Document Type : Original Article

Authors

1 Obstetrician and Gynecologist, Mehr Fertility Research Center, Guilan University of Medical Sciences, Rasht, Iran

2 Developmental Biologist, Mehr Fertility Research Center, Guilan University of Medical Sciences, Rasht, Iran

3 Embryologist, Mehr Fertility Research Center, Guilan University of Medical Sciences, Rasht, Iran

4 Statistician, Mehr Fertility Research Center, Guilan University of Medical Sciences, Rasht, Iran

5 Midwife, Mehr Fertility Research Center, Guilan University of Medical Sciences, Rasht, Iran

6 Professor, Embryologist, Mehr Fertility Research Center, Guilan University of Medical Sciences, Rasht, Iran

Abstract

Background: While anti-Müllerian hormone (AMH) level allows quantitative evaluation of ovarian reserve, its predictive value for live births following assisted reproductive technology cycles has remained controversial. The aim of the present study was to assess the importance of AMH in predicting live birth following intrauterine insemination (IUI) in the case of low or very low ovarian reserve.
Methods: In this retrospective cohort study, 123 patients with AMH≤1 ng/ml, who underwent a total of 137 IUI cycles were enrolled and evaluated for live birth rate. Patients were divided into two groups based on serum AMH levels: group 1 with low level of AMH (0.4-1 ng/ml, n=83, cycles: 95) and group 2 with very low level of AMH (≤0.4 ng/ml, n=40, cycles: 42). The results were compared between the two groups. Main outcome was the pregnancy rate.
Results: The rates of biochemical pregnancy, clinical pregnancy and live birth in all patients were 11%, 8% and 7.3%, respectively. The two groups showed no significant difference in the rates of biochemical pregnancy (10.4% vs. 14.3%, p=0.3), clinical pregnancy (6.3% vs. 11.9%, p=0.2) and live birth (6.3% vs. 9.8%, p=0.5). In univariate regression analysis, baseline characteristics and ovarian stimulation parameters showed no significant relationship with the rates of pregnancy and live birth.
Conclusion: In women with AMH≤1 ng/ml, serum levels of AMH did not appear to reflect pregnancy outcomes and live births following IUI. It can be concluded that in women with low or very low levels of AMH, there is chance of pregnancy, and live birth following IUI.

Keywords

  1. La Marca A, Sighinolfi G, Radi D, Argento C, Baraldi E, Artenisio AC, et al. Anti-Müllerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update 2010; 16(2):113-30.
  2. Nardo LG, Gelbaya TA, Wilkinson H, Roberts SA, Yates A, Pemberton P, et al. Circulating basal anti-Müllerian hormone levels as predictor of ovarian response in women undergoing ovarian stimulation for in vitro fertilization. Fertil Steril 2009; 92(5):1586-93.
  3. Riggs R, Kimble T, Oehninger S, Bocca S, Zhao Y, Leader B, et al. Anti-Müllerian hormone serum levels predict response to controlled ovarian hyperstimulation but not embryo quality or pregnancy outcome in oocyte donation. Fertil Steril 2011; 95(1):410-2.
  4. Tremellen K, Kolo M. Serum anti‐Mullerian hormone is a useful measure of quantitative ovarian reserve but does not predict the chances of live‐birth pregnancy. Aust N Z J Obstet Gynaecol 2010; 50(6):568-72.
  5. La Marca A, Giulini S, Tirelli A, Bertucci E, Marsella T, Xella S, et al. Anti-Müllerian hormone measurement on any day of the menstrual cycle strongly predicts ovarian response in assisted reproductive technology. Hum Reprod 2006; 22(3):766-71.
  6. Gleicher N, Weghofer A, Barad DH. Anti-Müllerian hormone (AMH) defines, independent of age, low versus good live-birth chances in women with severely diminished ovarian reserve. Fertil Steril 2010; 94(7):2824-7.
  7. Weghofer A, Dietrich W, Barad DH, Gleicher N. Live birth chances in women with extremely low-serum anti-Mullerian hormone levels. Hum Reprod 2011; 26(7):1905-9.
  8. Kedem A, Haas J, Geva LL, Yerushalmi G, Gilboa Y, Kanety H, et al. Ongoing pregnancy rates in women with low and extremely low AMH levels. A multivariate analysis of 769 cycles. PLoS One 2013; 8(12):e81629.
  9. Reijnders IF, Nelen WL, IntHout J, van Herwaarden AE, Braat DD, Fleischer K. The value of Anti-Müllerian hormone in low and extremely low ovarian reserve in relation to live birth after in vitro fertilization. Eur J Obstet Gynecol Reprod Biol 2016; 200:45-50.
  10. Łukaszuk K, Kunicki M, Liss J, Bednarowska A, Jakiel G. Probability of live birth in women with extremely low anti-Müllerian hormone concentrations. Reprod Biomed Online 2014; 28(1):64-9.
  11. Freiesleben N, Rosendahl M, Johannsen TH, Løssl K, Loft A, Bangsbøll S, et al. Prospective investigation of serum anti-Müllerian hormone concentration in ovulatory intrauterine insemination patients: a preliminary study. Reprod Biomed Online 2010; 20(5):582-7.
  12. Li HW, Yeung WS, Lau EY, Ho PC, Ng EH. Evaluating the performance of serum antimullerian hormone concentration in predicting the live birth rate of controlled ovarian stimulation and intrauterine insemination. Fertil Steril 2010; 94(6):2177-81.
  13. Lie Fong S, Baart EB, Martini E, Schipper I, Visser JA, Themmen AP, et al. Anti-Müllerian hormone: a marker for oocyte quantity, oocyte quality and embryo quality? Reprod Biomed Online 2008; 16(5):664-70.
  14. Smeenk JM, Sweep FC, Zielhuis GA, Kremer JA, Thomas CM, Braat DD. Antimüllerian hormone predicts ovarian responsiveness, but not embryo quality or pregnancy, after in vitro fertilization or intracyoplasmic sperm injection. Fertil Steril 2007; 87(1):223-6.
  15. Koo HS, Song IO, Cha SH, Park CW, Kim HO. The likelihood of achieving pregnancy through timed coitus in young infertile women with decreased ovarian reserve. Clin Exp Reprod Med 2018; 45(1):31-7.
  16. Wang MH, Chen CH, Wang CW, Hsu MI, Tzeng CR. A higher anti-Müllerian hormone level is associated with an increased chance of pregnancy in patients undergoing controlled ovarian stimulation and intrauterine insemination. J Obstet Gynaecol 2015; 35(1):64-8.