Antimullerian hormone predicts pregnancy and live-birth rates after assisted reproduction and reflect oocyte quality besides oocyte quantity

Studies investigating the possibility that measures of ovarian reserve may be predictive for assisted reproductive outcomes have had conflicting results. It remains unclear whether there is an association between ovarian reserve and assisted reproductive outcome. It is also unclear whether estimates of ovarian reserve can provide information on oocyte quality in addition to oocyte quantity. Women with polycystic ovaries have the greatest number of antral follicles and comprise a large proportion of the assisted reproductive technology populations, but are usually excluded from ovarian reserve studies. This prospective observational study used antral follicle count (AFC) as a measure of ovarian reserve to test the hypothesis that ovarian reserve was associated with pregnancy and live birth rates in a large unselected assisted reproduction population covering the entire range of AFC. A secondary aim of the study was to determine whether AFC is just a quantitative measure of ovarian reserve or also provides information on oocyte quality. The study population was comprised 2092 women undergoing 4308 in vitro fertilization/intracytoplasmic sperm injection treatment cycles at a university-affiliated private infertility center between 1999 and 2009. The primary study outcome measures were pregnancy rate and live birth per started stimulation. There was a clear log-linear relationship between treatment outcome and AFC; pregnancy rate and life-birth rate increased relative to log-transformed AFC and leveled out (with no further increase) above an AFC of about 30. Women with polycystic ovaries had higher pregnancy rates and live birth rates (both P < 0.0001), independent of ovulatory status. These results remained significant after adjustment for age and number of oocytes retrieved. These findings show a strong log-linear association between AFC as a measure of ovarian reserve and assisted reproduction outcomes of pregnancy and live birth rate. The data suggest that women with polycystic ovaries, with the best outcome and highest ovarian reserve, are at the one extreme in the spectrum of AFC, with poor treatment outcome and the lowest reserve at the other extreme. The results also suggest that AFC provides information on oocyte quality as well as quality.

BACKGROUND The objective of this study was to evaluate the associations of basal gonadotrophins with pregnancy and delivery rates at IVF/ICSI. METHODS A prospective observational study was conducted at a university-affiliated private infertility centre. Patients were 745 women, who underwent 1328 IVF/ICSI treatment cycles. Basal FSH, basal LH and combinations of FSH and LH versus treatment data and pregnancy and delivery rates were measured. RESULTS Combinations of FSH and LH gave significantly better information than the LH:FSH ratio, or each gonadotrophin alone: highest mean pregnancy rate (39%) was achieved in women with low FSH (<6.7 U/l) and with high LH levels (>4.9 U/l), whereas pregnancy rate was lowest (22%) in women with high FSH and low LH levels. Pregnancy rates were intermediate (27-28%) if FSH and LH were either both low or both high (P for trend = 0.0004). Associations to delivery rates and measures of ovarian response and embryo quality followed the same pattern. CONCLUSIONS Basal LH modifies and improves the information given by basal FSH alone. Low FSH level combined with high LH probably reflects a well-preserved ovarian reserve and is associated with the highest success rates at IVF/ICSI.

Objective: To study the association between hormonal infertility treatment and ovarian neoplasia.Design: Historical cohort study.Setting: Three university hospitals in Sweden.Patient(s): A total of 2,768 women assessed and treated for infertility and infertility-associated disorders between 1961 and 1975.Intervention(s): Exposed women received clomiphene citrate and/or gonadotropins.Main Outcome Measure(s): Incidence of ovarian neoplasia.Result(s): No overall excess risk of invasive ovarian cancer emerged compared with the general population. In women with gonadotropin treatment for non-ovulatory disorders, the risk was elevated (standardized incidence ratio [SIR] = 5.89; 95% confidence interval [CI] 1.91-13.75); four of the five cases reported hCG treatment only, rendering the biological plausibility uncertain. Multivariate analysis within the cohort indicated that treatment with gonadotropins only was associated with an increased risk of invasive cancer (relative risk 5.28; 95% CI 1.70-16.47). For borderline tumors, a more than threefold overall increase of tumors (SIR 3.61; 95% CI 1.45-7.44) was noted; women exposed to clomiphene because of ovulatory disorders showed the highest risk (SIR = 7.47; 95% CI 1.54-21.83).Conclusion(s): Our findings of increased risk of ovarian cancer after gonadotropins and of borderline tumors after clomiphene treatment need to be interpreted with caution. However, concern is raised, and further research on the long-term safety particularly of modem hormonal infertility treatment in IVF programs is warranted. (Fertil Sterile (R) 2009;91:1152-8. (C) 2009 by American Society for Reproductive Medicine.)

Objective: To compare the performance of the Cook Sydney IVF (SIVF) embryo transfer (ET) catheter and the Edwards Wallace (EW) ET catheter.Design: Prospective randomized controlled clinical trial with an intention-to-treat analysis.Setting: Two center study.Patient(s): Four hundred consecutive women <40 years undergoing ET with two fresh embryos.Intervention(s): Women were randomly allocated to undergo ET with either the EW or the SIVF catheter, with possible catheter change in case of insertion difficulties.Main Outcome Measure(s): Live birth and clinical pregnancy rates.Result(s): Two hundred two women were allocated to the SIVF catheter and 198 to the EW catheter. No significant differences in the clinical pregnancy rates (odds ratio [OR] 0.99, 95% confidence interval [CI] 0.66-1.47) and live birth rates (OR 1.09, 95% CI 0.72-1.65) were found. The EW catheter had to be changed more often than the SIVF catheter (OR 9.5, 9.5% CI 3.3-27.5) because of catheter insertion problems.Conclusion(s): The pregnancy and live birth rates were not significantly different with the two catheters, but catheter insertion failure was significantly more common with the EW catheter than with the SIVF catheter.

OBJECTIVE:To investigate whether menstrual cycle length correlates with success rates at IVF/intracytoplasmic sperm injection (ICSI) and could be used as a marker of ovarian reserve. DESIGN:Prospective observational study. SETTING:Private infertility centre. PATIENT(S):A total of 6271 IVF/ICSI treatment cycles. INTERVENTION(S):Self-reported mean number of menstrual days during the last year was recorded before initiation of IVF/ICSI treatment. MAIN OUTCOME MEASURE(S):Relations between menstrual cycle length and pregnancy and delivery rates. RESULT(S):Increasing age was associated with a subtle shortening of mean menstrual cycle length. Menstrual cycle length correlated linearly with pregnancy and delivery rates, even after age adjustment. The chance of delivery after IVF/ICSI was almost doubled for women with a menstrual cycle length >34 days compared with women with a menstrual cycle length <26 days. Menstrual cycle length was also significantly associated with ovarian response to FSH/hMG stimulation and embryo quality. CONCLUSION(S):Mean menstrual cycle length is highly related to success rates in assisted reproduction, independently of age. A precise menstrual cycle history could be used as a simple marker of ovarian reserve.

BACKGROUND:Oocyte donation has been permitted by Swedish legislation since January 2003. According to the law, offspring have the right to receive identifying information about the donor when they reach a mature age. The aim of the present study was to investigate public opinion regarding different aspects of oocyte donation.METHODS:A study-specific questionnaire regarding attitudes towards aspects of oocyte donation was sent to a randomized sample of 1000 women (73% response) and 1000 men (56% response).RESULTS:A majority of respondents supported treatment with oocyte donation. Seventeen per cent of the women considered donating in the future, whereas 56% of the men would support their partner. While nearly half of the respondents considered that offspring should receive identifying information of the donor, one-third were opposed to this. Overall, women were more positive towards disclosure to the offspring than were men (P < 0.001).CONCLUSIONS:The present results indicate strong support for the use of oocyte donation among a subset of the Swedish population. There was considerable interest among women in donating oocytes anonymously. While a majority advocated openness regarding the donation between parents and child, there was less support for the offspring to have a legal right to receive identifying information about their donor.

BACKGROUND: Oocyte donation has been permitted by Swedish legislation since January 2003. While donors are anonymous to the receiving couple, offspring have the legal right to receive identifying information about the donor when they reach adult age. Our aim was to investigate factors of potential importance for women's willingness to donate oocytes. METHOD: A questionnaire regarding attitudes towards oocyte donation was sent to a randomized sample of 1000 women aged 25-35 years (73% response). RESULTS: Seventeen percent would consider donating oocytes, whereas 39% opposed this, and 44% were doubtful. Potential donors were less likely to have children of their own and thought the genetic link was of less importance. Potential donors would feel happy about helping a childless couple, and 38% would be glad to be contacted by the offspring. Factors that would increase women's willingness to donate were being able to talk to experienced donors, proximity to the clinic and availability of counselling. CONCLUSION: The results indicate considerable interest in donating oocytes among a subset of women in Sweden. Potential donors associated donation with altruistic motives. The issue of offspring's right to know about their origin appears to be complicated. This suggests that information about the consequences of donation is of great importance.

Long-term bromocriptine treatment was discontinued in 75 hyperprolactinemic women. Bromocriptine had been given for up to 65 months (median, 24 months). Treatment was reinstituted in 42 women (56%) after 1 to 3 months, mainly because of increasing prolactin levels. Thirty-three women (44%) were followed up for 6 months or more without treatment. Menstrual bleeding occurred in 19 of the 33 women (58%) after 6 months without treatment. The mean prolactin concentration in this group had decreased more than 60% compared with pretherapy concentrations. In 18 ofthe 42 women who had bromocriptine therapy again, treatment was discontinued a second time. Six of these patients have regular menstrual bleeding. Long-term bromocriptine treatment seems to induce longstanding normalization of prolactin secretion in patients with hyperprolactinemia.

Departments of Obstetrics and Gynaecology and Clinical Chemistry, University Hospital, S-750 14 Uppsala, Sweden

A nulliparous woman with 12 years of amenorrhea, galactorrhea, and hyperprolactinemia and radiologic evidence of a pituitary macroadenoma was treated with large doses of bromocriptine. During treatment the greatly increased prolactin levels normalized and ovulatory menstrual cycles were regained after 48 weeks of treatment. A transsphenoidal surgical exploration of the pituitary fossa was performed after 27 months of treatment. The findings at surgery suggested that regression of the pituitary adenoma had occurred during the prolonged treatment with bromocriptine. After discontinuation of the therapy, the patient continued to ovulate and subsequently conceived.