P–636 Anti-Müllerian-Hormone levels are not correlated to the probability of obtaining an ongoing pregnancy and time to pregnancy in women undergoing intra-uterine inseminations with donor sperm
Authors: Libarle M , Goldrat O , Demeestere I , Bouziotis J , Bruynbroeck M , Va. de. Abbeel E , Delbaere A 
Published: August 2021

Abstract

Study question
Is Anti-Müllerian hormone (AMH) level associated with the probability of obtaining an ongoing pregnancy (OP) and with time to pregnancy (TTP) in women undergoing d-IUI?

Summary answer
AMH is neither associated with the probability of obtaining an OP nor with time to pregnancy (TTP) in women undergoing d-IUI

What is known already
Anti-Müllerian hormone (AMH) is a glycoprotein produced by the granulosa cells of preantral and antral follicles. While AMH has been widely recognized as a quantitative marker of ovarian reserve used to predict ovarian responsiveness to ovarian stimulation in IVF, its relationship with fecundability in spontaneous conceptions is still a matter of debate. There is currently no consensus on the role of AMH on time to pregnancy in unassisted conceptions. The question of whether AMH is a qualitative marker of oocyte quality is therefore still unanswered.

Study design, size, duration
This prospective cohort study was carried out between 9/1/2017 and 12/30/2020 on 592 women aged 19 to 44, who underwent d-IUI in a natural cycle (n = 1788) the day after LH peak. Patients were single, homosexual, or heterosexual with an infertile partner and underwent 1 to maximum 6 d-IUI. All patients had regular ovulatory cycles and bilateral tubal patency confirmed before starting d-IUI. AMH evaluation was performed within the previous 3 months of the first d-IUI.

Participants/materials, setting, methods
The primary outcomes were the likelihood of obtaining an OP (&gt;14 weeks) and TTP calculated as the number of d-IIU up to an OP. Multivariate logistic regression was used to compare the probability of obtaining an OP according to age and AMH levels. Kaplan-Meier curves with log-rank test were used to assess the TTP stratified by age groups (≤35, &gt;35 to ≤ 39, and &gt; 39 years old) and AMH groups (&lt; 1ng/mL and ≥ 1ng/mL).

Main results and the role of chance
AMH levels were negatively correlated with age (p &lt; 0.001). OP were significantly lower with increasing age (OR 0.92 (0.89–0.95) p &lt; 0.001) but did not differ according to AMH levels (OR 1.07 (0.97–1.18) p = 0.18). When adjusting for AMH, the association between age and OP remained significant (OR 0.91 (0.88–0.95)). TTP was significantly different between age groups: ≤35 years old (n = 338), &gt;35 to ≤ 39 years old (n = 136) and &gt; 39 years old (n = 118) (p &lt; 0.001), but did not differ significantly according to AMH levels &lt; 1ng/mL (n = 130) and ≥1ng/mL (n = 462)(p = 0.55).

Limitations, reasons for caution
Our results concern d-IUI and can therefore not be extrapolated to natural conception. However, the study model is close to natural fecundity as there was no history of female infertility and as all IUI were performed on the day of ovulation with donor sperm proven to be fertile.
Wider implications of the findings: While measuring AMH seems necessary for gonadotropin dose adjustment in ART, our data suggest that it cannot qualitatively assess fertility outcome and should therefore not be used routinely for preconception counseling in the absence of infertility history.

Trial registration number
P2017/396