Predict Value of Relative Telomere Length, TERT, and Follicular Fluid Anti-mullerian Hormone Levels for IVF Outcome in Infertile Women

Abstract Background: Telomere attrition has been shown to play a critical role in the reproductive aging process in human beings. Telomere length (TL) is normally regulated by telomerase enzyme. Telomerase reverse transcriptase (TERT) is the main component of the telomerase. Anti-Mullerian hormone (AMH), a member of the transforming growth factor superfamily, is derived from the granulosa cells of early developing pre-antral and antral follicles. The aim of this study was to evaluate the associations between relative telomere length (RTL), TERT expression of granulosa cells (GC), follicular fluid (FF) AMH levels and ovarian/embryonic performance in infertile women at different age. Moreover, whether they acting as predictors for probability of clinical pregnancy were also assessed. Method: A total of 160 women underwent their first fresh cycle of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) were included in our study as follows: 100 women were enrolled for RTL measurement and 60 women were enrolled for TERT measurement. All these 160 women underwent FF AMH measurement. Correlations between RTL，TERT expression, FF AMH levels and age, ovarian/embryonic performance and probability of clinical pregnancy were assessed.Results: There was a statistically significant relationship between the expression levels of TERT, RTL, FF AMH levels and patient age(r = −0.20, P = 0.04; r=0.30, P=0.02; r=-0.191, P=0.003, respectively). Relationships between the expression levels of TERT, FF AMH levels and oocytes yield were significant (P<0.001; P<0.05, respectively). However, no statistically correlation was observed between the RTL of GC samples and oocytes yield. All these three biomarkers had no correlation with blastocyst formation rate. There was significant relationship between FF AMH levels and probability of clinical pregnancy in patients older than 35 years (OR=1.284, 95%CI=1.031-1.599, P=0.026). Conclusion: RTL, relative TERT expression in GC and AMH levels in follicular fluid are age-related, but all of them fail to predict embryonic outcomes. Relative TERT expression and FF AMH levels appear to be more reliable for prediction of ovarian response than RTL. FF AMH is also a good predictor for probability of clinical pregnancy in advanced women.