Intrafollicular anti-müllerian hormone concentrations of the preovulatory follicle are predictive of the implantation potential of the ensuing embryos obtained by in vitro fertilization

Abstract

OBJECTIVE: The strong relationship between serum anti-Müllerian hormone (AMH) levels and the number of antral follicles makes AMH a quantitative marker of the ovarian follicular status. Yet, it still is unclear whether the aptitude of an individual follicle to produce AMH reflects its reproductive competence. This study examined the relationship between serum or follicular fluid (FF) AMH concentrations and the fate of the ensuing oocytes and embryos obtained by in vitro fertilization-embryo transfer conducted in monodominant follicle cycles. DESIGN: Prospective study at the “G. Rummo” tertiary care teaching Hospital of Benevento, Italy. Patients included 132 infertile women at their first assisted reproductive technique (ART). MATERIALS AND METHODS: AMH, progesterone, and estradiol concentrations were measured in the serum on cycle d 3 and on the day of oocyte pickup (dOPU), and in FF. Cycles were sorted into three sets of three distinct groups according to whether serum d 3, serum dOPU, and FF AMH concentrations were 30th centile or below (low AMH), between the 31st and the 70th centiles (average AMH), or above the 70th centile (high AMH) of measurements. Clinical pregnancy and embryo implantation rates were assessed as main outcome measure. RESULTS: Clinical pregnancy rates (7.2, 21.0, and 43.5%, respectively; P < 0.002) and embryo implantation rates (10.8, 33.8, and 65.4, respectively; P <0.001) were markedly different among the low, moderate, and high FF AMH groups but not among the serum (d 3 or dOPU) AMH groups. Fertilization rates and embryo grading remained similar irrespective of AMH concentrations in the serum or in FF. FF AMH concentrations appeared negatively correlated with FF progesterone (r = -0.27; P <0.003) and FF estradiol (r = -0.21; P <0.02) concentrations. CONCLUSION: FF AMH concentrations, but not the serum ones, constitute a useful follicular marker of ocyte competence and embryo implantation and are negatively related to FF progesterone and estradiol concentrations.