Comparison of the outcomes of ART treatment between patients < 36 and ≥ 36 years of age with low serum AMH levels

Yıl 2016, , 0 - 0, 01.09.2016

Selçuk Selçuk , Çetin Kılıççı , Bülent Bilgiç Mehmet Küçükbaş , Melda Kuyucu Hüseyin Kutlu

https://doi.org/10.16948/zktb.81170

Öz

Objective: To compare the outcomes of ART treatment between women < 36 years and ≥ 36 years of age with low serum AMH levels.

Material and Method: Patients who underwent intracytoplasmic sperm injection (ICSI) treatment with low AMH levels at our infertility clinic were enrolled into the study, retrospectively. Patients were divided into two groups as <36 years and ≥ 36 years of age. The outcomes of ART treatment were compared between two groups.

Results: The total numbers of embryos were found significantly higher in women < 36 years of age than in women ≥ 36 years of age with low AMH levels. The total number of top quality embryos on day 1 was lower in women ≥ 36 years of age than in women < 36 years of age and the difference between two groups showed statistically significance. The biochemical, clinical, and ongoing pregnancy rates of women < 36 years of age were higher than women ≥ 36 years of age; however only the ongoing pregnancy rate showed statistical significant difference. The cycle cancellation rates of women < 36 years and women ≥ 36 years of age were 1.7% and 15.2%, respectively and the difference was found as statistically significant.

Conclusion: The higher ongoing pregnancy rates and embryo quality in younger women is an important outcome to encourage the young women with low serum AMH levels for ART treatment option. Age should take into account in the management and information of women with low AMH level in terms of pregnancy rates and characteristics of ART treatment particularly cycle cancellation rates.

Anahtar Kelimeler

assisted reproduction techniques, anti-Müllerian hormone, age

Serum AMH düzeyleri düşük olan < 36 ve ≥ 36 yaş hastaların YÜT sonuçlarının karşılaştırılması

Öz

Amaç: Serum anti-Müllerian hormon (AMH) düzeyleri düşük olan ve yardımcı üreme teknikleri (YÜT) ile tedavi edilen < 36 ve ≥ 36 yaş hastaların sonuçlarının karşılaştırılması.

Gereç ve Yöntem: Bu çalışmada, kliniğimizde serum AMH düzeyleri düşük olan ve intrasitoplazmik sperm enjeksiyon tedavisi uygulanan hastalar çalışmaya dahil edildi. Hastalar  < 36 ve ≥ 36 yaş olmak üzere iki gruba ayrıldı. YÜT tedavi sonuçları iki grup arasında karşılaştırıldı.

Bulgular: Total embryo sayısının; < 36 yaş hasta grubunda ≥ 36 yaş hasta grubuna göre istatistiksel olarak daha yüksek olduğu saptandı. 1.gün iyi kalite embryo sayısı, ≥ 36 yaş hasta grubunda < 36 yaş hasta grubuna göre anlamlı olarak daha düşük bulundu. Biyokimyasal, klinik ve devam eden gebelik oranları < 36 yaş hasta grubunda, ≥ 36 yaş hasta grubuna göre daha yüksekti; ancak sadece devam eden gebelik oranı iki grup arasında anlamlı farklılık gösterdi. Siklus iptal oranı; < 36 yaş hasta grubunda %1.7 iken ≥ 36 yaş hasta grubunda %15.2 olarak tespit edildi ve iki grup arasındaki fark istatistiksel olarak anlamlı bulundu.

Sonuç: Serum AMH düzeyi düşük olan genç hasta grubunda devam eden gebelik oranı ve embryo kalitesinin daha yüksek bulunması; bu hasta grubunun invitro fertilizasyon (IVF) tedavisine yönlendirilmelerini desteklemektedir. Yaş, serum AMH düzeyi düşük olan hastaların bilgilendirilmesinde ve yönetiminde IVF tedavi sonuçları ve özellikle siklus iptal oranları açısından dikkate alınmalıdır.

Anahtar Kelimeler

yardımcı üreme teknikleri, anti-Müllerian hormon, yaş

Kaynakça

• La Marca A, Sighinolfi G, Radi D, Argento C, Baraldi E, Artenisio AC, Stabile G, Volpe A. Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update 2010;16:113–130.
• Broer SL, Mol BW, Hendriks D, Broekmans FJ. The role of anti-Mullerian hormone in prediction of outcome after IVF: comparison with the antral follicle count. Fertil Steril 2009;91:705–714.
• La Marca A, Stabile G, Carducci Artenisio A, Volpe A. Serum anti-Mullerian hormone throughout the human menstrual cycle. Human Reprod (Oxford, England). 2006;21(12):3103–7.
• Nelson SM, Yates RW, Lyall H, Jamieson M, Traynor I, Gaudoin M, Mitchell P, Ambrose P, Fleming R. Anti-Mullerian hormone-based approach to controlled ovarian stimulation for assisted conception. Hum Reprod 2009;24:867–875.
• Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update 2006;12:685–718.
• Anckaert E, Smitz J, Schiettecatte J, Klein BM, Arce JC. The value of anti-Mullerian hormone measurement in the long GnRH agonist protocol: association with
• ovarian response and gonadotrophin-dose adjustments. Hum Reprod 2012;27:1829–1839.
• Stoop D, Ermini B, Polyzos NP, Haentjens P, de Vos M, Verheyen G, et al. Reproductive potential of a metaphase II oocyte retrieved after ovarian stimulation: an analysis of 23 354 ICSI cycles. Hum Reprod 2012;27:2030–5.
• Ferraretti AP et al. ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Human Reprod (Oxford, England). 2011;26(7):1616–24.
• Oudendijk JF, Yarde F, Eijkemans MJ, Broekmans FJ, Broer SL. The poor responder in IVF: is the prognosis always poor?: a systematic review. Hum Reprod Update. 2012 Jan-Feb;18(1):1-11.
• Pellestor F, Andreo B, Arnal F, Humeau C, Demaille J. Maternal aging and chromosomal abnormalities: new data drawn from in vitro unfertilized human oocytes. Hum Genet 2003; 112:195–203.
• Baker, V.L., Luke, B., Brown, M.B., Alvero, R., Frattarelli, J.L., Usadi, R., Grainger, D.A. and Armstrong, A.Y. (2010) Multivariate Analysis of Factors Affecting Probability of Pregnancy and Live Birth with in Vitro Fertilization: An Analysis of the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. Fertility and Sterility,94, 1410-1416.
• Tan, S.L., Royston, P., Campbell, S., Jacobs, H.S., Betts, J., Mason, B. and Edwards, R.G. (1992) Cumulative Conception and Live birth Rates after in-Vitro Fertilisation. The Lancet, 339, 1390-1394.
• Beckers, N.G., Macklon, N.S., Eijkemans, M.J. and Fauser, B.C. (2002) Women with Regular Menstrual Cycles and a Poor Response to Ovarian Hyperstimulation for in Vitro Fertilization Exhibit Follicular Phase Characteristics Suggestive of Ovarian Aging. Fertility and Sterility, 78, 291-297.
• Van Royen E, Mangelschots K, De Neubourg D, Valkenburg M, Van de Meerssche M, Ryckaert G, et al. Characterization of a top quality embryo, a step towards single-embryo transfer. Hum Reprod 1999;14: 2345–9.
• Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. Balaban B, Brison D, Calderon G, Catt J, Conaghan J, et al. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod 2011;26:1270–83.
• Broer SL, van DJ, Broeze KA, Dolleman M, Opmeer BC, Bossuyt P, Eijkemans MJ, Mol BW, Broekmans FJ. 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;19:26–36.
• Galey-Fontaine J, Cédrin-Durnerin I, Chaïbi R, Massin N, Hugues JN. Age and ovarian reserve are distinct predictive factors of cycle outcome in low responders. Reprod Biomed Online. 2005 Jan;10(1):94-9.
• Saldeen P, Kallen K, Sundstrom P. The probability of successful IVF outcome after poor ovarian response. Acta Obstet Gynecol Scand 2007;86:457–461.