Background: Anti-müllerian hormone (AMH) is a glycoprotein of gonadal origin belonging to the Transforming Growth Factor β family (TGF-β), secreted in women by granulosa cells. Assessment of ovarian reserve is an essential parameter in the evaluation of female infertility. It has been established that serum anti-müllerian hormone (AMH) is the best marker of ovarian reserve and predicts the quality of ovarian response to stimulation. However, there is some controversy about the prediction of pregnancy rates. Can the serum AMH assay predict the chances of successful In vitro fertilization (IVF)?
Objective: To analyze the association between AMH levels, the
number of mature oocytes obtained by oocyte puncture after stimulation and the
outcome of In vitro fertilization at the first attempt.
Methods: An analytical cross-sectional study with retrospective
data collection on 123 patients who had consulted for a desire to conceive and
undergone ovarian reserve evaluation followed by IVF in the assisted
reproduction department of the Poissy-Saint-Germain-en-Laye Intercommunal
Hospital Centre at its Poissy hospital site between January 2020 and March
2022.
Results: Of the 123 patients, 43.8% had normal AMH levels. At the
end of stimulation, almost half of patients (52.84%) had a sub-optimal ovarian
response and almost a quarter had a poor response (27.64%). We found a
statistically significant positive correlation [r = 0.42 b = 0.70 CI 95% (0.43
- 0.97) p = 0.000] between AMH level and the number of mature oocytes
collected. Of all patients with low AMH, 83.3% had a clinical pregnancy, while
61.1% of patients with normal AMH had no pregnancy. These differences were
statistically significant (p = 0.001). AMH level was significantly associated
with predicting ovarian response to stimulation and had a decreasing
association with IVF outcome. Indeed, compared with patients with low AMH
levels, those with normal AMH levels were 7 times more likely to have a good
response to stimulation [OR = 7.12 CI 95% (1.98 - 30.79) p = 0.003] and less
likely to achieve pregnancy after embryo transfer.
Conclusion: AMH assay is an important marker of ovarian reserve
and predicts ovarian response to stimulation. It correlates with the number of
mature oocytes that can be collected at puncture but does not predict the
chances of IVF pregnancy. Therefore, unless constrained by the patient’s age,
the AMH level should not justify a direct decision to donate oocytes; prior
stimulation should be attempted.
Author
(s) Details
A. A. Mwakila
Gynaecology-Obstetrics Department, Kinshasa University Clinics, University
of Kinshasa, Kinshasa, Congo.
E. J. Mboloko
Gynaecology-Obstetrics Department, Kinshasa University Clinics, University
of Kinshasa, Kinshasa, Congo.
K. D. Ngoyi
Gynaecology-Obstetrics Department, Kinshasa University Clinics, University
of Kinshasa, Kinshasa, Congo.
I. G. Likinda
Anesthesia and Intensive Care Department, Kinshasa University Clinics,
Protestant University of Congo, Kinshasa, Congo.
M. A. Mulinda
School of Public Health, University of Kinshasa, Kinshasa, Congo.
S. P. Mogwo
Gynaecology-Obstetrics Department, Kinshasa University Clinics, University
of Kinshasa, Kinshasa, Congo.
B. C. Moangi
Gynaecology-Obstetrics Department, Kinshasa University Clinics, University
of Kinshasa, Kinshasa, Congo.
B. C. Bikuelo
Gynaecology-Obstetrics Department, Kinshasa University Clinics, University
of Kinshasa, Kinshasa, Congo.
M. J. Mboloko
Gynaecology-Obstetrics Department, Kinshasa University Clinics, University
of Kinshasa, Kinshasa, Congo
Please see the book here:- https://doi.org/10.9734/bpi/msti/v10/4225
