Prediction value of anti-Mullerian hormone (AMH) serum levels and antral follicle count (AFC) in hormonal contraceptive (HC) users and non-HC users undergoing IVF-PGD treatment

Abstract

Use of hormone contraceptives (HC) is very popular in the reproductive age and, therefore, evaluation of ovarian reserve would be a useful tool to accurately evaluate the reproductive potential in HC users. We conducted a retrospective cohort study of 41 HC users compared to 57 non-HC users undergoing IVF-preimplantation genetic diagnosis (PGD) aiming to evaluate the effect of HC on the levels of anti-Mullerian hormone (AMH), small (2–5 mm), large (6–10 mm) and total antral follicle count (AFC) and the ability of these markers to predict IVF outcome. Significant differences in large AFC (p = 0.04) and ovarian volume (p < 0.0001) were seen, however, there were no significant differences in small and total AFC or in serum AMH and FSH levels. Oocyte number significantly correlated with AMH and total AFC in HC users (p < 0.001) while in non-HC users these correlations were weaker. In HC users, the significant predictors of achieving <6 and >18 oocytes were AFC (ROC-AUC; 0.958, p = 0.001 and 0.883, p = 0.001) and AMH (ROC-AUC-0.858, p = 0.01 and 0.878, p = 0.001), respectively. The predictive values were less significant in non-HC users. These findings are important in women treated for PGD, in ovum donors and for assessing the fertility prognosis in women using HC and wishing to postpone pregnancy.

Chinese abstract

甾体激素避孕药（HC）在育龄期女性中很受欢迎, 因此, 判断卵巢储备能力是准确评估用HC女性生育能力的一种有效手段。我们采用回顾性队列研究分析比较了接受IVF-胎盘植入前遗传学诊断（PGD）的41名服用HC女性与57名服用非HC女性, 旨在评估HC对抗苗勒管激素（AMH）, 小窦卵泡（2-5毫米）, 大窦卵泡（6-10毫米）及总窦卵泡数（AFC）水平的影响, 并对这些指标预测IVF预后的准确性做出判断。结果显示, 大窦卵泡（p = 0.04）和卵巢体积（p < 0.0001）之间差异有显著统计学意义, 然而, 小窦卵泡以及总窦卵泡数与血清AMH以及FSH之间差异无统计学意义。服用HC女性中卵母细胞数量与AMH以及总AFC数量显著相关（p < 0.0001）, 在服用非HC女性中, 这种相关性较弱。在服用HC女性中, 卵母细胞数量达到6和18的重要指标分别为AFC（ROC-AUC; 0.958, p = 0.001和0.883, p = 0.001）及AMH（ROC-AUC-0.858, p = 0.01和0.878, p = 0.001）。对于服用非HC女性来说这些指标显得不那么重要。但是这些指标对于接受PGD, 卵子供体以及使用HC延迟怀孕的女性进行生育预后评估有重要意义。

Keywords:

• Anti-Mullerian hormone
• antral follicle count
• ovarian reserve
• preimplantation genetic diagnosis

Declaration of interest

The authors report no conflicts of interest.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.