The relationship between anti-müllerian hormone and aneuploidy in reproductive-age women undergoing preimplantation genetic testing; is there a correlation?

Abstract

The primary objective of this study was to investigate whether there is a correlation between serum anti-Müllerian hormone (AMH) levels and embryo chromosomal abnormality as determined by pre-implantation genetic testing for aneuploidy (PGT-A), and whether this differs by patient age. This is a retrospective single-institution study. Demographics of patients undergoing in vitro fertilization (IVF) with PGT-A during a 4-year period were recorded, as well as characteristics of their resultant embryos. There were 1653 IVF/PGT-A cycles performed by patients who also had a serum AMH assay measured at our institution; patients who had AMH drawn elsewhere were not included in this study. The percent of euploid embryos per number of embryos biopsied and cryopreserved at day 5/6 of embryogenesis was calculated for each IVF cycle. Patients were separated into two age groups: less than 39 yo and greater than or equal to 39 yo. AMH values were classified as low if <1.0 and normal if ³1.0. Statistical analysis was performed by using the Kruskal-Wallis and Chi-square tests as appropriate. Of the 1653 IVF/PGT-A cycles analyzed, 1266 cycles included patients who had an AMH ³1.0, and 387 had an AMH <1.0. We further stratified the patients by age (<39and ³39yo).A total of 735 cycles included patients who were <39yo, and 531 were ³39yo. For women who were <39yo, there was an average of 48.2% euploid embryos per IVF/PGT-A cycle for those with an AMH ³1.0,compared to women <39yo with an AMH <1.0 for whom there was an average of 40.1% euploid embryos per cycle (p=0.01). For women ³39yo with an AMH ³1.0,there was an average of 16.9% euploid embryos per IVF/PGT-A cycle, compared to those with an AMH <1.0for whom there was an average of 15.4% euploid embryos per cycle (p=0.062). The relationship between serum AMH levels and embryo chromosomal abnormality in patients undergoing IVF with PGT-A has yet to be determined. Previous studies have limited data pertaining to the relationship between AMH and aneuploidy prior to embryo transfer (ET) and conception in patients utilizing IVF. Most research on this subject has been disparate in terms of how and when these serum assays were obtained, and without controlling for the use of IVF. Additionally, most studies measured AMH during a clinical pregnancy, at which time AMH levels will be suppressed physiologically. The results from our study found that in women less than 39yo, AMH is significantly correlated with percent euploid embryos per the number of embryos biopsied in a given IVF/PGT-A cycle. No significant difference was found in women greater than or equal to 39yo. Therefore, it is reasonable to expect that women of younger reproductive age to have a disparity in terms of yield of euploid embryos after IVF/PGT-A depending on ovarian reserve as determined by AMH level, and to discuss it with our patients as part of IVF/PGT-A counseling.