Düşük over rezervi tanısı alan hastalarda gebeliği etkileyen faktörler

Abstract

Amaç: Bu çalışmada, düşük over rezervi (LOR) nedeniyle in vitro fertilizasyon (IVF) uygulanan hastaların gebelik oranları değerlendirilmiş, çok düşük ve düşük anti-Müllerian hormon (AMH) düzeyleri olan hastalar arasında gebelik oranları karşılaştırılmış ve gebelik başarısını etkileyen faktörler belirlenmiştir. Yöntem: LOR tanısı olan 217 kadında toplam 311 IVF siklusu analiz edilmiştir. Hasta seçimi, kötü over yanıtı için belirlenen Bologna kriterlerine göre yapılmıştır. Gebe kalan (n=22) ve kalamayan (n=289) hastalar; AMH, antral folikül sayısı (AFC), oosit parametreleri ve klinik sonuçlar açısından karşılaştırılmıştır. Çok değişkenli lojistik regresyon analizi ile gebelik başarısını bağımsız olarak etkileyen faktörler belirlenmiştir. Bulgular: Gebe kalan hastalarda, daha yüksek AFC (4.6±2.4'e karşı 3.4±2.3, p=0.008) ve AMH değerleri (0.6±0.2'ye karşı 0.4±0.3 ng/mL, p=0.024) gözlenmiştir. AMH düzeyi ≤0.5 ng/mL olan hastalarda siklus iptal oranları (%26.1'e karşı %4.2, p<0.001) daha yüksek bulunmuş, ancak klinik gebelik oranları AMH grupları arasında benzer kalmıştır (%6'ya karşı %8.3, p=0.421). Çok değişkenli analiz sonucunda, AFC (OR: 1.32, %95 GA: 1.08-1.62, p=0.007) ve oosit sayısı (OR: 1.28, %95 GA: 1.05-1.56, p=0.015), gebelik başarısının bağımsız belirleyicileri olarak tanımlanmıştır. Sonuç: Bu çalışmada, AMH düzeylerinin düşük over rezervine sahip hastalarda ovaryan yanıtı öngördüğü, ancak gebelik sonuçlarını öngörmede yetersiz kaldığı belirlenmiştir. AFC ve oosit sayısı ise başarılı IVF sonuçlarının daha güçlü öngörücüleri olarak öne çıkmıştır.

Keywords

• Düşük Over Rezervi
• Anti-Müllerian Hormon
• İnfertilite
• Gebelik Oran
• İn Vitro Fertilizasyon

Factors affecting pregnancy rates in IVF patients with low ovarian reserve: the role of anti-Müllerian hormone and antral follicle count

Abstract

Aims: This study evaluated in vitro fertilization (IVF) pregnancy rates in patients with low ovarian reserve (LOR), compared pregnancy rates between patients with very low and low anti-Müllerian hormone (AMH) levels, and identified factors affecting pregnancy outcomes. Methods: We analyzed 311 IVF cycles in 217 women with LOR. Patient selection followed the Bologna criteria for poor ovarian response. We compared the pregnant (n=22) and non-pregnant (n=289) groups for AMH, antral follicle count (AFC), oocyte parameters, and clinical outcomes. Multivariate logistic regression identified the independent predictors of pregnancy success. Results: Pregnant patients showed higher AFC (4.6±2.4 vs 3.4±2.3, p=0.008) and AMH values (0.6±0.2 vs 0.4±0.3 ng/ml, p=0.024). Patients with AMH ≤0.5 ng/ml had higher cycle cancellation rates (26.1% vs. 4.2%, p<0.001), and clinical pregnancy rates remained similar between the AMH groups (6% vs. 8.3%, p=0.421). Multivariate analysis identified AFC (OR: 1.32, 95% CI: 1.08-1.62, p=0.007) and oocyte count (OR: 1.28, 95% CI: 1.05-1.56, p=0.015) as independent predictors of pregnancy success. Conclusion: In our clinic, AMH levels predicted ovarian response, but not pregnancy outcomes, in patients with LOR. AFC and oocyte count were better predictors of successful IVF.

Keywords

• Low ovarian reserve
• anti-Müllerian hormone
• infertility
• pregnancy rate
• in vitro fertilization

References

1. Vander Borght M, Wyns C. Fertility and infertility: definition and epidemiology. Clin Biochem. 2018;62:2-10. doi:10.1016/j.clinbiochem. 2018.03.012
2. Kondagari L, Kahn J, Singh M. Sonography gynecology infertility assessment, protocols, and interpretation. 2023 Jun 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
3. Ubaldi FM, Cimadomo D, Vaiarelli A, et al. Advanced maternal age in IVF: still a challenge? The Present and the future of ıts treatment. Front Endocrinol (Lausanne). 2019;10(20):94. doi:10.3389/fendo.2019.00094
4. Makoyo O, Moungala LW, Lendoye E. Ovarian reserve of infertile women in Libreville: a retrospective analysis of 124 cases at the University Mother and Child Hospital in Libreville, Gabon. Afr J Reprod Health. 2023;27(3):19-24. doi:10.29063/ajrh2023/v27i3.2
5. Pacheco A, Cruz M, Iglesias C, García-Velasco JA. Very low anti-müllerian hormone concentrations are not an independent predictor of embryo quality and pregnancy rate. Reprod Biomed Online. 2018;37(1): 113-119. doi:10.1016/j.rbmo.2018.03.015
6. Gottardo F, Kliesch S; World Health Organization. Ejakulatdiagnostik: spermiogramm nach WHO-Kriterien 2010 [Semen analysis: spermiogram according to WHO 2010 criteria]. Urologe A. 2011;50(1): 101-1088. doi:10.1007/s00120-010-2466-6
7. Pastore LM, Christianson MS, Stelling J, Kearns WG, Segars JH. Reproductive ovarian testing and the alphabet soup of diagnoses: DOR, POI, POF, POR, and FOR. J Assist Reprod Genet. 2018;35(1):17-23. doi: 10.1007/s10815-017-1058-4
8. Huang Y, Li J, Zhang F, et al. Factors affecting the live-birth rate in women with diminished ovarian reserve undergoing IVF-ET. Arch Gynecol Obstet. 2018;298(5):1017-1027. doi:10.1007/s00404-018-4884-4

9. Fanton M, Cho JH, Baker VL, Loewke K. A higher number of oocytes retrieved is associated with an increase in fertilized oocytes, blastocysts, and cumulative live birth rates. Fertil Steril. 2023;119(5):762-769. doi:10. 1016/j.fertnstert.2023.01.001
10. La Marca A, Donno V, Longo M, et al. Predicting the total number of retrieved oocytes following double ovarian stimulation (DuoStim). Hum Reprod. 2023;38(9):1784-1788. doi:10.1093/humrep/dead148
11. Scheffer JB, Carvalho RF, Aguiar APS, et al. Which ovarian reserve marker relates to embryo quality on day 3 and blastocyst; age, AFC, AMH? JBRA Assist Reprod. 2021;25(1):109-114. doi:10.5935/1518-0557. 20200060
12. Arvis P, Rongières C, Pirrello O, Lehert P. Reliability of AMH and AFC measurements and their correlation: a large multicenter study. J Assist Reprod Genet. 2022;39(5):1045-1053. doi:10.1007/s10815-022-02449-5
13. Zhang Y, Xu Y, Xue Q, et al. Discordance between antral follicle counts and anti-Müllerian hormone levels in women undergoing in vitro fertilization. Reprod Biol Endocrinol. 2019;17(1):51. doi:10.1186/s12958-019-0497-4
14. Abdalla H, Thum MY. An elevated basal FSH reflects a quantitative rather than qualitative decline of the ovarian reserve. Hum Reprod. 2004;19(4):893-898. doi:10.1093/humrep/deh141
15. Romanski PA, Gelvin B, Bortoletto P, Rosenwaks Z, Kang HJ. Live-birth outcomes among women with ınfertility and anti-Müllerian hormone levels of 0.3 ng/ml or lower. Obstet Gynecol. 2022;140(5):743-750. doi:10. 1097/AOG.0000000000004895
16. La Marca A, Nelson SM, Sighinolfi G, et al. Anti-Müllerian hormone-based prediction model for a live birth in assisted reproduction. Reprod Biomed Online. 2011;22(4):341-349. doi:10.1016/j.rbmo.2010.11.005
17. Broer SL, van Disseldorp J, Broeze KA, et al. Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach. Hum Reprod Update. 2013;19(1):26-36. doi:10.1093/humupd/dms041
18. Nelson SM, Klein BM, Arce JC. Comparison of antimüllerian hormone levels and antral follicle count as predictor of ovarian response to controlled ovarian stimulation in good-prognosis patients at individual fertility clinics in two multicenter trials. Fertil Steril. 2015;103(4):923-930.e1. doi:10.1016/j.fertnstert.2014.12.114
19. Iliodromiti S, Anderson RA, Nelson SM. Technical and performance characteristics of anti-Müllerian hormone and antral follicle count as biomarkers of ovarian response. Hum Reprod Update. 2015;21(6):698-710. doi:10.1093/humupd/dmu062
20. Greene AD, Patounakis G, Segars JH. Genetic associations with diminished ovarian reserve: a systematic review of the literature. J Assist Reprod Genet. 2014;31(8):935-946. doi:10.1007/s10815-014-0257-5