Serum antimüllerian hormone is not predictive of oocyte quality in vitro fertilization.

OBJECTIVES: The assessment of the ovarian reserve is mandatory in women undergoing assisted reproduction. Antimüllerian hormone (AMH) produced by granulosa cells from preantral and early antral follicles, is a promising indicator of ovarian reserve. However, few studies have evaluated the predictive value of AMH on oocyte quality. MATERIAL AND METHODS: A retrospective study was undertaken at the Bretonneau University Hospital of Tours. A total of 559 women undergoing in vitro fertilization treatment between January 2007 and December 2007 were included in the study. Serum AMH levels were determined by using an ultrasensitive ELISA test. Total number of oocytes, rate of mature oocytes, fertilization rate, embryo quality and clinical pregnancy rate were recorded. RESULTS: Serum AMH was significantly lower in groups of patients with few oocytes collected. However, serum AMH was not predictive of nuclear maturity of oocytes, fertilization rate and quality of early embryos. Additionally, low levels of AMH do not preclude clinical pregnancy, in in vitro fertilization. CONCLUSION: At the moment, serum AMH is a relatively predictive indicator of the ovarian reserve, in terms of quantity but not in terms of quality. Moreover, it is still not possible to determine serum AMH cut-off value to predict clinical pregnancy in IVF programmes.

Efficacy of IVF using frozen donor semen in cases of previously failed DI cycles compared with tubal infertility: a cohort study.

A cohort follow-up study was designed to compare the efficacy of IVF using frozen donor semen (IVF-D) following previously failed DI cycles (unexplained female infertility) and direct IVF-D treatment because of tubal infertility (control group). The cohort comprised 189 couples initiating IVF-D after previously failed DI cycles (n = 126) or directly (n = 63). Couples were followed until completion (success or drop-out for personal or medical reasons). Live births and drop-out were expressed both as rate per cycle and crude cumulative rate. Characteristics of IVF-D cycles were similar between the two groups. Moreover, overall outcome was also similar in terms of crude cumulative live birth rate (54.0 versus 57.1% for failed DI cycles and tubal infertility groups respectively). This is the first report on crude cumulative live birth rate based on a cohort follow-up study in unexplained previously failed DI cycles and tubal infertility. Previously failed DI cycles did not impair the chances of achieving a successful pregnancy using IVF-D in this series. Slight oocyte dysfunction, which might underlie the failure of DI cycles, might be overcome using IVF-D.

Efficacy of blastocyst transfer after implantation failure.

Clinicians who treat unsuccessful couples despite repeated transfers of good quality embryos face a challenge. Among the various strategies that have been described, embryo transfer at the blastocyst stage has been postulated to improve implantation. A prospective non-randomized analysis was performed in 276 IVF patients who failed to conceive after at least two early embryo transfers of at least two grade 1-2 embryos per cycle. For the next attempt, couples chose between day 2 embryo transfer (D2 group; n = 147) and day 5/6 blastocyst transfer (D5/D6 group; n = 129) before starting the following attempt. Embryo quality was assessed and results were expressed as clinical pregnancy, live birth and implantation rates per cycle. Embryo grade 1 number was similar between both groups, whereas mean embryo score of the whole cohort was slightly higher in the D2 group. The live birth rates per cycle (27.9 versus 19.7%) and implantation rates per cycle (25.4 versus 12.4%) were higher in the D5/D6 group compared with the D2 group. Improved embryo selection and uterine receptivity may explain the additional benefit of embryo transfer at the blastocyst stage for couples with repeated implantation failures.

[Preimplantation assessment: experimental data on animals and humans]. / Pronostic implantatoire: données expérimentales chez l'animal et l'homme.

Assessing and/or improving the implantation prognostic remain a major goal for research studies as well as for teams doing embryo transfer in many species. Criteria for such a goal were focussed ten years ago and combined theoretically: -sensitivity for applying to one embryo; -clear cut-off for individual decision; -fastness to be suitable for embryo transfer in due time; -no toxicity or invasiveness for embryo; -finally some simple technical approach in order to be applies by a large number of teams. Moreover whatever may be qualitative or quantitative criteria, they should be relied to the final result as alive newborn. The more ancient way to appreciate embryo quality deal with the simple observation of morphological and kinetic criteria about embryo, but such non invasive approach was obviously limited, in spite of the positive influence of regular blastomers, absence of fragmentation and synchronization with time of transfer on implantation rate. The major transcriptional activity of human embryo developing between 6 and 8 cells stage, of course, were unassessed by transfer to day 2. Moreover the apparent quality of the embryo better reflected oocyte quality than embryo quality. Coculture development encompassed only partially such limitation. Using fluorescent probes, it was possible to evaluate some metabolic activity as well as membrane integrity, but such criteria revealed to be both invasive and uneasily reliable with developmental ability of the embryo. Methods dealing with glucidic, protidic or lipidic metabolisms are developed elsewhere, but revealed uneasy to apply, due both to their invasiveness or technical difficulties and their large inter-individual variability. Some hope has raised by the finding of growth factors or cytokines which are expressed by the embryo and/or embryotrophic but a lot of works remain to be down before an easy practical application.