The Predictive Value Of Follicular Fluids AMH,BMP-15 And ActivinA In IVF-ET Outcome And Ovarian Response

Background and ObjectiveThe incidence of infertility in the world is 15%-20%.The World Health Organization predicts that infertility may become the third largest disease after cancer and cardiovascular and cerebrovascular diseases,which is a serious threat to human health.Assisted reproductive technology brings hope to infertile couples,but the clinical efficacy of in vitro fertilization-embryo transfer-clinical pregnancy rate and infant-bearing rate is far from the patient's expectations.In the process of controlled ovulation induction,exogenous gonadotropin stimulates ovarian multifollicular development;ovarian reactivity is the different responsiveness of ovarian stimulation to Gn stimulation.Therefore,predicting and evaluating ovarian function and ovarian response is beneficial to obtain appropriate quality high-quality oocytes and high-quality embryos to improve pregnancy rate and reduce ovarian adverse reactions.Various cytokines and hormones in follicular fluid promote oocyte maturation.BMP-15 contributes to follicular development;Activin A and AMH are follicles and ovarian function.This study investigated the predictive value of the concentration of follicular fluids AMH,BMP-15,and Activin A on ovarian response and clinical pregnancy.MethodsA total of 155 infertile patients undergone controlled ovarian stimulation therapy in our reproductive center were divided into three groups(low,normal and high response)according to oocytes retrieved.Then grouped according to age and pregnancy outcome,a total of four groups <35 years old pregnant and non-pregnant group;? 35 years old pregnant and non-pregnant group.The clinical and laboratory data of each group were compared.Follicular fluid(FF)were collected during oocytes retrieval.The concentration of AMH,BMP-15 and Activin A in FF samples were assessed by double-antibody sandwich ELISA.The logistic regression analysis and receiver operating characteristic curve(ROC)were used to compare the predictivevalue of three follicular fluid components for ovarian response and pregnancy outcome.Results1.With the increase of reactivity in patients with different ovarian reactions,the age and basal serum follicle stimulating hormone levels of the patients decreased,the number of basal sinus follicles increased,and the dosage of Gn decreased,with statistically significant differences(P<0.01).The total fertilization rate of IVF/ICSI and D3 high quality embryonic rate had significant difference between groups(P<0.05).BMP-15 in follicular fluid was correlated with ovarian response(P<0.05),the poor ovarian response have higher levels of BMP-15.2.When the patient was <35 years old,the total fertilization rate of IVF and D3 quality embryonic rate in the pregnant group were higher than those in the non-pregnant group,and the difference was statistically significant(P<0.05).The three follicular fluid factors were associated with the pregnancy outcome.The concentrations of AMH and BMP-15 in the follicular fluid of the pregnant group were higher than those in the non-pregnant group,the difference was significant(P<0.01).The concentration of Activin A in the non-pregnant group was higher than that in the pregnancy group,the difference was statistically significant(P<0.05).3.When the patient's age was ? 35 years old,there were no significant difference in the body mass index,the basic serum hormone level,the total dosage of Gn and the concentration of three follicular fluid factors between two groups.(P>0.05).4.The follicular fluid AMH and BMP-15 in predicting pregnancy outcome are independent influencing factors in patients younger than 35 years old.The area under the receiver operating characteristic curve(AUC)analysis of AMH and BMP-15 were0.748 and 0.76,respectively,and the cut-off points were 736.8 pg/ml and 27.26 pg/ml,respectively.ConclusionsThe follicular fluid BMP-15 was associated with ovarian reactivity,and the poor ovarian response have higher levels of BMP-15..For younger patients(age <35 years),the follicular fluid AMH and BMP-15 are effective predictors for clinical pregnancy outcomes.