SERUM ANTI-MÜLLERIAN HORMONE CONCENTRATIONS IMPACTS NOT ONLY THE QUANTITY, BUT ALSO THE QUALITY OF THE OVARIAN RESERVE: THE IMPORTANCE OF TIME-LAPSE IMAGING SYSTEM

Abstract

Serum anti-müllerian hormone (AMH) concentration has been implicated as the most valuable marker of the ovarian reserve, as it correlates highly with the baseline antral follicle count. The AMH has been assigned as a marker of ovarian function mainly in the assessment of the quantitative aspect of the ovarian reserve. On the other side, the predictive value of AMH on oocyte quality and embryo developmental competence is controversial. Time-lapse imaging (TLI) systems allow for the assessment of morphological changes with the exact time-point of occurrence, and may be a valuable tool to evaluate the correlation between serum AMH concentration and the competences of both oocyte and developing embryo. The goal for the present study was to evaluate whether the serum AMH concentration impacts morphokinetic events in a TLI system. This retrospective cohort study was performed in a private university-affiliated IVF center from March 2019 to December 2020 and included 902 injected oocytes from 114 ICSI cycles, cultured in a TLI incubator until the fifth day of development. The effects of serum AMH concentrations on morphokinetic events and ICSI outcomes were evaluated by taking into account clustering of data (multiple embryos per cycle), using generalized mixed models. Evaluated kinetic markers were: pronuclei appearance (tPNa), timing to pronuclei fading (tPNf), timing to two (t2), three (t3), four (t4), five (t5), six (t6), seven (t7), and eight cells (t8), and timing to blastulation (tB). Durations of the second (t3-t2) and third (t5-t3) cell cycles (cc2 and cc3, respectively) and timing to complete synchronous divisions s1 (t2-tPNf), s2 (t4-t3), and s3 (t8-t5) were also evaluated. The post hoc achieved power was > 98.0%. Inverse relationships were observed between serum AMH concentrations and faster tPNf (B: -0.047, CI: -0.071 – -0.024, p<0.001), t3 (B: -0.070, CI: -0.102 – -0.039, p<0.001), t4 (B: -0.080, CI: -0.114 – -0.046, p<0.001), t5 (B: -0.075, CI: -0.123 – -0.028, p=0.002), t6 (B: -0.105, CI: -0.147 – -0.064, p<0.001), t7 (B: -0.120, CI: -0.165 – -0.075, p<0.001), t8 (B: -0.170, CI: -0.220 – -0.119, p<0.001), and tB (B: -0.153, CI: -0.224 – -0.082, p<0.001), cc2 (B: -0.041, CI: -0.062 – -0.019, p<0.001), and s3 (B: -0.086, CI: -0.129 - -0.044, p<0.001). There was a positive association between serum AMH concentration and implantation rate (B: -19.11, CI: -29.12 - -9.11, p<0.001). No significant associations were found between serum AMH concentrations and other morphokinetic parameters or clinical outcomes. Increased serum AMH concentrations correlate with faster embryo development in a TLI incubator and implantation rates.