ABSTRACT
OBJECTIVE: This study sought to determine the relationships between serum or intrafollicular ovarian steroids and anti-mullerian hormone (AMH) and to predict impact of steroids to AMH ratios on oocyte quantity and metaphase II (MII) oocyte rate in normo-ovulatory (control) and polycystic ovary syndrome (PCOS) patients. DESIGN: Prospective study. SETTING: University hospital and research center. PATIENTS: Thirty-two patients with PCOS and 37 controls undergoing IVF-ET. METHODS: Serum (day 3) and follicular fluid (FF) from more than one follicle ≥ 17 mm on the day of oocyte retrieval were collected from each patients. MAIN OUTCOME MEASURES: Serum or follicular fluid steroids, AMH, retrieved oocytes number and maturation rate. RESULTS: In control group, intrafollicular AMH levels were positively related to P4 and T levels (p = .002, p = .011, respectively). Multiple linear regression analysis showed serum basal AMH and T levels as independent positive predictors while T/AMH ratio and intrafollicular AMH were negative predictors for both retrieved and MII oocyte number. The presence of PCOS and intrafollicular P4/AMH ratio revealed as important negative factors influencing oocyte maturation rate. CONCLUSIONS: Serum basal T, AMH as well as their ratio and intrafollicular P4/AMH ratio may be used as predictors for retrieved oocyte number and their nuclear maturation rate, respectively.
Subject(s)
Anti-Mullerian Hormone/analysis , Fertilization in Vitro , Gonadal Steroid Hormones/analysis , Oocyte Retrieval , Oogenesis/physiology , Polycystic Ovary Syndrome/therapy , Adult , Anti-Mullerian Hormone/blood , Anti-Mullerian Hormone/metabolism , Efficiency , Female , Fertilization in Vitro/methods , Follicular Fluid/chemistry , Follicular Fluid/metabolism , Gonadal Steroid Hormones/blood , Gonadal Steroid Hormones/metabolism , Humans , Infertility, Female/diagnosis , Infertility, Female/etiology , Infertility, Female/metabolism , Infertility, Female/therapy , Oocyte Retrieval/methods , Oocytes/cytology , Oocytes/physiology , Ovarian Follicle/chemistry , Ovarian Follicle/metabolism , Polycystic Ovary Syndrome/complications , Polycystic Ovary Syndrome/diagnosis , Polycystic Ovary Syndrome/metabolism , Pregnancy , Prognosis , Young AdultABSTRACT
BACKGROUND AND OBJECTIVES: The prediction of in vitro fertilization (IVF) outcomes by anti-Müllerian hormone (AMH) measurement is getting increasing attention from clinicians. This study compares the relationship between serum or intrafollicular AMH levels and IVF outcomes in women with and without polycystic ovary syndrome (PCOS). METHODS: This prospective study was carried out in two university-based fertility clinics. Serum samples were collected on cycle day 3 and follicular fluid (FF) was collected on the day of oocyte retrieval from 26 women with PCOS and 42 normo-ovulatory controls. AMH levels were measured in the samples using immunoenzymatic assay. The relationship between serum or FF AMH levels and IVF outcomes, including number of oocytes retrieved, oocyte maturation rate, fertilization rate, implantation rate, high quality grade embryo rate, and biochemical and clinical pregnancy rates were further assessed. RESULTS: Median serum basal AMH and FF AMH levels were significantly higher in the PCOS group as compared to controls, the values being 14.2 ng/mL vs. 3.2 ng/mL (P<.001) and 8.2 ng/g protein vs. 4.7 ng/g protein (P<.01), respectively. In both groups, serum basal AMH levels showed a positive correlation with number of oocytes retrieved (r=0.323; P=.037 in control vs. r=0.529; P=.005 in PCOS). In the control group, there was a positive relationship between serum basal AMH levels and percentage of matured oocytes (r = 0.331; P=.032) and implantation rate (r=0.305; P=.05). CONCLUSION: Serum basal, and not intrafollicular, AMH levels may be a good predictive factor for quantitative and qualitative IVF outcomes in normo-ovulatory, but not in PCOS patients.
