The Value Of AMH In Predicting The Clinical Outcomes Of IVF-ET: A Prospective Cohort Study

Objective:A prospective cohort study to research the relationship between AMH levels and clinical outcomes in infertile women of in vitro fertilization-embryo transfer (IVF-ET).Methods:The clinical, laboratory and follow-up data of patients with different reasons such as polycystic ovarian syndrome, diminished ovarian reserve, tubal factors of infertility who received IVF-ET in the women’s hospital, School of Medicine, Zhejiang University between January 2014 to August 2015 were reviewed. AMH levels in peripheral blood were measured before the egg retrieval surgery. Firstly, we analyzed the influence factors of IVF-ET clinical pregnancy outcomes by dividing the patients into clinical pregnancy group and no clinical pregnancy group. Secondly, prospectively compared the IVF-ET clinical outcomes of patients with different AMH levels. Thirdly, according to infertility causes, explored the AMH level and baseline levels by using single factor analysis and binary logistic regression analysis. Lastly, explored the correlation of AMH levels with different infertility causes and clinical pregnancy outcome, to predict the value of AMH in predicting clinical outcomes.Results:79 infertile patients from the center were included in the analysis. According to whether clinical pregnancy or not, single factor analysis found that clinical pregnancy patients had more numbers of optimal embryo and embryos transferred (P<0.05). There was no statistical difference in infertile time, female body mass index, age, basic endocrine hormone levels, antral follicle number, Gn using duration, Gn quantity, number of eggs, fertilization rate, good quality embryo rate. According to the levels of serum AMH, we found that AMH levels was proportional with the numbers of retrieved oocytes (P<0.05). However, AMH levels had no obvious correlation with the fertilization rate, good quality embryo rate and clinical pregnancy rate. When AMH was between 0.7 mg/L-3.5 mg/L, the periodic transplantation success rate was as high as 54.76%, yet there was no significant difference. According to the cause of infertility, single factor analysis and correlation analysis with the AMH level found that compared with tubal factors, PCOS patients had higher basal blood testosterone(TTE) level and AMH level, more antral follicle numbers, egg numbers, and lower fertilization rate(P<0.05). Similarly, compared with tubal factors, DOR patients had higher basal FSH, basal FSH/LH ratio, lower basal blood testosterone (TTE), AMH level, and less egg number (P<0.05). AMH level of pregnancy subgroup was significantly higher than no pregnancy subgroup in DOR patients(P<0.05).Conclusions:Assessing AMH levels before starting IVF-ET cycle is beneficial for predicting ovarian reserve and ovarian response, formulating optimal COS plan to avoid ovarian hyperstimulation syndrome. In some patients, especially patients with poor ovarian reserve, clinical pregnancy outcomes of IVE-ET can be predicted according to their AMH level, since AMH levels was positively correlated with pregnancy rates in DOR patients. Women with low levels of AMH can be predicted to have small number of oocytes, and women with high levels of AMH can be predicted to retrieve more oocytes, and can choose mild COS plan to avoid the occurrence of ovarian hyperstimulation syndrome. Because of the limited sample size, expanded sample size and prospective multi-center research are needed to better verify the value of AMH in predicting the clinical outcomes of IVF-ET and to provide new ideas and clues for future precision prediction.