Impact of female age and male infertility on ovarian reserve markers to predict outcome of assisted reproduction technology cycles

Abstract

Background: This study was designed to assess the capability of ovarian reserve markers, including baseline FSH levels, baseline anti-Müllerian hormone (AMH) levels, and antral follicle count (AFC), as predictors of live births during IVF cycles, especially for infertile couples with advanced maternal age and/or male factors.

Methods: A prospective cohort of 336 first IVF/ICSI cycles undergoing a long protocol with GnRH agonist was investigated. Patients with endocrine disorders or unilateral ovaries were excluded.

Results: Among the ovarian reserve tests, AMH and age had a greater area under the receiving operating characteristic curve than FSH in predicting live births. Furthermore, AMH and age were the sole predictive factors of live births for women greater than or equal to 35 years of age; while AMH was the major determinant of live births for infertile couples with absence of male factors by multivariate logistic regression analysis. However, all the studied ovarain reserve tests were not preditive of live births for women < 35 years of age or infertile couples with male factors.

Conclusion: The serum AMH levels were prognostic for pregnancy outcome for infertile couples with advanced female age or absence of male factors. The predictive capability of ovarian reserve tests is clearly influenced by the etiology of infertility.

Figure 1

The correlation between ovarian reserve markers and the number of retrieved oocytes. A. chronologic age, B. basal FSH levels, C. basal AMH levels, D. antral follicle count. The Pearson correlation coefficient (r) was presented as the value (95% confidence interval, P value).

Figure 2

Comparison of the outcome of IVF cycles grouping by baseline levels of serum anti-Mullerian hormone (the 25^th, 50^th, and 75^th percentile levels are 1.08 ng/ml, 1.97 ng/ml, and 3.26 ng/ml, respectively). A. The number of retrieved oocytes, B. the number of cultured good embryos, C. implantation rates, D. the rates of clinical pregnancy, E. the live birth rate. a. p < 0.05 by one-way ANOVA and post-hoc Bonferroni test compared to all the other three groups. b. p < 0.05 by X² test.