Analysis of the women with the AMH concentrations below the limit of reference range but with the ideal number of retrieved oocytes.

PURPOSE

Serum anti-Mullerian hormone (AMH) shows a strong positive correlation to the number of oocytes retrieved but the patients undergoing assisted reproductive technology (ART) with lower AMH concentrations also could retrieve an ideal number of oocytes sometimes. The aim of the current study was to assess the performance of this population.

METHODS

This retrospective study included a total of 44 in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment cycles as test group, in which their AMH levels were below the limit of reference range but more than 7 eggs were retrieved, and 103 control cases enrolled from May 2016 to December 2018 after matched with the same range of age from 24 to 38 years old and the same number range of retrieved oocytes from 7 to 18 and chosen randomly according to clinical ovarian stimulation protocols by the ratio of 3:7. Several parameters, which include age, basal endocrine status, number of oocytes, the maturation rate of eggs, 2PN fertilization rate, 3PN rate, total fertilization rate, cleavage rate, 8-cell embryo rate of D3 and the utilization rate of embryo, were compared and evaluated between two groups by Wilcoxon rank-sum test and t test for two independent samples.

RESULTS

Although the same age range from 24 to 38 years and the same retrieval eggs from 7 to 18, compared with the control group, the test group showed less number of oocytes collected (9.455 vs 10.767, p = 0.016), younger ages (28.36 vs 32.59, p = 0.000), and higher FSH of basal endocrine status (9.783 vs 7.338, p = 0.021). Between the two groups, there were no significant differences in parameters such as the mature eggs (7.05 vs 7.92, p = 0.079), the mature oocyte rate (74.189% vs 73.916%, p = 0.924), the number of 2PNs (5.36 vs 5.91, p = 0.236), 2PN rate (73.678% vs 75.125%, p = 0.769), the number of 3PNs (0.39 vs 0.50, p = 0.773), 3PN rate (5.104% vs 5.592%, p = 0.697), number of total fertilizations (6.77 vs 7.35, p = 0.241), total fertilization rate (96.461% vs 93.166%, p = 0.332), cleavage rate (82.003% vs 81.382%, p = 0.673), the number of 8-cells on D3 (1.59 vs 1.91, p = 0.227), the rate of 8-cell on D3 (36.259% vs 41.084%, p = 0.551) and the utilization rate of embryo (62.853% vs 61.824%, p = 0.806).

CONCLUSIONS

These findings indicate that there are no significant differences in the maturation of oocytes and the embryo quality for the women with low AMH level and ideal retrieval eggs but they should undergo IVF treatment and achieve successful pregnancy as soon as possible due to the higher basal FSH, the relatively fewer number of retrieval eggs and the possibility of coming diminished ovarian reserve (DOR) or poor respond (PR) despite their younger ages.