Oocyte yields per anti-müllerian hormone (AMH) at different female ages change with advancing female age: a new tool to assess oocyte quality?

Abstract

Oocyte yields and anti-Müllerian hormone (AMH), reflecting functional ovarian reserve (FOR), decline with advancing female age. Whether they do so in parallel is unknown, and may reflect oocyte quality. Cohort study. We investigated 598 consecutive 1st IVF cycles in 62 oocyte donors and 536 infertility patients by establishing oocyte/AMH ratios, and tracking mean ratios over advancing age. Oocyte donors, after down-regulation with long agonist, were stimulated with 150-300 IU of gonadotropins. Suffering from diminished ovarian reserve, over 90% of infertility patients were stimulated with microdose agonist protocols and 450-600 IU of gonadotropins daily. The rest were down-regulated in a long luteal phase agonist protocol, and stimulated with 225-375 IU of gonadotropins. Oocyte/AMH ratios to a significant degree increase with advancing female age (R2 = 0.022; t = 3.561; P=< 0.0001), reflecting increasing oocyte production per AMH and/or decreasing AMH production per oocyte. Since AMH inhibits follicle recruitment, and attenuates FSH effects on small developing follicles, here reported findings demonstrate in a new way that the complex process of follicle maturation changes with advancing female age. These data are, thus, supportive of a new concept of ovarian aging, which no longer assumes that resting follicles/oocytes, prior to recruitment, age as women age, but, instead, that perpetually young, unrecruited oocytes enter into an aging ovarian environment for follicle maturation, which negatively affects evolving oocyte quality [Reprod Biol Endocrinol 2011;9:23]. The oocyte/AMH ratio, therefore, deserves further investigation as a promising tool in objectively assessing oocyte quality. It may also in future lend itself to assessments of treatment success with pharmaceutical agents meant to improve aging ovarian environments.