GnRH agonist group, r=-0.515, P<0.001; GnRH antagonist group, r=-0.420, P=0.015)

FF AMH levels were positively correlated with ovarian sensitivity index (OSI) in the GnRH agonist group (r=0.514, P<0.001), and the correlation with the number of retrieved oocytes trend to be significant (r=0.245, P=0.087). Negative correlations were noted between FF AMH levels and M II oocytes (r=-0.404, P=0.020), fertilized oocytes (r=-0.439, P=0.011), number of obtained embryos (r=-0.439, P=0.011) in the GnRH antagonist group, and the correlation with the number of retrieved oocytes trend to be significant (r=-0.326, P=0.064). However, there were not any correlations between FF AMH levels and the rates of oocyte maturation or fertilization, or with the high quality embryo rate, embryos cleavage rate, or implantation rate in any of the studied groups. In addition, no significant differences were noted in FF AMH levels between pregnant and non pregnant women in any of the studied groups, which also was confirmed by the Receiver Operating Characteristic (ROC) Curve analysis.

Conclusions: High FF AMH negatively affects ovarian folliculogenesis during the flexible GnRH antagonist protocol. However, the good follicular angiogenesis during the long GnRH agonist protocol overcomes FF AMH effects and improves the retrieved oocytes' yield.

Keywords: Anti-Müllerian Hormone, Amh, In-Vitro Fertilization, Ivf, Intra-Cytoplasmic Sperm Injection, Icsi, Gnrh Agonist, Gnrh Antagonist.