ABSTRACT
BACKGROUND: Although anti-mullerian hormone (AMH) level is known to predict ovarian reserve, there is conflicting evidence regarding the association between AMH and clinical pregnancy or live birth (LB). AIM: Our aim is to establish if there is any association between AMH and LB considering the effects of age and other relevant confounding factors in predicting LB. SETTINGS AND DESIGN: 200 in-vitro fertilisation (IVF) cycles were retrospectively analysed in a tertiary fertility centre. MATERIALS AND METHODS: From the database, data regarding the women's age, AMH level, IVF/intracytoplasmic sperm injection, the factors of infertility, protocols, median AMH level and live birth rates (LBRs) were compared between the groups with and without LB in four age groups. The influences of age and AMH in predicting LB were analysed. Statistical analysis was performed using the Statistical Package for the Social Sciences version 21 software (SPSS Inc., Chicago, IL, United States). RESULTS AND CONCLUSION: There were no significant differences in any of the confounding factors analysed between the groups with and without LB. In the higher two age groups, median AMH levels in the group with LB were higher than that in the group without LB. The odds of having a LB was significantly higher in the younger three age groups, and when AMH level was >20 pmol/l. AMH was not found to be the IVF outcome defining factor in younger women, but was relevant in those above 35 years. Older women with significantly higher AMH level had significantly higher LBR than their peers with low AMH level. Thus AMH does have a role in counselling women when predicting live birth from IVF, although age of women plays a major role in determining success from IVF treatment.
ABSTRACT
Although embryo freezing is a routine clinical practice, there is little contemporary evidence on how couples make the decision to freeze their surplus embryos, or of their perceptions during that time. This article describes a qualitative study of 16 couples who have had in vitro fertilisation (IVF) treatment. The study question was 'What are the personal and social factors that patients consider when deciding whether to freeze embryos?' We show that while the desire for a baby is the dominant drive, couples' views revealed more nuanced and complex considerations in the decision-making process. It was clear that the desire to have a baby influenced couples' decision-making and that they saw freezing as 'part of the process'. However, there were confusions associated with the term 'freezing' related to concerns about the safety of the procedure. Despite being given written information, couples were confused about the practical aspects of embryo freezing, which suggests they were preoccupied with the immediate demands of IVF. Couples expressed ethical conflicts about freezing 'babies'. We hope the findings from this study will inform clinicians and assist them in providing support to couples confronted with this difficult decision-making.
