Comparison of Levels of Anti-Mullerian Hormone, Follicle-Stimulating Hormone and Antral Follicular Count with Ovarian Response and Fertility in Infertile Women after IVF and ICSI

Document Type : Original Article


1 Professor, Department of Obstetrics and Gynecology, Ovulation Dysfunction Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Associate Professor, Department of Obstetrics and Gynecology, Ovulation Dysfunction Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Resident of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Resident of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

5 M.Sc. of Embryology, Islamic Azad University of Karaj, Karaj, Iran.


Introduction: Poor and low fertility in IVF cycles can be due to hormonal status and hormonal levels results from induced ovulation protocols. In cases of decreased ovarian reserve, follicular response to gonadotropin stimulation also decreases and the small number of oocytes will be resulted. This article measured the predictive effects of anti-mullerian hormone (AMH) and follicle-stimulating hormone (FSH) levels and antral follicle count (AFC) in infertile women prior to IVF and ICSI on ovarian response and the success rate of pregnancy.
Methods: This prospective observational study was conducted during 2011 to 2013 on 60 patients referred to Montaserie infertility center of Mashhad, Iran for IVF or ICSI. Serum levels of AMH, FSH, CBC, LFT, TFT, Ur, Cr and Prolactin were measured and vaginal ultrasound was performed to determine AFC. Required number of gonadotropin ampoules were determined and recorded. At days 20 and 21 of menstrual cycle patients underwent imitated transfer and GnRH was injected. At the 2nd day of menstruation, gonadotropin was injected. 6 days after injection, the ultrasound was performed every other day until at least two follicles up to 17-18mm were observed. Based on the number of follicles, 5000 to 10000 units of hCG was administered. After 36 to 40 hours, IVF or ICSI was performed. Finally bHCG was measured as an index of pregnancy. Data were analyzed by SPSS software version 11andt-test and chi-square tests. P value less than 0.05 was considered significant.
Results: The mean number of antral follicular and oocytes before and after treatment was 4.43±4.17 and 3.09±3.71, respectively. Mean of bHCG after treatment was 94.79±265±86 Pmol/dl. Adequate ovarian response occurred in 52 cases (86.7%) and the incidence of pregnancy was 30% (18 cases). In all patients, AMH was 1.34±2.66 Pmol/dl and FSH was 6.81±4.54 Pmol/dl. Comparison of hormone levels in women with positive and negative ovarian response showed no significant differences (p>0.05), but the differences of these hormones were significant in terms of pregnancy and pregnancy outcomes (p<0.05). In pre-treatment, the level of AFC in these groups showed no significant difference (p>0.05),.
Conclusion: AMH and FSH hormones are predictive factor for positive pregnancy in infertile women after IVF and ICSI.


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