Investigating the correlation between AMH and the number of high-quality embryos from IVF/ICSI in 30-44 year-old infertile women
Authors: GU Xiao-Ling , chen Yannan , yu minyan , zhong Shuping , Wang Xia 
Published: March 2022

Abstract
Background To explore the effect of anti-Müllerian hormone (AMH) on embryonic development by studying the relationship between serum AMH concentration and the high-quality embryo number during the first cycle of in vitro fertilization (IVF) /intracytoplasmic sperm injection (ICSI) in 30-44 year-old infertile women.Methods A retrospective cohort study of 335 cycles was conducted. The study population was the patients who received the first IVF/ICSI cycle at the Reproductive Medicine Center of * * * * * * from January 2019 to December 2020. The basic characteristics, clinical medication and cycle outcome of patients were collected, and the correlation between AMH and the number of high-quality embryos was analyzed.Results After adjusted for confounding factors (female age, AFC and COH protocol), sensitivity analysis showed that high-quality embryo number in high AMH group increases by 2.2 units for each additional unit of AMH (≥8.5 ng/mL) (95%CI: (0.8, 3.7), P=0.003). The two-piecewise regression model identified the inflection point as AMH=7.1 ng/mL, and the effect size, 95% CI and P value on both sides of the inflection point were 0.5(0.3, 0.7), <0.001 and 0.1(-0.1, 0.2), 0.518, respectively. The results of stratified analysis and interaction test showed that the relationship between AMH and the high-quality embryo number was stable among different subgroups (P>0.05).Conclusion When AMH<7.1ng/mL, there is a positive correlation between AMH and the number of high-quality embryos in this study population. Therefore, the effect of age-related ovarian reserve biomarker AMH on reproductive prognosis can provide reference for ART clinical treatment.Plain English summary Diminished ovarian reserve (DOR) refers to a decrease in the number and/or quality of oocytes in the ovary, accompanied by a decrease in anti-Müllerian hormone (AMH) levels, a decrease in antral follicle count (AFC) and an increase in follicle stimulating hormone (FSH) levels. The most common clinical symptoms are shortened menstrual cycle and decreased menstrual flow. Most patients go to the hospital after long-term unsuccessful attempts to conceive, so delays in diagnosis are common. Assisted reproductive technology (ART) is the main means of achieving pregnancy in patients with DOR. With the improvement and adjustment of the ovulation induction program and the innovation of laboratory technology, the clinical pregnancy rate of ART has increased. However, DOR patients have poor ovarian response to gonadotropins (Gn), manifested as less follicle development, low blood estrogen levels, high Gn dosage, lower-than-expected oocyte retrieval, high cycle cancellation rate, and low clinical pregnancy rate in ovarian stimulation cycles. Therefore, this type of patients is a difficult point in the field of assisted reproduction. In the present study, elevated AMH was associated with an increased number of high-quality embryos in individuals aged 30-44 years at high risk for DOR. AMH can assess the potential reproductive prognosis of such patients and provide valuable data for clinical treatment of such patients.