Anti-Müllerian Hormone Dynamics During Controlled Ovarian Hyperstimulation And Correlations With Clinical Outcomes

Objective : To evaluate the dynamics and reason of anti-Müllerian hormone(AMH)of serum and follicular fluid(FF)during controlled hyperstimulation(COH)which include Gn RH-a long protocol and non pituitary down regulation protol.To analyse the reason of serum AMH levels were elevated on the day of Gn starting.To explore the reason and meaning of AMH levels 3 days after take the eggs.Explore the relationship between AMH levels in serum and follicular fluid and the outcomes of COH,and to evaluate the effect of AMH in follicular fluid on oocytes.Methods:A total of 76 eligible IVF/ICSI-ET cycles owing to the tubal or male factors from July.2015 to Dec.2015 were studied,which were randomly grouped into Gn RH-a long protocol and non pituitary down regulation protocol.Serum AMH levels were measured at D2/3 of previous menstrual cycle(baseline),D2/3 of menstrual during down regulation,the day of Gn starting,day 5 of Gn stimulation(Gn5),day of h CG administration(dh CG),the day before oocyte retrieval and 3 days after oocyte retrieval.FF was grouped into huge(?18mm),middle(14-17mm)and small(<14mm)depending on diameters.We record and compared the AFC,BMI,b FSH,b LH,b LH,b E2,b P,the day of Gn,the dosage of Gn,E2 levels on h CG,retrieved oocytes,numbers of MII,2PN of fertilization,avaliable embryos,top quality embryos in the two COH groups.And to analyse the relationship of AMH levels of serum and follicular fluid among of AFC,the dosage of Gn,E2 levelson h CG,tetrieved oocytes,numbers of MII,2PN of fertilization,avaliable embryos,top quality embryos.Results:1 The characteristics of subjects in the two COH protocols:Age,AFC,infertility years,BMI,basic FSH,LH,E2 and P,all had no statistical difference(P>0.05)between the two groups.In two groups,no significant differences were observed except the total dose of Gn used and E2 on h CG day(P<0.05).The dosage of Gn in non pituitary down regulation group 2110.20±150.00 IU was greater than in long luteal down-regulation protocol group1998.68±154.76 IU.M?numbers of eggs,2PN numbers of fertilization,high quality embryos and avaliable embryos in the non pituitary down regulation group were slightly higher than in long luteal down-regulation protocol group,but no statistical difference(P>0.05).The days of Gn and retrieved oocytes in long luteal down-regulation protocol group were slightly higher than in non pituitary down regulation group,but no statistical difference(P>0.05).2 The long luteal down-regulation protocol group: With the application of Gn RH-a about 10 days,D2/3 menstruation during the down-regulation,AMH had a downward tendency compared with baseline,with no statistical difference(P> 0.05).On the 18 th with Gn RH-a continuimg to application,that is on the start-up day of Gn 5.15±1.64 ng/ml,compared with baseline3.79±1.65 ng/ml,serum AMH had a significantly increased.3 Non pituitary down regulation: Serum AMH level with the application of exogenous Gn decreased gradually during COH,similar to the long luteal down-regulation protocol group.4 Significant difference in serum AMH levels with the exogenous Gn using of two groups between the start-up day of Gn and d PO3 was observed.It was significantly higher on the day of Gn starting 5.15±1.64 ng/ml in long luteal down-regulation protocol than baseline 3.70±1.89 ng/ml in non pituitary down regulation(P<0.01).5 AMH levels of FF in COH: The concentrations of AMH in three kinds of FF(huge,middle and small)in two groups were gradually decreased with folliculars' diameters increasing.The concentration of AMH in huge and small FF was higher in long luteal down-regulation protocol than in non pituitary down regulation.AMH concentration of small FF in long luteal down regulation protocol was lower than it in non pituitary down regulation.6 Serum AMH levels on baseline was tightly correlated with AFC and dosage of Gn(r=0.29;r=-0.33,respectively,P<0.05).Serum AMH levels on Gn5 was positively correlated with COH outcomes,such as retrieved oocytes,numbers of MII,available embryos(r=0.29;r=0.28;r=0.43,respectively,P<0.05).AMH levels in huge were correlated with 2PN of fertilization.Conclusions:Serum AMH levels were significantly changed during COH:AMH level is significantly elevated after pituitary down regulation,to predict the response of ovarian,to decide the Gn dosage,and this augments the number of recruited follicles and improves follicle synchronization.In addition,we can adjust Gn dosage depending on AMH level of Gn starting to avoid the high response of ovarian.AMH is gradually decreased with exogenous Gn using.Gn5 serum AMH level may be a better predictive marker of the outcomes of IVF.AMH level of follicular fluid and Gn RH-a all had some effects on the quality on oocytes.