Discordance between day-3 follicle stimulating hormone & anti-Müllerian hormone is predictive of clinical pregnancy during fertility treatment

Abstract

Objective

To evaluate the role of discordant Day-3 follicle stimulating hormone (FSH) & anti-Müllerian hormone (AMH) levels in predicting pregnancy outcome after controlled ovarian stimulation (COS) followed by intrauterine insemination or timed intercourse.

Methods

Retrospective study of 745 couples with regular menstrual cycles, at least one patent fallopian tube, and normal semen analysis that underwent infertility treatment between June 2013 and March 2017. Women with documented serum AMH and FSH levels (<10 (mIU/ml were considered normal), and undergo COS were studied. Clinical pregnancy rate is the cumulative pregnancy obtained after maximum of three cycles of COS with or without IUI.

Results

As expected, patients with normal concordant AMH/FSH achieved a significantly (p < .01) higher pregnancy than all other groups. 22.4% of those with discordant normal AMH/abnormal FSH became pregnant while only 10.8% of those with discordant abnormal AMH/normal FSH levels did. 11.7% of patients with abnormal concordant values achieved pregnancy. Patients with discordant abnormal AMH/normal FSH were not statistically different (p = .084) from abnormal concordance AMH/FSH but significantly (p < .01) lower than normal concordant AMH/FSH. However, patients with discordant normal AMH/abnormal FSH were statistically different from both concordant normal and concordant abnormal AMH/FSH values (p < .04).

Conclusions

This study showed that both discordant abnormal Day-3 FSH and/or abnormal AMH serum levels, as well as concordant abnormal FSH and AMH values, were predictive of lower clinical pregnancy rates after COS. However, abnormal FSH with a normal AMH does not have as poor a prognosis as the presence of an abnormal AMH.

第3天卵泡刺激素和抗苗勒管激素之间的不一致可预测生育治疗期间的临床妊娠 摘要

目的：评估不一致的第3天卵泡刺激素（FSH）和抗苗勒管激素（AMH）水平在预测控制性卵巢刺激（COS）后宫内人工授精（IUI）或定时性交后妊娠结局中的作用。

方法：对2013年6月至2017年3月期间接受不孕症治疗的745对夫妇进行了回顾性研究, 这些夫妇月经规律, 至少有一条输卵管通畅, 精液分析正常。有记录血清AMH和FSH水平（<10 mIU/ml被认为正常）, 并接受COS的女性被研究。临床妊娠率是指在有或没有IUI的情况下进行COS最多三个周期后获得的累积妊娠率。

结果：正如预期的那样, AMH、FSH一致正常者的妊娠率显著高于所有其他组（p<0.01）。AMH正常/FSH异常者中22.4%妊娠, 而AMH异常/FSH正常者中仅有10.8%妊娠。AMH异常/FSH异常者中11.7%妊娠。AMH异常/FSH正常者与AMH异常/FSH异常者比较, 差异无统计学意义（p=0.084）, 但显著低于AMH、FSH一致正常者（p<0.01）。然而, AMH正常/FSH异常者与AMH、FSH一致正常者和AMH、FSH一致异常者相比, 差异有统计学意义（p<0.04）。

结论：本研究表明, 第3天FSH异常和/或AMH水平异常, 以及FSH和AMH均异常, 均预示着COS后临床妊娠率较低。然而, FSH异常、AMH正常者的预后并不像AMH异常者那么差。

Keywords:

• Ovarian reserve testing
• discordance
• anti-Müllerian hormone
• Day-3 FSH
• controlled ovarian stimulation
• IUI
• timed-intercourse
• pregnancy rate

Acknowledgements

The authors wish to thank all the clinical staff at Fertility Institute, Navicent Health specially Deanna Nelsen, RN, BSN and Cynthia Clower, RNC, for their enthusiastic support.

Disclosure statement

The authors did not report any potential conflicts of interest.