Antimüllerian hormone in gonadotropin releasing-hormone antagonist cycles: prediction of ovarian response and cumulative treatment outcome in good-prognosis patients
Objective To assess the relationships between serum antimüllerian hormone (AMH) and ovarian response and treatment outcomes in good-prognosis patients undergoing controlled ovarian stimulation using a gonadotropin-releasing hormone (GnRH) antagonist protocol. Design Secondary analysis of data prospe...
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| Veröffentlicht in: | Fertility and sterility 2013-05, Vol.99 (6), p.1644-1653.e1 |
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| creator | Arce, Joan-Carles, M.D., Ph.D La Marca, Antonio, M.D., Ph.D Mirner Klein, Bjarke, Ph.D Nyboe Andersen, Anders, M.D Fleming, Richard, Ph.D |
| description | Objective To assess the relationships between serum antimüllerian hormone (AMH) and ovarian response and treatment outcomes in good-prognosis patients undergoing controlled ovarian stimulation using a gonadotropin-releasing hormone (GnRH) antagonist protocol. Design Secondary analysis of data prospectively collected in a randomized, assessor-blind trial comparing two different gonadotropin preparations with respect to ongoing pregnancy rate. Setting Twenty-five centers in seven countries. Patient(s) 749 women, aged 21 to 34 years, with primary diagnosis of infertility being unexplained infertility or mild male factor infertility and with serum follicle-stimulating hormone (FSH) level 1–12 IU/L and antral follicle count (AFC) ≥10. Intervention(s) Controlled ovarian stimulation with highly purified human menopausal gonadotropin (hphMG) or recombinant FSH in a GnRH antagonist cycle with compulsory single-blastocyst transfer and potential subsequent 1-year cryopreserved blastocyst replacement in natural cycles. Main Outcome Measure(s) Relationships between AMH at start of stimulation and ovarian response and treatment outcome. Result(s) Serum AMH concentration was strongly correlated with oocyte yield: AMH accounted for 85%, FSH for 14%, and inhibin B and AFC for |
| doi_str_mv | 10.1016/j.fertnstert.2012.12.048 |
| format | Article |
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Design Secondary analysis of data prospectively collected in a randomized, assessor-blind trial comparing two different gonadotropin preparations with respect to ongoing pregnancy rate. Setting Twenty-five centers in seven countries. Patient(s) 749 women, aged 21 to 34 years, with primary diagnosis of infertility being unexplained infertility or mild male factor infertility and with serum follicle-stimulating hormone (FSH) level 1–12 IU/L and antral follicle count (AFC) ≥10. Intervention(s) Controlled ovarian stimulation with highly purified human menopausal gonadotropin (hphMG) or recombinant FSH in a GnRH antagonist cycle with compulsory single-blastocyst transfer and potential subsequent 1-year cryopreserved blastocyst replacement in natural cycles. Main Outcome Measure(s) Relationships between AMH at start of stimulation and ovarian response and treatment outcome. Result(s) Serum AMH concentration was strongly correlated with oocyte yield: AMH accounted for 85%, FSH for 14%, and inhibin B and AFC for <1% each of the explained variation in oocyte yield. Also, AMH showed a high accuracy for the prediction of poor (≤3 oocytes) and high response (≥15 oocytes), which was statistically significantly better than basal FSH, AFC, or inhibin B. AMH was statistically significantly positively associated with ongoing pregnancy rate in the fresh cycle as well as with the 1-year cumulative ongoing pregnancy and live-birth rates. Conclusion(s) There is a positive relationship between AMH and oocyte yield in GnRH antagonist cycles, and AMH is the best predictor for identifying patients with poor and high ovarian response. The positive association between AMH and cumulative live-birth rates after fresh and cryopreserved cycles reflects the availability of more oocytes/blastocysts, not higher quality. Clinical Trial Registration Number NCT00884221.</description><identifier>ISSN: 0015-0282</identifier><identifier>EISSN: 1556-5653</identifier><identifier>DOI: 10.1016/j.fertnstert.2012.12.048</identifier><identifier>PMID: 23394782</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; animal ovaries ; antagonists ; Anti-Mullerian Hormone - blood ; Antimüllerian hormone ; blastocyst ; blood serum ; clinical trials ; cryopreservation ; Female ; follicle-stimulating hormone ; GnRH antagonist ; gonadotropin-releasing hormone ; Gonadotropin-Releasing Hormone - antagonists & inhibitors ; Gonadotropin-Releasing Hormone - metabolism ; Humans ; Infertility, Female - blood ; Infertility, Female - diagnosis ; Infertility, Female - therapy ; inhibin ; Internal Medicine ; live birth ; Male ; menopause ; Obstetrics and Gynecology ; Oocyte Retrieval - methods ; Oocyte Retrieval - trends ; oocytes ; ovarian response ; Ovary - metabolism ; Ovulation Induction - methods ; Ovulation Induction - trends ; patients ; prediction ; Predictive Value of Tests ; Pregnancy ; pregnancy rate ; Pregnancy Rate - trends ; Prognosis ; Prospective Studies ; Single-Blind Method ; Treatment Outcome ; women ; Young Adult</subject><ispartof>Fertility and sterility, 2013-05, Vol.99 (6), p.1644-1653.e1</ispartof><rights>American Society for Reproductive Medicine</rights><rights>2013 American Society for Reproductive Medicine</rights><rights>Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c569t-8a855b782612977dadf36b161f6aab2cabbeb749f3c95cbe8f53c6fbc0cbc3223</citedby><cites>FETCH-LOGICAL-c569t-8a855b782612977dadf36b161f6aab2cabbeb749f3c95cbe8f53c6fbc0cbc3223</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0015028213000101$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23394782$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Arce, Joan-Carles, M.D., Ph.D</creatorcontrib><creatorcontrib>La Marca, Antonio, M.D., Ph.D</creatorcontrib><creatorcontrib>Mirner Klein, Bjarke, Ph.D</creatorcontrib><creatorcontrib>Nyboe Andersen, Anders, M.D</creatorcontrib><creatorcontrib>Fleming, Richard, Ph.D</creatorcontrib><title>Antimüllerian hormone in gonadotropin releasing-hormone antagonist cycles: prediction of ovarian response and cumulative treatment outcome in good-prognosis patients</title><title>Fertility and sterility</title><addtitle>Fertil Steril</addtitle><description>Objective To assess the relationships between serum antimüllerian hormone (AMH) and ovarian response and treatment outcomes in good-prognosis patients undergoing controlled ovarian stimulation using a gonadotropin-releasing hormone (GnRH) antagonist protocol. Design Secondary analysis of data prospectively collected in a randomized, assessor-blind trial comparing two different gonadotropin preparations with respect to ongoing pregnancy rate. Setting Twenty-five centers in seven countries. Patient(s) 749 women, aged 21 to 34 years, with primary diagnosis of infertility being unexplained infertility or mild male factor infertility and with serum follicle-stimulating hormone (FSH) level 1–12 IU/L and antral follicle count (AFC) ≥10. Intervention(s) Controlled ovarian stimulation with highly purified human menopausal gonadotropin (hphMG) or recombinant FSH in a GnRH antagonist cycle with compulsory single-blastocyst transfer and potential subsequent 1-year cryopreserved blastocyst replacement in natural cycles. Main Outcome Measure(s) Relationships between AMH at start of stimulation and ovarian response and treatment outcome. Result(s) Serum AMH concentration was strongly correlated with oocyte yield: AMH accounted for 85%, FSH for 14%, and inhibin B and AFC for <1% each of the explained variation in oocyte yield. Also, AMH showed a high accuracy for the prediction of poor (≤3 oocytes) and high response (≥15 oocytes), which was statistically significantly better than basal FSH, AFC, or inhibin B. AMH was statistically significantly positively associated with ongoing pregnancy rate in the fresh cycle as well as with the 1-year cumulative ongoing pregnancy and live-birth rates. Conclusion(s) There is a positive relationship between AMH and oocyte yield in GnRH antagonist cycles, and AMH is the best predictor for identifying patients with poor and high ovarian response. The positive association between AMH and cumulative live-birth rates after fresh and cryopreserved cycles reflects the availability of more oocytes/blastocysts, not higher quality. Clinical Trial Registration Number NCT00884221.</description><subject>Adult</subject><subject>animal ovaries</subject><subject>antagonists</subject><subject>Anti-Mullerian Hormone - blood</subject><subject>Antimüllerian hormone</subject><subject>blastocyst</subject><subject>blood serum</subject><subject>clinical trials</subject><subject>cryopreservation</subject><subject>Female</subject><subject>follicle-stimulating hormone</subject><subject>GnRH antagonist</subject><subject>gonadotropin-releasing hormone</subject><subject>Gonadotropin-Releasing Hormone - antagonists & inhibitors</subject><subject>Gonadotropin-Releasing Hormone - metabolism</subject><subject>Humans</subject><subject>Infertility, Female - blood</subject><subject>Infertility, Female - diagnosis</subject><subject>Infertility, Female - therapy</subject><subject>inhibin</subject><subject>Internal Medicine</subject><subject>live birth</subject><subject>Male</subject><subject>menopause</subject><subject>Obstetrics and Gynecology</subject><subject>Oocyte Retrieval - methods</subject><subject>Oocyte Retrieval - trends</subject><subject>oocytes</subject><subject>ovarian response</subject><subject>Ovary - metabolism</subject><subject>Ovulation Induction - methods</subject><subject>Ovulation Induction - trends</subject><subject>patients</subject><subject>prediction</subject><subject>Predictive Value of Tests</subject><subject>Pregnancy</subject><subject>pregnancy rate</subject><subject>Pregnancy Rate - trends</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Single-Blind Method</subject><subject>Treatment Outcome</subject><subject>women</subject><subject>Young Adult</subject><issn>0015-0282</issn><issn>1556-5653</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNks2KFDEQx4Mo7jj6Cpqjlx7zMekPD8Lu4hcseFj3HNLp6jFjd9Im6YF5IZ_Cmy9mtTOr4EkoEgK_-lel_kUI5WzDGS9f7Tc9xOxTxnMjGBcbDLatH5AVV6osVKnkQ7JijKuCiVpckCcp7RljJa_EY3IhpGy2VS1W5Pulz278-WMYIDrj6ZcQx-CBOk93wZsu5BgmfEQYwCTnd8U9YXw2iLiUqT3aAdJrOkXonM0ueBp6Gg7mt2SENAWfloyO2nmcB5PdAWiOYPIIPtMwZxvGc9HQFVMMOx-SS3RCFIn0lDzqzZDg2flek7t3bz9ffyhuPr3_eH15U1hVNrmoTa1Uix8ruWiqqjNdL8uWl7wvjWmFNW0LbbVtemkbZVuoeyVt2beW2dZKIeSavDzpYgvfZkhZjy5ZGAbjIcxJc7mtt03NeYVofUJtDClF6PUU3WjiUXOmF5f0Xv91SS8uaQx0CVOfn6vM7Qjdn8R7WxB4cQJ6E7TZRZf03S0qKHRU1A1ya3J1IgCncXAQdbI4KYsGRLBZd8H9Tx9v_hGxg_POmuErHCHtwxw9TltznTBB3y77tKwTl7hKKC1_AbwhzqA</recordid><startdate>20130501</startdate><enddate>20130501</enddate><creator>Arce, Joan-Carles, M.D., Ph.D</creator><creator>La Marca, Antonio, M.D., Ph.D</creator><creator>Mirner Klein, Bjarke, Ph.D</creator><creator>Nyboe Andersen, Anders, M.D</creator><creator>Fleming, Richard, Ph.D</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>FBQ</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130501</creationdate><title>Antimüllerian hormone in gonadotropin releasing-hormone antagonist cycles: prediction of ovarian response and cumulative treatment outcome in good-prognosis patients</title><author>Arce, Joan-Carles, M.D., Ph.D ; La Marca, Antonio, M.D., Ph.D ; Mirner Klein, Bjarke, Ph.D ; Nyboe Andersen, Anders, M.D ; Fleming, Richard, Ph.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c569t-8a855b782612977dadf36b161f6aab2cabbeb749f3c95cbe8f53c6fbc0cbc3223</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>animal ovaries</topic><topic>antagonists</topic><topic>Anti-Mullerian Hormone - blood</topic><topic>Antimüllerian hormone</topic><topic>blastocyst</topic><topic>blood serum</topic><topic>clinical trials</topic><topic>cryopreservation</topic><topic>Female</topic><topic>follicle-stimulating hormone</topic><topic>GnRH antagonist</topic><topic>gonadotropin-releasing hormone</topic><topic>Gonadotropin-Releasing Hormone - antagonists & inhibitors</topic><topic>Gonadotropin-Releasing Hormone - metabolism</topic><topic>Humans</topic><topic>Infertility, Female - blood</topic><topic>Infertility, Female - diagnosis</topic><topic>Infertility, Female - therapy</topic><topic>inhibin</topic><topic>Internal Medicine</topic><topic>live birth</topic><topic>Male</topic><topic>menopause</topic><topic>Obstetrics and Gynecology</topic><topic>Oocyte Retrieval - methods</topic><topic>Oocyte Retrieval - trends</topic><topic>oocytes</topic><topic>ovarian response</topic><topic>Ovary - metabolism</topic><topic>Ovulation Induction - methods</topic><topic>Ovulation Induction - trends</topic><topic>patients</topic><topic>prediction</topic><topic>Predictive Value of Tests</topic><topic>Pregnancy</topic><topic>pregnancy rate</topic><topic>Pregnancy Rate - trends</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Single-Blind Method</topic><topic>Treatment Outcome</topic><topic>women</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Arce, Joan-Carles, M.D., Ph.D</creatorcontrib><creatorcontrib>La Marca, Antonio, M.D., Ph.D</creatorcontrib><creatorcontrib>Mirner Klein, Bjarke, Ph.D</creatorcontrib><creatorcontrib>Nyboe Andersen, Anders, M.D</creatorcontrib><creatorcontrib>Fleming, Richard, Ph.D</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>AGRIS</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Fertility and sterility</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Arce, Joan-Carles, M.D., Ph.D</au><au>La Marca, Antonio, M.D., Ph.D</au><au>Mirner Klein, Bjarke, Ph.D</au><au>Nyboe Andersen, Anders, M.D</au><au>Fleming, Richard, Ph.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antimüllerian hormone in gonadotropin releasing-hormone antagonist cycles: prediction of ovarian response and cumulative treatment outcome in good-prognosis patients</atitle><jtitle>Fertility and sterility</jtitle><addtitle>Fertil Steril</addtitle><date>2013-05-01</date><risdate>2013</risdate><volume>99</volume><issue>6</issue><spage>1644</spage><epage>1653.e1</epage><pages>1644-1653.e1</pages><issn>0015-0282</issn><eissn>1556-5653</eissn><abstract>Objective To assess the relationships between serum antimüllerian hormone (AMH) and ovarian response and treatment outcomes in good-prognosis patients undergoing controlled ovarian stimulation using a gonadotropin-releasing hormone (GnRH) antagonist protocol. Design Secondary analysis of data prospectively collected in a randomized, assessor-blind trial comparing two different gonadotropin preparations with respect to ongoing pregnancy rate. Setting Twenty-five centers in seven countries. Patient(s) 749 women, aged 21 to 34 years, with primary diagnosis of infertility being unexplained infertility or mild male factor infertility and with serum follicle-stimulating hormone (FSH) level 1–12 IU/L and antral follicle count (AFC) ≥10. Intervention(s) Controlled ovarian stimulation with highly purified human menopausal gonadotropin (hphMG) or recombinant FSH in a GnRH antagonist cycle with compulsory single-blastocyst transfer and potential subsequent 1-year cryopreserved blastocyst replacement in natural cycles. Main Outcome Measure(s) Relationships between AMH at start of stimulation and ovarian response and treatment outcome. Result(s) Serum AMH concentration was strongly correlated with oocyte yield: AMH accounted for 85%, FSH for 14%, and inhibin B and AFC for <1% each of the explained variation in oocyte yield. Also, AMH showed a high accuracy for the prediction of poor (≤3 oocytes) and high response (≥15 oocytes), which was statistically significantly better than basal FSH, AFC, or inhibin B. AMH was statistically significantly positively associated with ongoing pregnancy rate in the fresh cycle as well as with the 1-year cumulative ongoing pregnancy and live-birth rates. Conclusion(s) There is a positive relationship between AMH and oocyte yield in GnRH antagonist cycles, and AMH is the best predictor for identifying patients with poor and high ovarian response. The positive association between AMH and cumulative live-birth rates after fresh and cryopreserved cycles reflects the availability of more oocytes/blastocysts, not higher quality. Clinical Trial Registration Number NCT00884221.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23394782</pmid><doi>10.1016/j.fertnstert.2012.12.048</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult animal ovaries antagonists Anti-Mullerian Hormone - blood Antimüllerian hormone blastocyst blood serum clinical trials cryopreservation Female follicle-stimulating hormone GnRH antagonist gonadotropin-releasing hormone Gonadotropin-Releasing Hormone - antagonists & inhibitors Gonadotropin-Releasing Hormone - metabolism Humans Infertility, Female - blood Infertility, Female - diagnosis Infertility, Female - therapy inhibin Internal Medicine live birth Male menopause Obstetrics and Gynecology Oocyte Retrieval - methods Oocyte Retrieval - trends oocytes ovarian response Ovary - metabolism Ovulation Induction - methods Ovulation Induction - trends patients prediction Predictive Value of Tests Pregnancy pregnancy rate Pregnancy Rate - trends Prognosis Prospective Studies Single-Blind Method Treatment Outcome women Young Adult |
| title | Antimüllerian hormone in gonadotropin releasing-hormone antagonist cycles: prediction of ovarian response and cumulative treatment outcome in good-prognosis patients |
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