Pregnancy Outcomes In Women With Discordance Between Anti-mullerian Hormone And Antral Follicle Count After Assisted Reproductive Technology

Background:In addition to female age,many other factors,such as antral follicle count(AFC),basal follicle-stimulating hormone(FSH),and anti-Mullerian hormone(AMH)levels,collectively known as biomarkers for ovarian reserve tests(ORTs),are widely used to predict ovarian responses and pregnancy outcomes of assisted reproductive technology(ART).Among them,AMH and FSH levels were discordant in 20-43%of women undergoing ART treatment,and AMH was proven to be superior in predicting live birth rate.AFC and AMH levels have been widely used to predict ovarian responses and been considered essentially interchangeable,yet discordance rate between them has been reported as 6.6-18.1 1%.However,few data have looked at the discordance of AMH and AFC in assisted reproduction outcomes.This study aims to determine whether AMH or AFC is associated with pregnancy and neonatal outcomes after ART when the test results are discordant,and to provide clues for optimal fertility counseling.Methods:A retrospective cohort study was conducted with 44,069 women with their first autologous oocytes in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI)cycles from July 2013 to January 2019 in the Reproductive Hospital Affiliated to Shandong University.The participants were categorized into four cohorts:(A)AFC<7,AMH<1.1 ng/ml;(B)AFC<7,AMH≥1.1 ng/ml;(C)AFC≥7,AMH<1.1 ng/ml;(D)AFC≥7,AMH≥1.1 ng/ml.Pregnancy and neonatal outcomes from their first fresh embryo transfer cycles were compared.In order to evaluate the impact of age,patients were stratified into two age subgroups:<35 and≥35 years.Binary logistic regression of all individuals with discrepant AMH and AFC was taken into consideration to adjust for the influences of confounding factors.Results:There were 13.03%women(n=5,740)with discordant AMH and AFC levels;of these,3.24%(n=1,427)showed less AFC but normal AMH(cohort B),while 9.79%(n=4,313)had normal AFC but low AMH(cohort C).In crude analysis,live birth rate,clinical pregnancy rate and pregnancy loss rate were comparable between cohort B and C.After stratified by age and adjusted confounding factors,equivalent pregnancy outcomes were also shown for women younger than 35 yrs.Nonetheless,women≥35yrs from cohort B showed higher clinical pregnancy rate(38.82%vs 35.56%,P-adj=0.013,OR:1.349,95%CI:1.066-1.707)and lower poor ovarian response rate(POR)(27.32%vs 35.04%,P-adj=0.001,OR:0.696,95%CI:0.5590.866)compared with those from cohort C,while the LBR was still similar(26.32%vs 26.17%,P-adj=0.322).Maternal and neonatal complications were equivalent between discordant cohorts.Conclusion:In summary,our results revealed a 13.03%discordance between AMH and AFC levels in 44,069 autologous IVF/ICSI cycles.With the definition of normal ovarian reserve test set at AMH≥1.1 ng/ml and AFC≥7,low AMH was associated with decreased clinical pregnancy and increased rate of POR in women over 35 years when it discords with AFC,yet young women(<35 years)with discrepant AMH and AFC levels had comparable pregnancy outcomes.Hence,for women aged≥35 years who have discrepant AMH and AFC levels,AMH levels may have better directive significance in clinical practice and personalized counseling.