anti-Müllerian Hormone Groups Research Articles

P-371 It’s worth the freeze: outcomes from thawing electively cryopreserved oocytes are comparable in patients with reduced vs normal ovarian reserve at the time of cryopreservation

Abstract Study question For patients coming back to use oocytes derived from elective cryopreservation, does their initial ovarian reserve predict thaw survival, embryos’ developmental milestones and pregnancy success? Summary answer Thaw survival, fertilization rate, embryo development and pregnancy success rates do not vary significantly according to AMH level at initial cryopreservation. What is known already Increasing numbers of patients are electing to cryopreserve oocytes for future use. AMH (Anti Mullerian Hormone) is an ovarian reserve marker often assessed prior to initiation of treatment that predicts response to fertility treatment and the resulting oocyte yield. However, it is not known whether oocytes derived from a patient with compromised ovarian reserve (perhaps over multiple treatment cycles) will fare as well as that of a patient with normal ovarian reserve and a higher per cycle oocyte yield. Our study seeks to shed light on whether a lower initial AMH level negatively impacts the prognosis of the thawed oocytes. Study design, size, duration We included in our retrospective study all oocyte thaw cycles resulting from electively cryopreserved oocytes since 1996 at a single academically affiliated fertility center. 325 patients completed a total of 510 thaw cycles. 315 cycles were excluded from analysis for no AMH information. 6376 oocyte cryopreservation cycles were performed over that timeframe. The primary outcomes were laboratory statistics including oocyte survival, fertilization and embryo blastulation rates, while the secondary outcome was cumulative live birth rates. Participants/materials, setting, methods AMH categories of < 1, 1-2 and > 2 were selected to stratify reduced, low-normal, and normal ovarian reserves, respectively. 70.7% inseminated oocytes with partner sperm while the remaining 29.3% used donor sperm. Mean age at time of oocyte cryopreservation was 36.5 (range 27.5 to 46.2) while mean age at time of oocyte thaw was 39.2 (range 27.7 to 47.5). The statistical analysis was performed using ANOVA for mean comparisons and chi-squared for pregnancy data. Main results and the role of chance Average oocyte yield per cryopreservation cycle was significantly different across AMH groups (7.7 oocytes in AMH < 1, 10.5 oocytes in AMH 1-2, and 17.2 oocytes in AMH > 2, p < 0.01). The number of treatment cycles completed was highest in patients with AMH < 1 at 1.26 cycles. Oocyte survival (mean 89.0%), fertilization rate (mean 75.3%), and blastocyst conversion rate (mean 62.4%) did not vary significantly across AMH groups. Time to oocyte use was not significantly impacted by AMH at the time of initial testing. Those with reduced AMH < 1 came back earlier to utilize the oocytes (787 days), vs 1141 days for patients with AMH 1-2 and 1021 days for patients with AMH > 2. However, this difference was not statistically significant, p = 0.4. The rate of PGT-A euploid embryos did not vary between groups (38.8% in AMH < 1, 45.3% in AMH 1-2, 53.0% in AMH > 2, p = 0.07). Clinical pregnancy, miscarriage rate, and live birth rate in the first transfer cycle was not impacted by AMH. Total cumulative live birth rate was not correlated with AMH (31.6% in AMH < 1, 44.4% in AMH 1-2, 47.8% in AMH > 2, p = 0.48). Limitations, reasons for caution This data was collected at a single fertility center and thus has limited generalizability. 8.0% of patients came back to utilize their oocytes, which varies widely across the published literature. 60.6% of patients did not have AMH assessed as part of their pre-treatment testing and were excluded from analysis. Wider implications of the findings Although reduced ovarian reserve impacts oocyte yield, many studies find no impact on resulting oocyte quality, embryo development and pregnancy success rates. Those with compromised AMH have comparable oocyte thaw outcomes to those with normal ovarian reserve, though more oocyte cryopreservation cycles may be needed to achieve a successful outcome. Trial registration number N/A

The Association of AMH Level with the Number and Quality of Oocytes in Women Undergoing IVF/ICSI: A Single-Center Study

Background: The recognized role of Anti-Müllerian hormone (AMH) as a marker for women's biological age and ovarian reserve prompts debate on its efficacy in predicting oocyte quality during IVF/ICSI. Recent findings challenging this view compelled us to conduct this study to examine the correlation between AMH levels and quantity/quality of oocytes in IVF/ICSI procedures.
 Methods: The data were collected retrospectively from the medical records of 320 women between 25-42 years old. The included patients were divided into two groups: the high AMH group (>1.1 ng/ml) and the low AMH (=<1.1 ng/ml) group. The high AMH group comprised 213 patients, while the low AMH group consisted of 107 patients. Spearman's correlation coefficient and Multinomial logistic regression were computed to assess the relationships between different variables.
 Results: Significant positive correlations were detected between AMH level and the number of aspirated follicles (rho=0.741, p<0.001), retrieved oocytes (rho=0.659, p< 0.001), M2 oocytes (rho=0.624, p<0.001), grade A embryos (rho=0.419, p<0.001), and grade AB embryos (rho=0.446, p<0.001. In contrast, AMH levels had negative associations with the number and duration of cycles (p<0.05). AMH emerged as a statistically significant independent predictor of the number of M2 oocytes.
 Conclusions: Serum AMH level could represent the quantity and quality of oocytes following IVF/ICSI treatments. Future studies should aim to delve deeper into the correlations between AMH levels and both the quality and quantity of embryos. Additionally, it would be beneficial to consider the influence of sperm factors, as well as assess pregnancy rates.

The Correlation between Sex Hormone-Binding Globulin and Clinical Characteristics According to Anti-Müllerian Hormone in Women with Regular Menstrual Cycles: A Prospective Study.

Polycystic ovarian syndrome (PCOS) can be diagnosed when the anti-Müllerian hormone (AMH) levels are high, but in clinic, women who do not meet the diagnosis of PCOS but have elevated AMH levels are often seen. This study aimed to compare the differences in menstrual cycle patterns and hormone levels in women with regular menstrual cycles, but not PCOS, by dividing them into high and low AMH groups. This multicenter prospective study included 68 healthy women. Participants with regular menstrual cycles were divided into two groups according to their AMH levels. The main outcome measures were menstrual cycle pattern, body mass index, and hormone levels (thyroid stimulating hormone, prolactin, testosterone, sex hormone-binding globulin, and free androgen index), which were compared between the groups according to AMH levels. The ovulation was assessed by performing pelvic ultrasound, and by assessing the hormone levels of the luteinizing hormone and progesterone. The criteria for determining normal and high AMH levels were based on previous literatures. The participants were divided into normal (39 people) and high (29 people) AMH group. No differences were found in age or BMI between the two groups, and no other differences were observed in TSH, prolactin, testosterone, or free androgen index. However, the high AMH group had significantly higher SHBG levels than the normal group (normal group: 65.46 ± 25.78 nmol/L; high group: 87.08 ± 45.05 nmol/L) (p = 0.025). This study is the first to analyze the association between SHBG and AMH levels in women with regular menstrual cycles. Elevated AMH levels are associated with increased levels of SHBG levels.

Sildenafil as a Salvage Treatment for Ovarian Torsion: A Rat Model

OBJECTIVE: In this study, we aimed to investigate the effect of sildenafil, acting as an anti-oxidant on the ischemic rat ovarian torsion model by pointing out ovarian reserve via AMH levels which is the best marker for oocyte pool.STUDY DESIGN: This study is an experimental animal study conducted according to the principles of the Declaration of Helsinki. Twenty-seven rats were assigned into three groups, each consisting of nine individuals. Group 1: Sham operation (laparotomy only) was performed. Group 2: The torsion group had bilateral torsion and detorsion of the ovaries. Group 3: In Sildenafil and torsion group the rats received 0.7 mg/kg sildenafil (Viagra, Pfizer, New York, ABD) intraperitoneally one hour before torsion and detorsion operation. One month after the initial operation, blood was drawn via the intra-cardiac route, and serum antimullerian hormone (AMH) concentrations were studied.RESULTS: The mean weights of the rats were similar 224 g, 229 g, and 222 g for groups 1, 2, and 3 respectively. Only one rat from Group 2(T/D) died during the experiment leaving eight rats for analysis. The mean value for AMH was 24.9227±12.19124 ng/ml and the mean value for weight was 226.22±19.200. The differences in AMH groups were not statistically significant (p=0.873)CONCLUSIONS: As a result, as is shown in our study, the ovarian reserve may not be influenced by ischemia developed by ovarian torsion or any influences could not change AMH levels. Sildenafil which was given to the rats before detorsion to protect against reperfusion ischemia was found to be ineffective on ovary reserve according to AMH assessment.

Elevated Thyroglobulin Antibody Level is Associated with Decreased Anti-Müllerian Hormone in Women of Reproductive Age.

Women with Hashimoto's thyroiditis (HT) have an increased risk of ovarian insufficiency. However, whether thyroid antibodies affect the ovarian reserve remains controversial. The aim of this study was to explore the possible relationship between anti-Müllerian hormone (AMH) and thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels in women of reproductive age. A total of 483 women between 18 and 45 years old who had their TPOAb, TgAb, thyroid-stimulating hormone (TSH), free thyroxine (FT4), and AMH levels measured on the same day were enrolled in this study. The levels of TSH, FT4, TPOAb, and TgAb, the prevalence of overt and subclinical hypothyroidism, and the positive rate of TPOAb and TgAb were compared between patients with low (below the 10th percentile), normal (10th to 90th percentile), and high (higher than the 90th percentile) AMH levels. The median AMH level was 1.72 (0.33-4.27) ng/mL. A total of 9.9% of patients had low AMH levels. The TgAb levels and the prevalence of TgAb positivity were higher in the low AMH group (37.62 (13.10-232.68) IU/mL, 35.42%) than in the normal (12.46 (10.0-67.04) IU/mL, 19.59%) and high (13.61 (10.0-95.74) IU/mL, 23.4%) AMH groups (p=0.001, p=0.040, respectively). Serum AMH levels were inversely correlated with TgAb levels (r = -0.114, p=0.013). The AMH of women of reproductive age is affected by HT. Furthermore, women with the lowest AMH level had higher levels of TgAb and a positive rate of TgAb, and high TgAb levels may cause autoimmune damage to the ovaries.

Optimal antimüllerian hormone levels in oocyte donors: a national database analysis

To study the relationship between high antimüllerian hormone (AMH) levels in oocyte donors and embryo development and pregnancy outcomes among donor oocyte recipients. Retrospective cohort study. Donor Egg Bank Database. Patients undergoing invitro fertilization using vitrified donor oocytes from 35 invitro fertilization centers in the United States between 2013 and 2021. For each recipient, the first oocyte lot that was received with a planned insemination and embryo transfer (ET) was included. Oocyte donor-recipient cycles. Ongoing pregnancy rate (OPR) per ET. A total of 3,871 donor oocyte-recipient thaw cycles were analyzed. On the basis of donor AMH serum concentration, cycles were stratified into the high AMH group (AMH ≥5 ng/mL; n = 1,821) and the referent group (AMH <5 ng/mL; n = 2,050). Generalized estimating equation models were used to account for donors that contributed more than one lot of oocytes. The number of usable embryos per lot (median [interquartile range]) was significantly increased in the high AMH group (2 [2-4]) compared with the referent group (2 [1-3]) (relative risk [RR] 1.06; confidence interval [CI] 1.01-1.12). Among recipients with a planned ET, there was no difference in OPR between the high AMH group (45.4%) and the referent group (43.5%) (RR 1.04; 95% CI 0.94-1.15). Among preimplantation genetic testing for aneuploidy cycles, the embryo euploidy rate per biopsy was similar at 66.7% (50%-100%) in both groups (RR 1.04; CI 0.92-1.17). The OPR per euploid ET among patients who used preimplantation genetic testing for aneuploidy was also comparable, at 52% in the high AMH group and 54.1% in the referent group (RR 0.95; CI 0.74-1.23). This large national database study observed that there was no association between a high level of AMH (≥5 ng/mL) in oocyte donors and an OPR in the recipient after the first ET. On the basis of these findings, recipients and physicians can be reassured that oocyte donors with a high AMH level can be expected to produce outcomes that are at least as good as donors with an AMH level (<5 ng/mL).

Effects of postpartum diseases on antral follicle count and serum concentration of Anti-Müllerian hormone in dairy cows

The antral follicle count (AFC) and Anti-Müllerian hormone (AMH) concentration are validated markers for ovarian reserve in cattle, but their use as fertility markers is controverse. Here we assessed the effects of postpartum diseases on AFC and AMH concentration, as well as the influence of parity and breed on these parameters. Cows (n = 513, mostly Holstein Friesian and Brown Swiss, parity 3.0 ± 1.8) underwent a single ultrasonography examination 28–56 days after parturition and categorized as having low (n ≤ 15 follicles), intermediate (n = 16–24 follicles), or high (n ≥ 25 follicles) AFC based on objective video analysis of recorded sequences. Blood samples for AMH determination were collected at the time of examination and animals divided into low (< 0.05 ng/ml) and high AMH (≥ 0.05 ng/ml) group, respectively. No effects of postpartum diseases or breed on either AFC or AMH groups could be observed. There was a strong interaction between parity and AFC, primiparous cows having less follicles (13.6 ± 6.2 vs. 17.1 ± 7.0, P < 0.001) than pluriparous cows. The AFC did not affect reproductive parameters or productivity of the cows. In comparison, pluriparous cows with high AMH concentration had shorter calving to first service (86.0 ± 37.6 vs. 97.1 ± 46.7 days, P < 0.05) and calving to conception (123.8 ± 51.9 vs. 135.8 ± 54.4 days, P < 0.05) intervals, but lower milk yield (8440.3 ± 2292.9 vs. 8927.9 ± 2192.5 kg, P < 0.05) compared to cows with low AMH. In conclusion, no effect of postpartum diseases on AFC or AMH concentration of dairy cows could be observed. However, an interaction between parity and AFC, as well as associations of AMH with fertility and productivity in pluriparous cows, were demonstrated.

P-176 Is there a relationship between ovarian reserve, oocyte and embryo quality in patients undergoing PGT-A?

Abstract Study question Is there a relationship between ovarian reserve, oocyte and embryo quality in patients undergoing PGT-A? Summary answer Our data revealed no relationship between percentage of aneuploid blastocysts in patients with hormonal signs of reduced ovarian reserve. What is known already Poor ovarian reserve, as determined by serum anti-mullerian hormone (AMH) and antral follicle count (AFC) levels, is a known risk factor for poor outcomes in in vitro fertilization (IVF). Ultrasound imaging is considered to be the most reliable method for measuring ovarian reserve, as it provides a direct and accurate assessment of the number of ovarian follicles. However, the relationship between ovarian reserve and oocyte quality is not well understood, and further research is needed to fully understand the implications of these test results for IVF outcomes. Study design, size, duration The present retrospective case-control study, performed between 2015 and 2021, aims to investigate the association between ORTs and the rate of euploid embryos conceived through ICSI. 680 patients underwent in vitro fertilization procedures that included blastocyst biopsy and 23-chromosome aneuploidy testing. Regardless of cycle day, a level greater than 1,2 ng/mL was regarded as normal, less than 10 antral follicles in total were associated with diminished ovarian reserve according to current knowledge. Participants/materials, setting, methods AMH and AFC were studied to determine their relationship with rates of abnormal embryo development. Patients were divided into two groups based on their baseline hormone levels. The AMH group (n = 680) had 562 individuals with normal ovarian reserve in Group 1 and 118 with lower reserve in Group 2. A similar division was made in the same group based on AFC values, resulting in 210 patients with low AFC and 348 with normal AFC. Main results and the role of chance Low AMH Group was made up of slightly older patients, as would be expected (39,9 compared with 40,41 years for group 1; P = 0,193). Patients with low AMH shown FSH levels significantly higher (P = 0,022) compared to those with normal ones. Not surprisingly, aspirated follicles, oocytes retrieved, pre-ovulatory follicles, fertilizable oocyte, fertilized oocytes and evolutionary embryos appeared significantly higher in people with normal levels of AMH (respectively P&amp;lt;0,01; P&amp;lt;0,01; P = 0,004; P = 0,013; P = 0,009; P = 0,015). This means the latter had a better oocyte quality even though they shown a comparable non-evolutionary embryo mean (P = 0,047). Regarding euploid embryos, it didn’t result in a statistically significant difference between the 2 groups (P = 0,14) AMH cohort and (P = 0,12) AFC cohort. We obtained the almost the same results taking into account AFC cohort. As expected, regarding protocols and gonadotropins used to stimulate women, our data shown a statistically significant value (P = 0,016) due to personalized protocols for women predicted as poor or normal/high responders. Limitations, reasons for caution There are many points affecting diminished ovarian reserve (DOR), linked to a variety of etiologies. However, the genetic determinants of DOR remain largely unknown. All these features don’t allow making an easy model for better studying this condition. Wider implications of the findings This study can help clinics provide more accurate and informative counseling to patients undergoing IVF, by giving them a better understanding of the factors that affect their chances of success and how they can impact their treatment. Trial registration number None

Antimüllerian hormone (AMH) and age as predictors of preimplantation genetic testing for aneuploidies (PGT-A) cycle outcomes and blastocyst quality on day 5 in women undergoing in vitro fertilization (IVF).

The objective of this study was to investigate whether women with diminished ovarian reserve who planned for PGT-A exhibit a lower number of blastocysts for biopsy, ploidy outcomes, and blastocyst quality on day 5, regardless of age. A retrospective analysis was performed between March 2017 and July 2020 at ART Fertility Clinics Abu Dhabi, including couples that were triggered for final oocyte maturation in an ovarian stimulated cycle planned for PGT-A. Patients were stratified into four AMH groups: < 0.65ng/ml, 0.65-1.29ng/ml, 1.3-6.25ng/ml, and > 6.25ng/ml; four age categories: ≤ 30, 31-35, 36-40, and > 40years. A total of 1410 couples with a mean maternal age of 35.2 ± 6.4years and AMH of 2.7 ± 2.6ng/ml were included. In a multivariate logistic regression analysis, controlling for age, the chance of having at least one blastocyst biopsied/stimulated cycle (1156/1410), the chance of having at least one euploid blastocyst/stimulated cycle (880/1410), and the chance of having one euploid blastocyst once biopsy was performed (880/1156) were affected in all patients with AMH < 0.65ng/ml [AdjOR 0.18[0.11-0.31] p = 0.008)], [AdjOR 0.18 [0.11-0.29] p < 0.001], and [AdjOR 0.34 [0.19-0.61] p = 0.015] as well as in patients with AMH 0.65-1.29ng/ml (AdjOR 0.52 [0.32-0.84] p < 0.001), (AdjOR 0.49 [0.33-0.72] p < 0.001), and (AdjOR 0.57 [0.36-0.90] p < 0.001), respectively. In a multivariate linear regression analysis, AMH values did not affect blastocyst quality (- 0.72 [- 1.03 to - 0.41] p < 0.001). Irrespective of age, patients with diminished ovarian reserve (AMH < 1.3ng/ml) have a lower chance of having at least one blastocyst biopsied and lower chance of having at least one euploid blastocyst per ovarian stimulated cycle. Blastocyst quality was not affected by AMH values.

Serum Anti-Mullerian Hormone (AMH) Levels Among Different PCOS Phenotypes and Its Correlation with Clinical, Endocrine, and Metabolic Markers of PCOS.

Anti-Mullerian hormone (AMH) is one of the direct indicators of follicular pool but no standard cutoff has been defined for diagnosis of polycystic ovary syndrome (PCOS). The present study evaluated the serum AMH levels among different PCOS phenotypes and correlated the AMH levels with clinical, hormonal, and metabolic parameters among Indian PCOS women. Mean serum AMH was 12.39 ± 5.3ng/mL in PCOS cohort and 3.83 ± 1.5 ng/mL in non-PCOS cohort (P < 0.01). Out of 608 PCOS women, 273 (44.9%) women belonged to phenotype A, 230 (37.8%) women were phenotype D. Phenotypes C and B were 12.17% and 5.10% respectively. Among those with the highest AMH group (AMH>20ng/ml; 8.05%), majority belonged to phenotype A. Menstrual cycle length, serum testosterone, fasting total cholesterol levels, and follicle number per ovary had positive correlation with serum anti-Mullerian levels (P < 0.05). AMH cutoff for the diagnosis of PCOS was calculated as ≥ 6.06 ng/mL on ROC analysis with sensitivity and specificity of 91.45% and 90.71% respectively. The study shows high serum AMH levels in PCOS are associated with worse clinical, endocrinological, and metabolic parameters. These levels may be used to counsel patients regarding treatment response, help in individualized management and prediction of reproductive and long-term metabolic outcomes.

Which is more predictive ovarian sensitivity marker if there is discordance between serum anti-Müllerian hormone levels and antral follicle count? A retrospective analysis

This retrospective study aims to determine the more predictive ovarian reserve marker when there is discordance between anti-Müllerian hormone (AMH) and antral follicle count (AFC) in patients with diminished ovarian reserve (DOR). Patients who underwent ICSI because of DOR were divided into three groups. Group 1: patients with low AMH (<1.1 ng/ml) and AFC (n < 7), group 2: patients with low AMH (<1.1 ng/ml) and normal AFC (n ≥ 7) and group 3: patients with normal AMH (≥1.1 ng/dl) and low AFC (n < 7). Demographic values, follicle output rate (FORT) score and follicle to oocyte index (FOI) score of the groups were compared. Totally, 662 cycles were enrolled in the study. There were 418 cycles in group 1, 167 cycles in group 2 and 77 cycles in group 3. As the primary result, FORT and FOI scores were higher in group 3 than the other two groups. Median FORT Score with quartiles: group 1: 100 (66–150), group 2: 71 (57–100), group 3: 136 (96–200), p<.01 – median FOI score with quartiles: group 1: 83 (50–140), group 2: 71 (40–100), group 3: 116 (66–216), p<.01. In conclusion, serum AMH level has more predictive value for stimulation success if there is discordance with AFC. Impact Statement What is already known on this subject? Female age, serum Anti-Müllerian Hormone (AMH) levels, and antral follicle count (AFC) are commonly used to assess ovarian reserve and predict response to ovarian stimulation. AMH and AFC are both positively correlated with ovarian reserve. What do the results of this study add? If there is discordance between AFC and AMH in patients with diminished ovarian reserve (DOR), the ovarian response is better in patients with high AMH and low AFC than the patients with low AMH and high AFC. What are the implications of these findings for clinical practice and/or further research? It is important to assess both AFC and AMH before controlled ovarian hyperstimulation, to predict ovarian response in DOR patients, rather than assessing AFC or AMH alone.

Serum level of Total Antioxidant Status and Malondialdehyde in the Patients with Polycystic Ovarian Syndrome: a Comparative Study

Background: Polycystic ovary syndrome (PCOS) is a complex endocrine disorder in women of reproductive age and a major cause of infertility. Anti- Mullerian Hormone (AMH), a valid marker of ovarian function, is used for the diagnosis of PCOS. The aim of this study is to assess the serum level of total antioxidant status (TAS) and malondialdehyde (MDA) in the premenopausal women with PCOS. &#x0D; Methods: A cross-sectional analytical study was conducted at Padmashree Diagnostics, Department of Gynecology, India from April 2016 to March 2017. Census method was used to select the samples. The oxidative stress was measured by measuring the level of TAS and MDA. The data was recorded in structured proforma and and enter in SPSS version 16.0. The data were expressed in frequency, percentage, mean and standard deviation and the results obtained were analyzed using pearson’s correlation and student’s t-test. The p-value less than 0.05 was taken as statistically significant.&#x0D; Results: The measured serum AMH level among the patients with PCOS was within normal range in 67.5% (27) and above normal range in 32.5% (13). The serum TAS level in normal AMH group was 814.0 + 291 µMol/L and in above normal range group was 720 + 240 µMol/L, (p &lt;0.001). Similarly, the serum level of MDA in normal AMH group was 6.64 + 0.21 µMol/L, and in above normal range group was 8.78 + 0.22 µMol/L (p = 0.01). The measured level of AMH was significantly associated with the increased level of MDA (p&lt;0.001) and decreased level of TAS (p&lt;0.001). The measured MDA level in high AMH group did show statistically significant than the normal AMH group.&#x0D; Conclusions: Serum level of TAS and MDA along with AMH are valuable diagnostic biomarker for the diagnosis of PCOS in the resource poor settings where ultrasound facility is unavailable.

P–636 Anti-Müllerian-Hormone levels are not correlated to the probability of obtaining an ongoing pregnancy and time to pregnancy in women undergoing intra-uterine inseminations with donor sperm

Abstract Study question Is Anti-Müllerian hormone (AMH) level associated with the probability of obtaining an ongoing pregnancy (OP) and with time to pregnancy (TTP) in women undergoing d-IUI? Summary answer AMH is neither associated with the probability of obtaining an OP nor with time to pregnancy (TTP) in women undergoing d-IUI What is known already Anti-Müllerian hormone (AMH) is a glycoprotein produced by the granulosa cells of preantral and antral follicles. While AMH has been widely recognized as a quantitative marker of ovarian reserve used to predict ovarian responsiveness to ovarian stimulation in IVF, its relationship with fecundability in spontaneous conceptions is still a matter of debate. There is currently no consensus on the role of AMH on time to pregnancy in unassisted conceptions. The question of whether AMH is a qualitative marker of oocyte quality is therefore still unanswered. Study design, size, duration This prospective cohort study was carried out between 9/1/2017 and 12/30/2020 on 592 women aged 19 to 44, who underwent d-IUI in a natural cycle (n = 1788) the day after LH peak. Patients were single, homosexual, or heterosexual with an infertile partner and underwent 1 to maximum 6 d-IUI. All patients had regular ovulatory cycles and bilateral tubal patency confirmed before starting d-IUI. AMH evaluation was performed within the previous 3 months of the first d-IUI. Participants/materials, setting, methods The primary outcomes were the likelihood of obtaining an OP (&amp;gt;14 weeks) and TTP calculated as the number of d-IIU up to an OP. Multivariate logistic regression was used to compare the probability of obtaining an OP according to age and AMH levels. Kaplan-Meier curves with log-rank test were used to assess the TTP stratified by age groups (≤35, &amp;gt;35 to ≤ 39, and &amp;gt; 39 years old) and AMH groups (&amp;lt; 1ng/mL and ≥ 1ng/mL). Main results and the role of chance AMH levels were negatively correlated with age (p &amp;lt; 0.001). OP were significantly lower with increasing age (OR 0.92 (0.89–0.95) p &amp;lt; 0.001) but did not differ according to AMH levels (OR 1.07 (0.97–1.18) p = 0.18). When adjusting for AMH, the association between age and OP remained significant (OR 0.91 (0.88–0.95)). TTP was significantly different between age groups: ≤35 years old (n = 338), &amp;gt;35 to ≤ 39 years old (n = 136) and &amp;gt; 39 years old (n = 118) (p &amp;lt; 0.001), but did not differ significantly according to AMH levels &amp;lt; 1ng/mL (n = 130) and ≥1ng/mL (n = 462)(p = 0.55). Limitations, reasons for caution Our results concern d-IUI and can therefore not be extrapolated to natural conception. However, the study model is close to natural fecundity as there was no history of female infertility and as all IUI were performed on the day of ovulation with donor sperm proven to be fertile. Wider implications of the findings: While measuring AMH seems necessary for gonadotropin dose adjustment in ART, our data suggest that it cannot qualitatively assess fertility outcome and should therefore not be used routinely for preconception counseling in the absence of infertility history. Trial registration number P2017/396

P–698 Antimüllerian Hormone (AMH) value as a predictive marker of cycle ploidy outcome

Abstract Study question Do woman with diminished ovarian reserve exhibit poor blastocyst formation and ploidy outcomes, irrespective of age? Summary answer Patients with extreme diminished ovarian reserve (AMH≤0.65ng/ml) have a lower chance to have at least one euploid blastocyst compared to their age-related reference population (AMH=1.3–6.25ng/ml). What is known already AMH is an established marker of the ovarian reserve for predicting ovarian response to ovarian stimulation and it is strongly correlated with female age. However, it has been suggested that AMH is not only a quantitative, but also a qualitative biomarker of oocyte/embryo competence. Previous studies show conflicting outcomes as to whether reduced ovarian reserve per se is associated with decreased oocyte developmental competence, leading to increased aneuploidy rates in embryos independent of the patient’s age. Study design, size, duration A retrospective analysis was performed between March 2017 and July 2020 at ART Fertility Clinics (Abu Dhabi) including all couples that were triggered for final oocyte maturation and planned for Preimplantation Genetic Testing for Aneuploidies (PGT-A). Patients were stratified into four age categories [≤30, 31–35, 36–40, &amp;gt;40 years]. For each age category patients were further divided into three AMH groups: ≤0.65ng/ml, 0.65–1.3ng/ml and 1.31–6.25ng/ml (reference group). Participants/materials, setting, methods Trophectoderm biopsy samples were subjected to Next Generation Sequencing. AMH serum levels (ng/ml) were determined using the commercial fully automated Elecsys® (Roche) assay. Patients with a Progesterone rise of &amp;gt; 1.5ng/ml on the day of final oocyte maturation and patients with AMH values &amp;gt;6.25ng/ml were excluded from the analysis. Per patient that was triggered, the chance to have at least one euploid blastocyst in that cycle, was calculated. Main results and the role of chance A total of 1.300 couples were included with an mean maternal age of 35.6±6.2 years, AMH of 2.1 ±1.5ng/ml and body mass index of 27.5±5.0 kg/m2. The chance to have at least one blastocyst biopsied per cycle was affected in all patients with extreme low AMH (≤0.65ng/ml), irrespective of age; ≤30 years: 58.33%–100.00%–94.84% (p &amp;lt; 0.001); 31–35 years: 50.00%–74.55%–95.32% (p &amp;lt; 0.001); 36–40 years: 56.52%–81.93%–92.56% (p &amp;lt; 0.001) and ≥40 years: 38.06%–73.02%–88.24% (p &amp;lt; 0.001), for AMH ≤0.65ng/ml, 0.65–1.3ng/ml and 1.31–6.25ng/ml, respectively. In all age categories, patients with AMH values ≤0.65ng/ml had a significantly reduced probability of having a euploid blastocyst compared to the reference group (1.31–6.25ng/ml). For women ≤30 years the chances of getting a euploid blastocyst decreased from 88.89% (n = 252) to 41.67% (n = 12) (OR 0.01 [0.03–0.30], p &amp;lt; 0.001), for 31–35 years from 88.09% (n = 235) to 43.75% (n = 32) (OR 0.10 [0.05–0.23], p &amp;lt; 0.001), for 36–40 years from 77.67% (n = 215) to 21.74% (n = 69) (OR 0.08 [0.04–0.15], p &amp;lt; 0.001) and among women &amp;gt;40 years from 29.42% (n = 102) to 6.45% (n = 155) (OR 0.16 [0.08–0–36], p &amp;lt; 0.001). Woman within AMH range of 0.65–1.3ng/ml presented the same decreased probability of having a euploid blastocyst only when 31–35 (52.73%, n = 55) or 36–40 years old (56.63%, n = 83) (OR 0.15 [0.08–0.29], p &amp;lt; 0.001 and OR 0.37 [0.22–0.64], p &amp;lt; 0.001, respectively). Limitations, reasons for caution The main limitation of this study is its retrospective design. Wider implications of the findings: AMH is a clear biomarker of oocyte-embryo competence. Incorporation of AMH-specific counseling recommendations into clinical practice guidelines, could lead to a more informed guidance on cycle ploidy outcomes, rather than age alone. Trial registration number Not applicable

Pretreatment antimüllerian hormone levels and outcomes of ovarian stimulation with gonadotropins/intrauterine insemination cycles

To evaluate the association, if any, between serum antimüllerian hormone (AMH) levels and probability of clinical pregnancy and spontaneous abortion (SAB) in the infertility setting. Retrospective cohort study. Academic fertility center. A total of 1,861 gonadotropin stimulation/intrauterine insemination cycles stratified by AMH levels into 3 groups: Low, <25th percentile (<0.7 ng/mL); Middle, ≥25th and <75th percentile (0.7-4.4 ng/mL); and High, ≥75th percentile (≥4.5 ng/mL). Intrauterine insemination after stimulation with gonadotropins. Cumulative probability of clinical pregnancy over a maximum of 3 and/or 6 cycles and SAB incidence risk rate (IRR). The Kaplan-Meier failure function (log rank test), Cox proportional hazards models, and multilevel mixed-effects Poisson regression models were performed to compare outcomes among the AMH groups. Overall, in both unadjusted and adjusted models, the probability of achieving a clinical pregnancy was higher in the Middle and High AMH groups compared with that in the Low AMH group, both over 3 (hazard ratios [95% confidence interval], 1.55 [1.05-2.29] and 1.85 [1.22-2.81], respectively) and 6 (1.71 [1.17-2.48] and 2.12 [1.42-3.16], respectively) cycles. In the unadjusted models, the SAB IRR was higher among the Low AMH group (IRR [95% confidence interval], 2.17 (1.11-4.24]), with the relationship persisting after adjusting for age (1.83 [0.93-3.60]). When the SAB IRR were calculated separately for the subpopulations with and without polycystic ovary syndrome, a similar relationship was noted among the latter in the unadjusted (1.94 [0.97-3.88]) and adjusted (1.74 [0.86-3.49]) analyses. In women undergoing gonadotropin stimulation/intrauterine insemination, AMH appears to affect the probability of achieving a clinical pregnancy. A possible negative impact, independent of age, on the risk of SAB was also suggested.

Characterizing Anti-Müllerian Hormone (AMH) concentration and change over time in Holstein dairy cattle

The objective of this study was to characterize circulating Anti-Müllerian Hormone (AMH) concentrations in a population of Holstein heifers and examine the impact that life events and stage of life have on those concentrations. Virgin, Holstein heifers (n = 105) 13 ± 0.8 months old were heat detected using tail-chalk, bred via artificial insemination and pregnancy checked 32+ days later. Serum samples for AMH were collected upon enrollment (heifer), at 5–20 days in milk (fresh) and at 45–60 days in milk (pre-breeding). Transrectal ultrasonography was performed upon enrollment (heifer) and at 45–60 days in milk (pre-breeding) to determine antral follicle count (AFC), cyclicity status, and uterine health. Heifers were blocked into thirds by AMH concentration: HIGH (>354 pg/mL; n = 34), MID (183–354 pg/mL; n = 35) and LOW (<183 pg/mL; n = 36), with distribution re-evaluated at subsequent samplings (fresh, pre-breeding). As heifers, age and conception risk to first service were not impacted by AMH (P > 0.05). Reason for leaving the herd, health incidences and calving difficulty were not impacted by AMH (P > 0.05). AFC and cyclicity had a positive impact on heifer AMH (P < 0.01). AFC and AMH in heifers were highly correlated (0.56, P < 0.001). AFC for heifers differed by AMH group with the HIGH group having the greatest AFC (8.76), followed by the MID (5.87), then the LOW (3.53) group (P < 0.0001). However, this association was not evident in the pre-breeding group (P > 0.05). From the heifer to the fresh sample, average AMH dropped from 313.15 pg/mL to 160.01 pg/mL (P < 0.0001). Average AMH at the pre-breeding sample was 183.23 pg/mL, which was lower than the heifer sample (P < 0.0001), but not different from the fresh sample (P > 0.05). AFC and AMH at the heifer sample had a positive impact on AMH at the fresh sample (P < 0.01) and pre-breeding AMH was positively impacted by both the fresh and heifer AMH concentration (P < 0.001). Most animals kept their AMH categorization through all three time points with more of the LOW AMH animals maintaining their categorization than the other groups. However, 32.1% of animals changed their AMH categorization from the heifer sample to the fresh sample, with 53.8% moving to a lower AMH categorization (corresponding to lower AMH) and 46.2% moving to a higher AMH categorization (corresponding to higher AMH). No differences were seen in circulating AMH based on health events however, differences in AMH concentration over time indicate a drop in circulating AMH post-calving. Circulating AMH concentration as a pre-breeding heifer is highly indicative of circulating AMH concentration as a first lactation animal and may be used to predict an adult animal’s AMH concentration. However, it is necessary to compare AMH concentrations to herdmates as published AMH values vary widely from herd to herd. In addition, sampling time should be considered when determining AMH categorization of animals as circulating AMH concentration immediately post-calving may not be indicative of an animal’s true AMH categorization.

High anti-Müllerian hormone levels might not reflect the likelihood of clinical pregnancy rate in IVF/ICSI treatment.

Objective:To investigate if high anti-Müllerian hormone (AMH) concentration is a useful tool to predict the outcome of assisted reproductive treatment.Methods:Retrospective cohort study involving 520 patients who underwent IVF/ICSI procedures in a university hospital. We measured the serum AMH level on day 3 of the menstrual cycle. Based on AMH levels, we divided the patients into three groups as follows: low (<25th percentile) AMH group, average (25th to 75th percentile) AMH group and high (>75th percentile) AMH group. We recorded the fertilization rate (FR), the number of oocytes retrieved, the number of good quality embryos (GQEs) and the clinical pregnancy rate (CPR).Results:There was no difference between the three AMH groups in terms of maternal age, body mass index (BMI), follicle-stimulating hormone (FSH), estradiol (E2), luteinizing hormone (LH) and testosterone (T) in the IVF/ICSI cycles. The women in the high serum AMH group had a higher number of retrieved oocytes than those in the low or average AMH groups (p < 0.01) in the IVF/ICSI cycles. Compared with the low or average AMH groups, the women with high AMH levels had a higher number of good quality embryos (GQEs) in the IVF/ICSI cycles (p < 0.01). However, high AMH women had no significantly higher clinical pregnancy rate (CPR) compared to the women in the low or average AMH groups. In addition, for the prediction of CPR, the AMH levels alone were not an independent predictor of CPR for IVF and ICSI cycles in the ROC curve analysis.Conclusions:High anti-Müllerian hormone levels are an independent predictor of the number of retrieved oocytes and good quality embryos (GQEs), but might not reflect the likelihood of higher clinical pregnancy rates (CPR) in IVF/ICSI treatment.

Live birth outcomes from IVF treatments in younger patients with low AMH.

Objective:Anti-Müllerian hormone (AMH) is used to predict in vitro fertilization outcomes. However, predicting live birth is difficult in younger patients with low AMH. Thus, this study aimed to determine the live birth rates from younger patients with low anti-Müllerian hormone levels.Methods:A total of 296 infertile patients with AMH measured (younger group, aged 25-38 years; older group, aged 39-42 years) were included in this study. In vitro fertilization outcomes between patients with AMH levels of <1.0ng/mL and ≥1.0ng/mL were compared.Results:Younger patients with AMH levels <1.0ng/mL (younger low AMH group) exhibited lower number of oocytes retrieved than patients with AMH levels ≥1.0ng/mL (younger normal AMH group). However, there were no significant differences in cumulative pregnancy or cumulative live birth rates between groups. Older patients with AMH levels ≥1.0ng/mL (older normal AMH group) had significantly better outcomes as per mean number of oocytes, cumulative pregnancy rate, and cumulative live birth rate than older patients with AMH levels <1.0ng/mL (older low AMH group). In the younger low AMH group, the frequency of oocyte retrieval was significantly higher in patients who achieved live birth. In addition, the blastocyst transfer rate was significantly higher in individuals with live births versus subjects with non-live births.Conclusions:AMH is a predictor of live birth among older, but not younger, women. Our report suggests that younger women may become pregnant even with low AMH levels when they obtain blastocysts from frequent oocyte retrievals.

88 Plasma anti-Müllerian hormone as a marker for ovarian follicular population and oocyte quality in alpacas

The limited success of embryonic transfer technique in alpacas is related to the high variability of superovulation protocols, the response to which depends on, among other factors, the number of antral follicles growing along a follicular wave. The concentration of anti-Müllerian hormone (AMH) is correlated with antral follicle count, making it a reliable biomarker for identifying the number of available follicles and allowing us to ensure the reproductive potential of females. Studies in different production animals exist, but, thus far, no published studies exist on the use of AMH as a biomarker in alpacas. Thus, its study is necessary in order to be able to choose the best donors for embryonic transfer, reducing response variability and unnecessary expenses in superovulation protocols. The objective of this study was to determine whether AMH is a reliable marker for the number of follicles and quality of oocytes in an induced follicular wave in alpacas. We used 52 female, nonpregnant Suri alpacas of reproductive age (3–7 years), with a body condition score between 2.5 and 3.5 (where 1 is extremely thin and 5 is obese), and with the presence of a preovulatory follicle (diameter ≥7mm) determined through transrectal ultrasound. Blood samples were collected from nonpregnant Suri alpacas 5 days post-induction of ovulation and divided into groups according to AMH concentration. AMH concentrations were then correlated with the number of follicles and percentage by sizes of follicles using the least significant difference test with adjusted means. To relate the quality of oocytes with the AMH concentration groups, a Chi-square test was used. The high-AMH group had a greater number of follicles than the low-AMH group (20.51±2.76 vs. 11.58±2.55; P=0.036). There were no significant differences between AMH groups and percentage of follicle sizes. However, the high-AMH group had a greater percentage of follicles 3- to 7-mm long (67.49%). Furthermore, the high-AMH group showed dependence on the quality of oocytes (P=0.02). These results indicate that the plasma concentration of AMH can be a reliable marker for follicle and oocyte quality in Suri alpacas. Future investigations are needed to ensure the optimal timing to collect blood samples, a kit individualized to the species, and improvement of the future donors for current superovulation protocols in alpacas.

The correlation between AMH and number of embryos in POSEIDON groups: a retrospective cohort study

Research questionWhat is the association between serum anti-Müllerian hormone (AMH) concentrations and the number of utilizable embryos obtained per stimulation cycle of IVF/intracytoplasmic sperm injection (ICSI) in POSEIDON Groups 3 and 4? DesignRetrospective cohort study of 412 cycles, in which patients in POSEIDON Groups 3 and 4 (antral follicle count [AFC] ≤5 and AMH <1.2 ng/ml) underwent complete IVF/ICSI treatment cycles in the Reproductive Center of the First Affiliated Hospital of Xinjiang Medical University between January 2017 and March 2019. Patients underwent IVF/ICSI treatment using either progestin-primed ovarian stimulation (PPOS) or gonadotrophin-releasing hormone (GnRH) antagonist protocol as ovarian stimulation protocol. ResultsThree models were established to analyse the correlation between AMH and the number of utilizable embryos in this study. After adjusting for covariates (age, baseline FSH, stimulation protocol and AFC), the number of embryos increased by 0.1 (95% confidence interval [CI] 0.06–0.14) with each increment of 0.1 ng/ml in AMH concentration. AMH was transformed from a continuous variable to a categorical variable (through trisection of AMH concentrations) and for the sensitivity analysis it was found that the number of embryos in the high AMH group (0.52–1.19 ng/ml) was 0.62 (95% CI 0.37–0.97) higher than in the low AMH group (0.06–0.24 ng/ml). ConclusionsHigh AMH in patients in POSEIDON Groups 3 and 4 was found to be associated with an increase in the number of available embryos in IVF/ICSI. The potential reproductive prognosis can be assessed by AMH, to reduce the abandonment of treatment due to underestimation or to implement multiple ineffective stimulation cycles of treatment.