Prediction of reproductive outcomes according to different serum anti-Müllerian hormone levels in females undergoing intracystoplasmic sperm injection.

BACKGROUND AND AIM OF THE STUDY: Serum anti-Müllerian hormone (AMH) is a reliable marker of ovarian reserve, and it has been shown to be correlated with reproductive outcomes in grouped analyses. However, practical data is scarce for the physician and the patients to predict these outcomes in an individual couple according to serum AMH measured prior to assisted reproduction technology (ART) procedures. STUDY DESIGN: To address this question, we performed an analytic observational study including 145 females undergoing intracytoplasmic sperm injection (ICSI) in a single center. Results were analyzed according to serum AMH; subgroup analyses were performed by grouping patients according to patient's age and FSH levels. RESULTS: The risk of cycle cancellation decreased from 64% in patients with serum AMH ≤ 3 pmol/L (0.42 ng/mL) to 21% with AMH ≥ 15 pmol/L (2.10 ng/mL). Cycle cancellation occurred in approximately two-thirds of the patients with AMH ≤ 3 pmol/L irrespective of the FSH level. However, with higher AMH values the risk of cycle cancellation decreased more significantly in patients with normal FSH. The rate of good response increased from almost null in patients with AMH ≤ 3 pmol/L to 61% in those with AMH ≥ 15 pmol/L. The positive correlation between good response and AMH was also significant, but with lower absolute rates, when patients were grouped according to their age or FSH levels. Pregnancy rate increased moderately, but significantly, from 31% with AMH ≤ 3 pmol/L to 35% with AMH ≥ 15 pmol/L. CONCLUSIONS: We provide estimates of reproductive outcomes according to individualized values of serum AMH, in general and in subgroups according to patient's age or serum FSH, which are helpful for the clinician and the couple in their decision making about starting an assisted reproductive treatment.

Use of metaphase I oocytes matured in vitro is associated with embryo multinucleation.

OBJECTIVE: To evaluate the impact of oocyte maturational stage at retrieval on embryo multinucleation. DESIGN: Retrospective study. SETTING: Private institution for assisted reproduction. PATIENT(S): A total of 412 patients undergoing 500 intracytoplasmic sperm injection (ICSI) cycles between August 2006 and September 2010. INTERVENTION(S): Routine ICSI laboratory procedures. MAIN OUTCOME MEASURE(S): Normal and abnormal fertilization; embryo development; arrest at pronuclear stage; failure to undergo first mitotic division; presence of embryo multinucleation; embryo quality; pregnancy, implantation, and miscarriage rates. RESULT(S): A significantly lower percentage of multinucleation was found in embryos originating from metaphase II (MII) oocytes when compared with MI-II- and MI-derived oocytes. Significantly fewer multinucleated cells per embryo were observed in MII-derived oocytes. Clinical pregnancy and implantation rates were significantly higher when only embryos derived from MII oocytes were transferred. CONCLUSION(S): Embryo multinucleation rate increases when in vitro-matured (2-5 hours incubation) MI (MI-II) oocytes are used instead of in vivo-matured oocytes in ICSI. Furthermore, all other ICSI outcome parameters are also compromised. The use of donated gametes does not modify these results.