Dados do Trabalho

Title

Increased Anti-Mullerian Hormone secretion per antral follicle is linked to decreased ovarian response after controlled stimulation for IVF

Objective

The main objective of this study is to investigate if the anti-Mullerian Hormone secretion per antral follicle is linked to ovarian response after controlled stimulation in infertile patients undergoing IVF.

Methods

We did a retrospective study with 483 patients submitted to IVF with 24 - 45 years of age, during 2015-23. All of the studied patients presented both ovaries, with no morphological abnormalities (such as cysts, endometriomas, etc.), no history of past surgery and adequately visualised in transvaginal ultrasound scans; regular menstrual cycle lengths ranging between 25 and 35 days; no current or past diseases affecting ovaries or gonadotrophin or sex steroid secretion, clearance or excretion; no clinical signs of hyperandrogenism and BMI ranging from 16 to 30 kg/m2.
The controlled ovarian stimulation protocol was initiated with recombinant FSH therapy, the individual dosage was according to the physician’s option and continued until the day of hCG administration. All included patients received GnRH antagonist (flexible protocol) and daily FSH doses were adjusted according to the number of growing follicles.
Patients were divided into two groups according to the AMH/AFC ratio. Group 1 (n=359) < 0.39 and group 2 (n=124) when this ratio reaches the 75th percentile (>0.39). The primary outcome was determined by the number of mature (MII) oocytes after pickup. P was considered significant when < 5%.

Results

Groups were comparable in age (mean ± SD) 35.6 ± 4 for group 1 and 35.1 ± 5 for group 2, p=0.293. However, AMH (2.1±1.8 versus 7.6±2.8) and AFC (11±6 versus 9±5) were significantly different between both groups (p<0.05). Moreover, the group with a higher AMH secretion per AFC presented a lower number of collected oocytes (5±3 versus 4±2 , p=0.003) and a decreased number of mature oocytes (4±3 versus 3±2) compared to the group with AMH per AFC less than 0.4, p<0.05. Considering the AMH secretion per AFC (higher than 0.39) and the individual chance to present, after controlled ovarian stimulation, less than 5 mature oocytes, the odds were 2.10, 95%CI(1.30-3.45) in this group of patients.

Conclusion

Anti-Mullerian Hormone is an essential tool for the ovarian response after gonadotropin administration. This hormone is largely used to predict and decrease the incidence of ovarian hyperstimulation syndrome. However, this anti-gonadotrophic action could be detrimental when this secretion (per AFC) is above the 75th percentile cut-off.

Keywords

anti-Mullerian Hormone, Antral Follicle count, ovarian response, controlled ovarian stimulation.