Anti-Müllerian hormone dynamics during controlled ovarian hyperstimulation and its correlation with clinical outcomes

Abstract

Objective To evaluate the dynamics of anti-Mullerian hormone (AMH) of serum and follicular fluid (FF) during controlled ovarian hyperstimulation (COH) and to analyze the relationship between AMH and outcomes of COH. Methods A total of 76 eligible IVF/ICSI-ET cycles owing to the tubal or male factors were studied, which were randomly grouped into GnRH-a long protocol and non pituitary down regulation protocol. Serum AMH levels were measured at day 2/3 of previous menstrual cycle (baseline), day 2/3 of menstrual during down regulation, the day of Gn starting, day 5 of Gn stimulation (Gn5), day of hCG administration (dhCG), the day before oocyte retrieval and 3 d after oocyte retrieval. FF was grouped into huge (≥18 mm), middle (14-17 mm) and small (<14 mm) depending on diameters. Results Serum AMH level was significantly higher on the day of Gn staring compared with baseline after the GnRH-a. AMH was gradually decreased with exogenous Gn administration during COH. AMH in FF was gradually decreased with follicles diameter increasing. There was the strongest correlation between AMH of Gn5 and number of retrieved oocytes, the number of MII and embryos conditions during COH. AMH in middle FF was significantly related with antral follicle count (AFC), Gn used dosage and number of available embryos. Conclusions AMH level is significantly elevated after pituitary down regulation, and this augments the number of recruited follicles and improves follicle synchronization. In addition, we can adjust Gn used dosage depending on AMH level of Gn starting. AMH is gradually decreased with exogenous Gn using. At Gn5 serum AMH level may be a better predictive marker of the outcomes of IVF. Key words: Anti-Mulleran hormone (AMH); Non pituitary down regulation; Follicular fluid (FF); Controlled ovarian hyperstimulation (COH)