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|Title||Antimullerian Hormone as a Predictor of Ovarian Reserve and Ovarian Response in IVF Candidates|
Background: Antimullerian hormone (AMH) is expressed only in the gonads. In male, it is secreted by immature sertoli cells and in female by adult granulosa cells of the ovary. AMH is responsible for the regression of mullerian ducts in male fetus. Absence of AMH results in development of female fetus reproductive organs and it is believed to control the formation of primary follicles. Objective: To assess AMH in early follicular phase as a predictor of ovarian reserve among females undergoing in vitro fertilization (IVF) in the Gaza Strip. Methods: In this case-control prospective study, a meeting interview was used for filling in the questionnaire. AMH was determined by enzyme linked immunosorbent assay in 162 women: 81 women undergoing IVF atAl-BasmaFertilityCenter inGazaCity (cases) and 81 healthy women, having at least given birth to one healthy child (controls). The number of oocytes and embryos were recorded for each female in the controls group and the occurrence of pregnancy was followed for the three months. Data were computer analyzed using SPSS statistical package version 13. Results: The AMH mean level in the cases was significantly higher as compared to the controls (3.5±2.3 ng/mL vs. 1.7±0.5 ng/mL; p=0.00). The AMH in cases was significantly decreased with increasing age (3.7±2.0, 3.6±2.4 and 2.1±2.1 ng/mL at ≤25, 26-35 and >35 years, respectively; F=2.327 and p=0.104). The total number of retrieved oocytes was inversely associated with age (12.5±4.5, 11.0±5.4 and 6.9±4.7 at age ≤25, 26-35 and >35 years, F=4.793 and p=0.011). Results showed that the ovarian response to Menotrophin (FSH 75IU, LH 75 IU) stimulation was better with younger age (<4, 4-8, 9-16 and >16 oocytes at mean age of 36.5±5.0, 30.6±5.9, 27.0±4.5 and 26.3±5.2, respectively; F=4.934 and p=0.003). There was a significant positive association between ovarian response in terms of total number of oocytes and AMH levels (<4, 4-8, 9-16 and >16 oocytes at 1.0±0.5, 2.3±1.8, 3.7±1.8 and 5.90±2.9 ng/mL, respectively; F=9.174 and p=0.000), implying that AMH can be used as a good predictor of ovarian reserve and ovarian response. IVF results showed that the chance of pregnancy success increased with decreased age (F=3.077 and p=0.05). Moreover, the maximum level of AMH was observed in females who achieved positive pregnancies (4.5±2.5 ng/mL) followed by negative pregnancies (2.9±1.8 ng/mL) and no cleavage (2.1±1.5 ng/mL) with significant differences (F=6.862 and p=0.002). It is worth-mentioning that AMH levels may be associated with ovarian responsiveness, but not with the probability to achieve a pregnancy. The maximum number of total oocytes was recorded in females who achieved positive pregnancies (13.7±5.1 oocytes). Correlation coefficient revealed that the number of mature oocytes showed strong positive correlation with the AMH levels (r=0.469, p=0.001). Conclusion: AMH can be used in IVF programs as a good predictor of ovarian reserve and ovarian response.
|Publisher||the islamic university|
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