Assessment of the relationship of basal serum anti-mullerian hormone levels with oocyte quality and pregnancy outcomes in patients undergoing ICSI

Anti-Mullerian hormone [AMH] is constantly secreted during menstrual cycles and may offer several advantages over traditional biomarkers of ovarian reserve. To assess the relationship of anti-Mullerian hormone [AMH] values, which are used to evaluate ovary reserves, with oocyte and embryo quality and with ART outcomes in patients undergoing intra-cytoplasmic sperm injection [ICSI]. This cross sectional study was performed using 50 women undergoing ICSI in IVF center of Zeynep Kamil Women's and Children's Hospital, Istanbul, Turkey. All patients received the long protocol. Follicle-stimulating hormone, luteinizing hormone, estradiol, and AMH levels were measured and antral follicle counts were obtained on the 3[rd] day of menstruation. A cut-off value based on the number of oocytes was determined for AMH, and women were evaluated after being divided into two groups as bad responders and good responders, according to their AMH levels. Twelve [27.3%] women were in bad responders group and 32 [72.7%] women were in good responders group. AMH measurements were statistically significantly different between the two groups [p<0.01]. Based on this significance, the researchers used ROC analysis to estimate a cut-off point for AMH. The researchers detected the good responders with an AMH level 1.90 or above, with 87.50% sensitivity, 66.67% specificity, 87.50% positive prediction, and 66.67% negative prediction [AUC=0.777, p<0.01]. Basal AMH levels can be used as an indicator to determine the ovarian response in women undergoing ICSI. AMH can be used to predict the number of mature oocytes that can be collected during treatment and the number of oocytes that can be fertilized. However, AMH is not a valuable tool to evaluate oocyte quality, the development of high-quality embryos, or pregnancy conception

Association between serum estradiol level on the hCG administration day and IVF-ICSI outcome

Estradiol [E[2]] is required for follicular development and lay an important role in embryo implantation. The aim of this study was to assess the impact of serum E[2] levels on the day of hCG administration in IVF-ICSI patients who are performed controlled ovarian hyperstimulation [COH]. A total of 203 women who were undergone one time IVF cyclus were evaluated in this cross sectional study. All the patients were treated either with long protocol or with microdose flare protocol. The patients were categorized into five groups according to the serum E[2] levels on the day of hCG administration. The mean number of the retrieved oocytes was [NRO] 10.6 +/- 6.7, mean fertilization rate was 55.7 +/- 24.8, and implantation rate was 9.0 +/- 19.2. Of 203 patients, 43 [21%] patients were pregnant. When the overall results are examined, the number of the retrieved oocytes and the number of transferred embryos were better in patients with serum E[2] levels >4000 pg/ml and these values were statistically significant. There were no statistical difference in patients 37 years or older. In women 4000 pg/ml. In site of the lack of high quality evidence to support a positive association between serum E[2] levels and IVF-ICSI outcomes, this study shows that high E[2] levels during COH might be associated with an increased potential of pregnancy depending on better ovarian response. When the overall results are examined, the best scores were in patients with serum E[2] levels >4000 pg/ml

Comparison of the efficacy and cost-effectiveness of highly purified urinary follicle stimulating hormone [HP-uFSH] and recombinant follicle stimulating hormone [rFSH] in Poor Responders

We aimed to compare the clinical results and effectiveness of two gonadothropin treatment protocols; HP-uFSH and rFSH in poor responders. While HP-uFSH was given to 58 patients, rFSH was given to 62 patients. The patient selection criteria were the same [FSH value>15 iu/l or antral follicle number<4, on the second day of menstruation]. Endometrial thickness on hCG day [mm] was 9.0 +/- 2.7 and 7.8 +/- 2.7 in HP-uFSH group and rFSH group, respectively and this difference was statistically significant. Contrarily, fertilization rate [%] was better in rFSH than HP-uFSH [76.6 +/- 15.9 vs. 68.2 +/- 17.8] and this value was also statistically significant. Percentage of cancelled cycles [%] was 14 +/- 34 in HP-uFSH group and this parameter was significantly lower than rFSH group [29 +/- 45]. rFSH is as efficacious as HP-uFSH in poor responders. Fertilization rate was better in rFSH than HP-uFSH. Since rFSH is more expensive, the final treatment cost with rFSH to obtain a pregnancy was slightly higher, but this difference was not statistically significant [20060 TL vs. 17150 TL]