171 NORMAL VERSUS LOW ANTI-MULLERIAN HORMONE IN PATIENTS WITH ADVANCED MATERNAL AGE: IN VITRO FERTILIZATION OUTCOMES AND MORPHOKINETIC PARAMETERS

Abstract

Anti-Mullerian hormone (AMH) levels are often used in an IVF population for assessment of ovarian reserve. However, it is not well understood whether AMH levels predict implantation and clinical pregnancy in older women undergoing IVF. In this study, we sought to compare IVF outcomes and morphokinetic parameters in patients 38 years and older with normal versus low AMH levels. Experimental design was a single-centre, retrospective cohort study. Time-lapse imaging data were evaluated for patients 38 years and older (n = 81). Patients were divided into those with AMH values less than 1.0 (n = 47) versus greater than or equal to 1.0 (n = 34). Morphokinetic data was then analysed from transferred blastocysts from these patients cultured in the Embryoscope until transfer (n = 100). The morphokinetic parameters examined were time to 2 cell (t2), 4 cell(t4), 5 cell (t5), time to synchronous divisions (s2, s3), duration of the second cell cycle (cc2), and third cell cycle (cc3). Implantation and clinical pregnancy were identified based upon the presence of a gestational sac. Fertilization, implantation, clinical pregnancy, and blastocyst formation rates were compared between normal and low AMH groups (Table 1). Mean morphokinetic parameters were compared between the 2 AMH groups using an unpaired t-test. Chi-squared tests were used for proportions. P < 0.05 was considered statistically significant. Results: Age of the patients ranged from 38–43, (41.3 ± 2.2 years). The results are summarised below. There were significant differences between implantation and clinical pregnancy rates for low and normal AMH levels. Morphokinetic parameters among the transferred embryos did not differ significantly between the 2 AMH groups (NS, data not shown). Conclusions: This initial data indicates that, in an IVF population 38 years and older, AMH levels greater than or equal to the cutoff of 1 ng mL^–1 are associated not only with increased oocyte retrieval, but also with increased implantation rates and clinical pregnancy rates. These differences suggest that AMH may have a predictive role in determining the likelihood of clinical pregnancy in the 38 years and older patient population.

Table 1.  Oocyte harvest and IVF outcomes