Discordance between antral follicle counts and anti-Müllerian hormone levels in women undergoing in vitro fertilization

Yangyang Zhang, Yang Xu, Qing Xue, Jing Shang, Xiuli Yang, Xuemin Shan, Yanrong Kuai, Sheng Wang, Cheng Zeng, Yangyang Zhang, Yang Xu, Qing Xue, Jing Shang, Xiuli Yang, Xuemin Shan, Yanrong Kuai, Sheng Wang, Cheng Zeng

Abstract

Background: In general, anti-Müllerian hormone (AMH) is positively associated with antral follicle count (AFC). However, there is often discordance between the AMH level and AFC in clinical practice. In cases of discordance, which indicator should be chosen to predict ovarian response and subsequently develop an ovulation induction protocol? The objective of this study was to investigate which indicator was more accurate in predicting ovarian response and pregnancy outcomes when the AMH level and AFC were discordant.

Methods: A total of 1121 infertile women undergoing IVF/ICSI were recruited in this study. During the study period, patients were subjected to individualized controlled ovarian hyperstimulation (COH) protocols according to specific characteristics. The AMH levels and AFCs were measured on days 2-3 of the menstrual cycle. Serum samples were obtained to determine AMH levels. Transvaginal ultrasound was performed to determine the AFC. All patients were divided into four groups: Group A had AFCs and AMH levels in the normal range; Group B had normal AFCs and low AMH levels; Group C had low AFCs and normal AMH levels; and Group D had low AFCs and AMH levels.

Results: Two hundred three women (18.11%) showed discordant AFCs and AMH levels. In the two groups with discordant AFCs and AMH levels, namely, Group B and Group C, the oocyte yield, good-quality embryo rate and clinical pregnancy rate were significantly higher in Group B than in Group C. The incidence of poor ovarian response (POR) was significantly lower in Group B than in Group C. According to the stratified analysis of age, for the three categories above the age of 30, oocyte yield was higher in Group B than in Group C. In all age categories, the clinical pregnancy rate was higher in Group B than in Group C.

Conclusions: Our study demonstrated that approximately one in five patients in clinical practice showed discordance between AFCs and AMH levels. In view of the AFC being better than AMH for predicting POR, the AFC should be the preferred indicator for predicting ovarian response to subsequently develop an optimal individualized COH protocol.

Keywords: Anti-Müllerian hormone; Antral follicle count; Clinical pregnancy rate; Ovarian response.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Mean oocyte number in all age categories. Among all age categories, oocyte yield was highest in Group A and lowest in Group D. Although there were no statistically significant differences in oocyte yield between Group B and Group C, oocyte yield was higher in Group B than in Group C in all age categories except for the ≤30.0age category

References

    1. Nelson SM. Biomarkers of ovarian response: current and future applications. Fertil Steril. 2013;99:963–969. doi: 10.1016/j.fertnstert.2012.11.051.
    1. Broer SL, Dolleman M, Opmeer BC, Fauser BC, Mol BW, Broekmans FJ. AMH and AFC as predictors of excessive response in controlled ovarian hyperstimulation: a meta-analysis. Hum Reprod Update. 2011;17:46–54. doi: 10.1093/humupd/dmq034.
    1. Vural B, Cakiroglu Y, Vural F, Filiz S. Hormonal and functional biomarkers in ovarian response. Arch Gynecol Obstet. 2014;289:1355–1361. doi: 10.1007/s00404-013-3132-1.
    1. Broer SL, Mol BW, Hendriks D, Broekmans FJ. The role of anti-müllerian hormone in prediction of outcome after IVF: comparison with the antral follicle count. Fertil Steril. 2009;91:705–714. doi: 10.1016/j.fertnstert.2007.12.013.
    1. Cook CL, Siow Y, Taylor S, Fallat ME. Serum müllerian -inhibiting substance levels during normal menstrual cycles. Fertil Steril. 2000;73:859–861. doi: 10.1016/S0015-0282(99)00639-1.
    1. Kelsey TW, Wright P, Nelson SM, Anderson RA, Wallace WH. A validated model of serum anti-müllerian hormone from conception to menopause. PLoS One. 2011;6:e22024. doi: 10.1371/journal.pone.0022024.
    1. Jayaprakasan K, Campbell B, Hopkisson J, Johnson I, Raine-Fenning N. A prospective, comparative analysis of anti- Müllerian hormone, inhibin-B, and three-dimensional ultrasound determinants of ovarian reserve in the prediction of poor response to controlled ovarian stimulation. Fertil Steril. 2010;93:855–864. doi: 10.1016/j.fertnstert.2008.10.042.
    1. Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L. ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011;26:1616–1624. doi: 10.1093/humrep/der092.
    1. Satwik R, Kochhar M, Gupta SM, Majumdar A. Anti- Müllerian hormone cut-off values for predicting poor ovarian response to exogenous ovarian stimulation in in-vitro fertilization. J Hum Reprod Sci. 2012;5:206–212. doi: 10.4103/0974-1208.101023.
    1. Gleicher N, Weghofer A, Barad DH. Discordances between follicle stimulating hormone (FSH) and anti- Müllerian hormone (AMH) in female infertility. Reprod Biol Endocrinol. 2010;8:64. doi: 10.1186/1477-7827-8-64.
    1. Leader B, Hegde A, Baca Q, Stone K, Lannon B, Seifer DB, et al. High frequency of discordance between anti-müllerian hormone and follicle-stimulating hormone levels in serum from estradiol-confirmed days 2 to 4 of the menstrual cycle from 5,354 women in U.S. fertility centers. Fertil Steril. 2012;98:1037–1042. doi: 10.1016/j.fertnstert.2012.06.006.
    1. Barbakadze L, Kristesashvili J, Khonelidze N, Tsagareishvili G. The correlations of anti-müllerian hormone, follicle-stimulating hormone and antral follicle count in different age groups of infertile women. Int J Fertil Steril. 2015;8:393–398.
    1. Li HW, Lee VC, Lau EY, Yeung WS, Ho PC, Ng EH. Role of baseline antral follicle count and anti-Müllerian hormone in prediction of cumulative live birth in the first in vitro fertilisation cycle: a retrospective cohort analysis. PLoS One. 2013;8:e61095. doi: 10.1371/journal.pone.0061095.
    1. Chen Y, Ye B, Yang X, Zheng J, Lin J, Zhao J. Predicting the outcome of different protocols of in vitro fertilization with anti-Müllerian hormone levels in patients with polycystic ovary syndrome. J Int Med Res. 2017;45:1138–1147. doi: 10.1177/0300060517704140.
    1. Broekmans FJ, Knauff EA, Te VE, Macklon NS, Fauser BC. Female reproductive ageing: current knowledge and future trends. Trends Endocrinol Metab. 2007;18:58–65. doi: 10.1016/j.tem.2007.01.004.
    1. Yarde F, Voorhuis M, Dolleman M, Knauff EA, Eijkemans MJ, Broekmans FJ. Anti-müllerian hormone as predictor of reproductive outcome in subfertile women with elevated basal follicle-stimulating hormone levels: a follow-up study. Fertil Steril. 2013;100:831–838. doi: 10.1016/j.fertnstert.2013.05.009.
    1. Mutlu MF, Erdem M, Erdem A, Yildiz S, Mutlu I, Arisoy O, et al. Antral follicle count determines poor ovarian response better than anti-Müllerian hormone but age is the only predictor for live birth in in vitro fertilization cycles. J Assist Reprod Genet. 2013;30:657–665. doi: 10.1007/s10815-013-9975-3.
    1. Te VE, Pearson PL. The variability of female reproductive ageing. Hum Reprod Update. 2002;8:141–154. doi: 10.1093/humupd/8.2.141.

Source: PubMed

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