Correlationship of antimullerian hormone (AMH) in follicular fluid with oocyte, embryo quality and pregnancy outcome in ART cycles

Abstract

OBJECTIVE: To verify the correlationship of AMH concentration in collective follicular fluid with the quality of oocytes, embryos and pregnancy outcome in down regulated IVF cycles. DESIGN: Prospective study. MATERIALS AND METHODS: Controlled ovarian hyperstimulation with gonadotropins (225 IU daily) was done in 206 women undergoing IVF cycles. Egg collection was done after 34 hours of injection hCG. Follicular fluid (FF) from lead follicles (measuring > 15 mm in diameter) was collected and equal volume from each follicle was pooled. Estradiol, progesterone along with AMH concentration and protein content of the pooled FF were measured. Retrieved oocytes and resultant embryos were graded as per gradual embryo scoring method. D3 or D5 embryo transfer was done in 196 cycles. Day 14 serum β hCG level > 25 mIU /ml was considered as positive indication of pregnancy. Two weeks later, fetal sac with cardiac activity on transvaginal sonography was considered as clinical pregnancy. Statistical analysis of the data for three groups viz. low, medium and high as per < 25, 25 -75 and > 75 percentile of FF AMH was done. Student t test to differentiate pregnant and nonpregnant groups, P value, one way ANOVA to compare variance in three groups of FF AMH concentration, correlation coefficient, receiver operator characteristic (ROC) was done to establish cutoff values of FF AMH to predict embryo quality and pregnancy outcome. RESULTS: Out of 72 clinical pregnancies obtained in196 embryo transfers, 70 pregnancies occurred in low and medium FF AMH groups irrespective of age and poor or good responders. The Pearson r for pregnancy outcome in low and medium FF AMH groups was 0.7812 and 0.5923 as compared to -0.7354 in high FF AMH group (P value < 0.0001). The FF E2 showed inverse correlationship with FF AMH concentration (r = - 0.5624). A better oocyte and embryo quality was found in lower levels of AMH in follicular fluid (34.9 ± 13.2 ng / g protein) as compared to higher levels of AMH levels (58.2 ± 9.8 ng/g protein). ROC AUC of FF AMH for pregnancy outcome was observed as 87 % (sensitivity of 90.9 % and specificity of 71.4 %) with cutoff value < 27 ng/g protein where likelihood ratio was 1.0. CONCLUSIONS: Lower values of FF AMH favored higher FF E2 concentrations with a better oocyte and embryo quality resulting in positive pregnancy outcome in ART cycles.