The effect of anti mullerian hormone and follicle stimulating hormone discordance on oocyte quality and live birth rates

Abstract

Evaluating ovarian reserve is crucial in infertility treatment to determine the appropriate approach and predict success rates. Anti-Müllerian Hormone (AMH) and Follicle-Stimulating Hormone (FSH) are key parameters commonly used for this purpose, and they usually yield consistent results. A good ovarian reserve is typically indicated when FSH is below 10 IU/ml and AMH is 1 ng/ml or higher. However, in clinical practice, these parameters often conflict, with one suggesting a good ovarian reserve while the other indicates a diminished one. AMH is known to predict oocyte count effectively, but its ability to predict live births is weaker. This study aimed to investigate which parameter is more useful in predicting oocyte count, quality, and live birth outcomes in cases of discordance. This retrospective study was conducted on 82 patients who sought infertility treatment at Assisted Reproductive Techniques Center of Gülhane Training and Research Hospital between January 1, 2016, and December 31, 2020. Data collected included age, AMH and FSH levels, number of retrieved oocytes, mature (M2) oocytes, pregnancy outcomes, and embryos obtained. Statistical analyses were performed using SPSS 25.0. Normal distribution was assessed using the Kolmogorov-Smirnov test and graphical methods. Independent t-tests and One-Way ANOVA were used for normally distributed data, with a significance level set at p=0.05. Patients were divided into two groups: AMH <1 ng/ml & FSH ≥10 IU/ml, and AMH ≥1 ng/ml & FSH <10 IU/ml. Patients with AMH <1 ng/ml were older and shorter (p<0.05). This group also had fewer retrieved oocytes and M2 oocytes (p<0.05). However, no significant differences were observed between the groups regarding live births, miscarriages, or embryo counts(p>0.05). In cases of discordance, AMH is more reliable for predicting oocyte quantity and quality, while neither AMH nor FSH is superior in predicting live birth outcomes. Both markers have limitations in estimating live birth probabilities.