Intrafollicular antimüllerian hormone levels predict follicle responsiveness to follicle-stimulating hormone (FSH) in normoandrogenic ovulatory women undergoing gonadotropin releasing-hormone analog/recombinant human FSH therapy for in vitro fertilization and embryo transfer

Abstract

Objective: To investigate the relationship between antimüllerian hormone (AMH) and steroidogenesis in follicles of normoandrogenic ovulatory women undergoing follicle-stimulating hormone (FSH) therapy for in vitro fertilization/embryo transfer (IVF-ET).

Design: Prospective cohort.

Setting: Institutional/private practice.

Patient(s): 26 normoandrogenic ovulatory women. All women received gonadotropin-releasing hormone (GnRH) analog and ovarian stimulation for IVF-ET.

Intervention(s): Follicle fluid was aspirated at oocyte retrieval from the first follicle of each ovary.

Main outcome measure(s): Follicle fluid was assayed for AMH, estradiol (E(2)), progesterone, androstenedione, testosterone, dihydrotestosterone, insulin, and FSH.

Result(s): Intrafollicular AMH levels positively and negatively correlated with E(2) and FSH concentrations in follicles, respectively, causing a positive relationship between follicle fluid AMH levels and E(2)/FSH ratios as a measure of follicle sensitivity to FSH. A positive relationship also existed in follicles between AMH levels and E(2)/androgen ratios as a marker of aromatase activity.

Conclusion(s): The AMH levels in follicles of IVF patients positively correlate with follicle sensitivity to FSH.

Figures

Figure 1

Correlations between AMH and hormone concentrations in follicles of 26 normoandrogenic ovulatory women undergoing IVF-ET. AMH levels significantly correlated with E2 (R=+0.26; P<0.025) and FSH (R=−0.74; P<0.0001) concentrations as well as E2/FSH (R=+0.70; P<0.000), E2/A4 (R=+0.26; P<0.025) and E2/T (R=+0.31; P<0.0005) ratios. Conversion to SI units, AMH* 7.14 pmol/L. The first follicle of each ovary was selected by size (at least 16 mm in diameter) and accessibility to replicate the follicle size in which AMH previously has been shown to predict enhanced oocyte development (6).