O-322 What is the number of IVF cycles needed to produce at least one euploid blastocyst in patients of all ages with varied AMH levels
Authors: Alhelou Y , Fakih M 
Published: July 2024

Abstract

Study question
How many cycles are needed to get at least one blastocyst in patients of different AMH levels and varied ages?

Summary answer
Age and AMH determine the number of cycles, which ranges from 1 cycle in young patients up to 10 cycles in over-44-year-old patients.

What is known already
AMH secretion by ovarian granulosa cells initiates during the 36th week of gestation in pre-antral and antral follicles. This persists throughout a woman’s reproductive lifespan. AMH serves as a biomarker for assessing ovarian reserve and forecasting the ovarian response to stimulation. AMH is strongly associated with the quantity of antral follicles and the production of oocytes. AMH can be utilised to determine the initial dosage of FSH in an IVF cycle, as well as serving as a quantitative indicator of the number of oocytes produced.

Study design, size, duration
In this retrospective cohort study, data was collected from 16,417 ICSI cycles with Preimplantation Testing for Aneuploidy (PGT-A) conducted at three referral fertility centers from Jan 2019 to Dec 2023. We excluded cycles without serum AMH, endocrinopathies or recurrent pregnancy loss, males with total sperm count of less than 5 million and total motility less than 30%, and those with parental chromosomal abnormalities.

Participants/materials, setting, methods
Patients were stratified into three different categories of AMH (ng/ml), low (&lt; 1.1 ng/mL), intermediate (&gt;1.1 to &lt; 3.0 ng/mL) and high (&gt; 3.0 ng/mL). Each category was subdivided into 6 age sub-categories as follow (&lt; 35), (35 to &lt; 38), (38 to &lt; 40), (40 to &lt; 42), (42 to &lt; 44), (&gt; 44). All of the cycles underwent blastocyst stage biopsy and PGT-A utilising next generation sequencing (NGS).

Main results and the role of chance
Euploidy rate was statistically insignificant for all AMH levels in the same age group. However, euploid embryo numbers vary significantly. Euploid embryos numbers are shown in low, medium, and high AMH by age group. In the (&lt;35) years was 1.9±1.5, 2.9±2.3, and 4.7±3.5, p &lt; 0.0001. In the (35 to &gt; 38) years was 1.3±0.8, 2.1±1.8, and 3.2±2.6, p &lt; 0.0001. In the (38 to &gt; 40) years was 0.9±0.8, 1.7±1.4, and 2.6±1.7, p &lt; 0.0001. In the (40 to &gt; 42) years was 0.6±0.5, 0.9±0.7, and 1.5±1.4, p &lt; 0.0001. In the (42 to &gt; 44) year was 0.26±0.2, 0.49±0.38, and 0.6±53, p &lt; 0.0001. In the (≥44) years was 0.10±0.10, 0.23±0.21, and 0.40±0.37, p = 0.0170.
We calculated the number of cycles needed to produce at least one grade BB or higher euploid blastocyst from the mean number of euploid embryos per cycle: The number of cycles is presented in low, medium, and high AMH. In the (&lt;35) and (35 to &gt; 38), 1 cycle is needed. In (38 to &gt; 40) years, 2 cycles, 1 cycle and 1 cycle. In the (40-42) group 2 cycles, 2 cycles and 1 cycle. In the (42 to &lt; 44) group 4 cycles, 3 cycles and 2 cycles. In the (≥44) group 10 cycles, 5 cycles and 3 cycles.

Limitations, reasons for caution
The retrospective nature of the study is the main limitation.

Wider implications of the findings
The study offers valuable insights for patient counselling regarding the required number of cycles to achieve euploid embryos, as well as for financial budgeting for both patients and insurance companies.

Trial registration number
Not applicable