Anti-Müllerian hormone levels to predict oocyte maturity and embryo quality during controlled ovarian hyperstimulation.

BACKGROUND: The aim of this study was to assess the correlation between controlled ovarian hyperstimulation (COH) outcome parameters and anti-Müllerian hormone (AMH) serum levels during in vitro fertilization (IVF) treatment in women with varying ovarian reserve levels. METHODS: Prospective study of 46 women undergoing GnRH-antagonist short protocol for IVF. Participants included women with low ovarian reserve (N.=11), normoreserve (N.=16), and polycystic ovarian syndrome (PCOS; N.=19). AMH was measured on menstrual cycle day 1-3 (basal AMH), on the day of GnRH-antagonist administration (AMH-GnRH), on the day of hCG administration (AMH-hCG), and in follicular fluid on the day of oocyte retrieval (AMH-FF). RESULTS: Basal AMH was significantly correlated (P<0.001) with antral follicle count and number of follicles >11mm on hCG day (P<0.05). Both basal AMH and AMH-GnRH were significantly correlated (P<0.05) with the number of oocytes retrieved and metaphase II. AMH-hCG was correlated with top quality embryos (P=0.04). No correlations were found between COH outcome parameters and AMH-FF. CONCLUSIONS: Basal AMH serum concentration was the strongest predictor of oocyte yield. AMH concentration at the mid-follicular phase was also a good predictor of oocyte yield and this marker was the only useful ovarian reserve indicator during the follicle growth process to predict IVF outcomes. AMH-hCG levels appear to predict embryo quality. AMH levels during the COH can provide valuable data to help individualize treatment and predict COH results.

Anti-Müllerian hormone dynamics during GNRH-antagonist short protocol for IVF/ICSI in women with varying ovarian reserve levels.

BACKGROUND: Data on variations in anti-Müllerian hormone (AMH) levels according to ovarian reserve are scant. The aim of this study was to investigate changes in AMH levels during controlled ovarian hyperstimulation with a GnRH-antagonist protocol for in vitro fertilization (IVF). METHODS: Prospective, observational study of 46 women. The subjects were divided into three cohorts according to ovarian reserve levels: polycystic ovary syndrome (PCOS; N.=19), low ovarian reserve (LOR; N.=11), and normoreserve (NR; N.=16). Serum AMH concentration was measured at baseline (cycle day 2-3 before follicle stimulating hormone [FSH] administration) and just prior to GnRH-antagonist and human chorionic gonadotropin (hCG) administration. AMH concentration in follicular fluid (FF) was assessed on the day of oocyte retrieval. RESULTS: AMH serum concentration decreased significantly (P<0.001) and progressively in all three groups from baseline (initiation of stimulation) to all subsequent assessments. Serum AMH levels were significantly higher in the PCOS group at all determinations: (AMH1: 8.18±6.26ng/mL, AMH2: 5.3±3.97ng/mL, AMH3: 2.19±1.31ng/mL) versus the NR group (AMH1: 2.94±1.53ng/mL, AMH2: 1.44±0.77ng/mL, AMH3: 0.71±0.57ng/mL) and LOR group (AMH1: 0.63±0.42ng/mL, AMH2: 0.58±0.4ng/mL, AMH3: 0.31±0.2ng/mL). No significant between-group differences were observed for AMH levels in FF (PCOS: 3.56±3.19ng/mL, NR: 4.06±5.44ng/mL, LOR: 1.31±0.47ng/mL) nor for fertilization rate, number of top quality embryos, or clinical pregnancy rates. CONCLUSIONS: Serum AMH levels gradually decrease during GnRH-antagonist protocol for IVF. This decrease starts at the beginning of the follicular phase and continues up to the day of hCG administration. These results underscore the important role that AMH plays in the process of folliculogenesis and dominant follicle selection.

Developing and testing a new instrument to measure women's satisfaction with controlled ovarian stimulation treatment.

OBJECTIVES: To develop and test a new instrument (EFESO Questionnaire) to measure satisfaction with controlled ovarian stimulation (COS) treatment. METHODS: Literature review and focus groups with clinical experts provided content for the questionnaire. A preliminary version was pilot tested in 10 women to assess comprehension and relevance. The final version was administered to 606 women receiving COS. Feasibility, reliability and validity were tested by calculating the proportion of patients completing all items, by calculating Cronbach's alpha for the overall score, and by investigating whether the instrument discriminated between patients classified according to the level of overall satisfaction and response to treatment. Factor analysis was performed. RESULTS: The final questionnaire consisted of 17 items. 91.7% of patients completed all of the items. Cronbach's alpha was 0.93, indicating excellent reliability, and the instrument was capable of discriminating between patients categorized by responses to the question on overall satisfaction with treatment and by their response to treatment. Factor analysis showed the instrument to be unidimensional. CONCLUSIONS: The EFESO questionnaire is feasible, reliable and valid for the measurement of satisfaction with treatment in patients receiving COS treatment.

Ovulation induction with minimal dose of follitropin alfa: a case series study.

BACKGROUND: Gonadotropins are used in ovulation induction (OI) for patients with anovulatory infertility. Pharmacologic OI is associated with risks of ovarian hyperstimulation syndrome and multiple pregnancy. Treatment protocols that minimize these risks by promoting monofollicular development are required. A starting dose of 37.5 IU/day follitropin alfa has been used in OI, particularly among women at high risk of multifollicular development and multiple pregnancy. A retrospective case series study was performed to evaluate rates of monofollicular development and singleton pregnancy following standard treatment with 37.5 IU/day follitropin alfa. METHODS: Spanish centers that had performed at least five OI cycles during 2008 using 37.5 IU/day follitropin alfa as a starting dose were invited to participate. Data could be provided from any cycle performed in 2008 (up to a maximum of 12 consecutive cycles per site). Case report forms were collected during April-November 2009 and reviewed centrally. Descriptive statistics were obtained from all cases, and follicular development and clinical pregnancy rates assessed. Potential associations of age and body mass index with follicular development and clinical pregnancy were assessed using univariate correlation analyses. RESULTS: Thirty centers provided data on 316 cycles of OI using a starting dose of 37.5 IU/day follitropin alfa. Polycystic ovary syndrome was the cause of anovulatory infertility in 217 (68.7%) cases. Follitropin alfa at 37.5 IU/day was sufficient to achieve ovarian stimulation in 230 (72.8%) cycles. A single follicle≥16 mm in diameter developed in 193 cycles (61.1%; 95% confidence interval [CI] 55.7-66.4%). Seventy-eight women (24.7%; 95% CI 19.9-29.5%) became pregnant: 94.9% singleton and 5.1% twin pregnancies. Fourteen started cycles (4.4%) were cancelled, mainly due to poor response. Univariate correlation analyses detected weak associations. CONCLUSIONS: Monofollicular growth rate was comparable with optimal rates reported elsewhere and the pregnancy rate exceeded that in other studies of OI using gonadotropins. A starting dose of 37.5 IU/day follitropin alfa is an effective option in selected cases to prevent ovarian hyper-response without loss of efficacy. The analysis could not identify a single selection criterion for individuals who would benefit from this treatment approach; this merits further investigation in prospective studies.