Discordant ovarian reserve testing is a predictor of lower clinical pregnancy during COH-IUI fertility treatment

Abstract

Patients with poor ovarian reserve often have a diminished response to controlled ovarian hyperstimulation (COH). Both Anti-Mullerian hormone (AMH) and Day-3 FSH levels have been shown to independently reflect ovarian reserve and are predictive of pregnancy success rates. However, when the levels are discordant, it is unclear how to counsel patients. At present no studies have evaluated COH-IUI outcomes in women with discordant FSH and AMH levels. This study was designed to evaluate pregnancy outcomes in women with discordant FSH and AMH levels after COH fertility treatment. Retrospective Cohort of 745 women. Excluding only women with polycystic ovarian syndrome, data from all fertility patients undergoing COH cycles during the period June, 2013 through March 2017 were studied. Women were considered to have normal Day-3 FSH with value <10 (mIU/mL), and normal AMH if values fell within age specific reference value. Clinical pregnancy rate is the cumulative pregnancy achieved after maximum of three cycles of COH with or without IUI. Chi- Square were used for statistical analysis using SPSS. Table below show as expected, concordant abnormal AMH/FSH values (Grp D) have significantly lower pregnancy rate than concordant normal (Grp A) patients. Abnormal FSH discordance (Grp C) have an intermediate pregnancy rate, statistically lower than normal concordance but significantly higher than abnormal concordant group. Patients with discordant abnormal AMH/normal FSH (Grp B) were not statistically different from abnormal concordance group but significantly lower than normal concordant group. There was no statistical difference in mean age or BMI among the four groups.Tabled 1GroupsABCD%Pregnant (n/N)64.2%(300/467)7.9%(9/114)32.2%(30/93)14.1%(10/71)Statistical comparisons: A vs. D p<0.0001; A vs B p<0.0001; A vs. C p<0.001; C vs. D p<0.04; B vs. D p>0.05(NS). Open table in a new tab Statistical comparisons: A vs. D p<0.0001; A vs B p<0.0001; A vs. C p<0.001; C vs. D p<0.04; B vs. D p>0.05(NS). To the best of our knowledge, this is the first study to investigate pregnancy outcomes in women with discordant Day-3 FSH and AMH levels after non-IVF COH fertility treatment. The data clearly indicate that women with discordant FSH and AMH levels will frequently have lower clinical pregnancy rates after fertility treatment.This investigation also showed that, irrespective of age, low AMH, whether combined with a normal or high FSH level, is predictive of poor fertility treatment outcome. Abnormal Day-3 FSH in the presence of a normal AMH is also a predictor of decreased pregnancy success but the prognosis is not as poor as when the AMH is abnormal. Our data support obtaining a Day-3 FSH value in patient with normal AMH to be able to more accurately counsel them about their prognosis for pregnancy success.