Anti-mullerian Hormone And Ovarian Response And Pregnancy Outcome

Objective:To explore the predictive value of anti-Mullerian hormone (AMH/MIS) level during different phases of in vitro fertilization and embryo transfer (IVF-ET) treatment cycle on ovarian response and clinical-pregnancy outcome.Methods:A total of 60 patients undergoing IVF was prospectively recruited. On day 2-4 of the menstrual cycle, levels of serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) were measured by enzyme-linked fluorescent assay. Serum AMH levels were measured on day 2～4 of the menstrual cycle, day 5 gonadotropin (Gn)administration and hCG administration by enzyme-linked immunosorbent assay (ELISA); and ultrasound evaluation of ovarian antral follicle count (AFC). Age, body mass index (BMI), number of oocytes retrieved, mature oocytes, top quality embryo et al were recorded. The primary outcome measure of the study were the number of oocytes retrieved and poor ovarian response. Poor response was defined as fewer than five oocytes were retrieved; normal response was defined as more than five; those patients with OHSS were assigned to the OHSS group. The secondary outcome measure was clinical pregnancy. SPSS11.5 was applied for analysing each of the corresponding parameters between groups.Results:(1) The AMH levels on the basal line, day 5 Gn administration and hCG administration were significantly lower in poor ovarian responders than in the normal responders and ovarian hyperstimulation syndrome, the difference was statistically significant (p＜0.05); the AMH levels on the three different phases of IVF-ET were significantly higher in OHSS patients than in the normal responders, the difference was statistically significant (p＜0.05)(2) Day 2-4, day 5 Gn adminstration and hCG administration AMH were not statistically significantly different in pregnant and non pregnant group (p＞0.05) (3) Day 2～4, day 5 Gn adminstration and hCG administration AMH show a good discriminatory potential for predicting poor response (area under the receiver operating characteristics cerves,0.923,0.932and0.934, respectively).Conclusions:(1)The serum AMH levels of different phases during the IVF-ET treatment cycle can predicted ovarian poor response better than clinical indicators used currently, the sensitiving is better. (2) The serum AMH levels of different phases during the IVF-ET treatment cycle can not predict the outcome of pregnancy. (3)For ovarian poor responder, the AMH level on day 2～4 of the menstrual cycle, day 5 Gn administration and hCG administration, the each Cut-off value 1.72ng/ml,0.87 ng/ml,0.28 ng /ml as the criterion, the sensitivity and specificity of prediction can reach 80%.