P-687 Serum Anti-Müllerian hormone to antral follicle count ratio does not predict euploidy rate in young patients who had at least 1 zygote after fertilization
Authors: Marqueta L , Del Gallego Bonilla R , Kalafat E , Lawrenz B , Melado Vidales L , Elkhatib I , Ata B , Fatemi H 
Published: June 2023

Abstract

Study question
Does serum Anti-Müllerian hormone to antral follicle count ratio predict euploidy rate in young patients who had at least 1 zygote after fertilization?

Summary answer
Serum Anti-Müllerian hormone to antral follicle count ratio (AMH/AFC) does not predict euploidy rate in young patients who had at least 1 zygote after fertilization.

What is known already
AMH is produced by the granulosa cells of the growing follicles. It has been demonstrated that the antral follicles are the main contributors to its serum values.
AMH´s role as a quantitative predictor of the ovarian response to stimulation is undeniable. However, studies looking at its correlation with oocyte quality, assessed as embryo ploidy, have yielded conflicting results. All of them include only patients who had at least one blastocyst for biopsy obviating those who had all embryos arrested, which might be genetically abnormal. Besides, no study before has considered the per-follicle production of AMH when evaluating serum AMH levels.

Study design, size, duration
Retrospective analysis of women undergoing Preimplantation Genetic Testing for Aneuploidy at the blastocyst stage according to standard clinical procedures in a tertiary referral IVF center from April 2017 to August 2022.
As linear regression excluded an effect of age on euploidy rate until 35 years, 570 patients below this age were included.
AMH/AFC ratio was calculated as a marker of per-follicle AMH production. Patients were classified into quartiles. Euploidy rates/zygote were compared among them.

Participants/materials, setting, methods
Patients who had at least 1 zygote were included. AMH was measured by Elecsys within 6 months before start of stimulation. Scans were performed by 3 experienced sonographers.
Women with an AMH &gt; 5,98 ng/ml, endometriosis, autoimmune disease, non-functional ovarian cyst, hormonal treatment prior to AMH measurement or history of ovarian surgery, men with less than 1 million of sperm/milliliter of ejaculate, and couples with an abnormal karyotype or history or gonadotoxic treatment were excluded.

Main results and the role of chance
Included patients had a median (+ interquartile range) AMH of 2.73 ng/ml (1.68-3.77), median BMI of 25.7 kg/m2 (22.8-28.9) and median antral follicle count of 14 (11-19). Median number of oocytes collected was 14 (10-20) and median number of metaphase II oocytes was 11 (7-15).
Thresholds for p25th and p75th AMH/AFC ratios were 0.13 and 0.24 respectively. The number of patients included in the &lt;p25th, p25th-p75th and &gt;p75th groups were 134, 297 and 139, respectively.
Whereas median age and BMI wereńt statistically different among groups, significant differences were found in median AMH (&lt;p25th: 1.38 ng/ml (0.8-2.1); p25th-p75th: 2.75 ng/ml (2-3.7); &gt;p75th: 3.9 ng/ml (3.1-4.8), p &lt; 0.001) and AFC (&lt;p25th: 14 (9.2-20) p25th-p75th: 16 (12-20); &gt;p75th: 13 (10-16), p &lt; 0.001).
No significant differences were found in the fertilization rate (&lt;p25th: 0.75 (0.6-0.8); p25th-p75th: 0.75 (0.6-0.9); &gt;p75th: 0.78 (0.7-0.9)) nor in the biopsy rate/zygote (&lt;p25th: 0.64 (0.5-0.8), p25th-p75th: 0.6 (0.4-0.8), &gt;p75th: 0.6 (0.5-0.7)).
Euploidy rate/zygote wasńt statistically different among groups: &lt;p25th: 0.36 (0.2-0.5); p25th-p75th: 0.33 (0.2-0.5); &gt;p75th: 0.33 (0.2-0.5). When compared with p25th-p75th, patients with an AMH/AFC &lt;p25th showed a tendency towards a higher risk of not having an euploid embryo, due to culture arrest or aneuploidy (19.4% vs 10.8%, p 0.065).

Limitations, reasons for caution
The retrospective design of the study might restrict an adequate control of confounding factors. The small size of the lower quartile group might compromise the accuracy of the findings.

Wider implications of the findings
The association between AMH levels and live birth rate after In Vitro Fertilization remains debated. Whereas this study didńt find a correlation between AMH/AFC ratio and euploidy rate/zygote, further research will have to evaluate other markers of oocyte quality that might by affected by a low per-follicle production of AMH.

Trial registration number
Not applicable