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.

Achievement of second parenthood in an ART programme using frozen donor semen: cohort follow-up.

BACKGROUND: This study was designed to determine the efficacy of a programme using frozen donor semen in a cohort of patients returning for treatment after previously conceiving through donor insemination (DI). METHODS: The cohort included 222 couples with secondary infertility (previous live birth) in one University Hospital Centre. The treatment sequence involved DI cycles until completion. Live births, drop-out for personal or medical reasons and recourse to IVF with donor semen (IVF-D) were recorded for all patients. Live births were expressed as both rate per cycle and crude cumulative rate. RESULTS: At the end of the DI cycles, 65% of couples in the cohort achieved second parenthood. Most of them (77%) succeeded after only four DI cycles. The majority of couples who stopped treatment did so for personal reasons. CONCLUSIONS: Patients involved in a second parenthood project belong to a 'selected' population. Management and counselling of such patients need to reconcile the early efficacy of DI cycles, the invasiveness of the IVF-D procedure and the availability of donor semen.

[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.