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Setti AS, Braga DPDAF, Guilherme P, Iaconelli A, Borges E. Serum anti-Müllerian hormone concentrations are related to embryo development: lessons from time-lapse imaging. ZYGOTE 2023; 31:570-576. [PMID: 37743564 DOI: 10.1017/s0967199423000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Our objective was to study whether serum anti-Müllerian hormone (AMH) concentrations were associated with embryo morphokinetic events. This retrospective cohort study was performed in a private university-affiliated in vitro fertilization centre between March 2019 and December 2020 and included 902 oocytes cultured in a time-lapse imaging incubator, obtained from 114 intracytoplasmic sperm injection cycles performed. The relationship between AMH concentrations and morphokinetic events was investigated by considering the clustering of data (multiple embryos/patient). Evaluated kinetic markers were time to pronuclei appearance (tPNa) and fading (tPNf), time to two (t2), three (t3), four (t4), five (t5), six (t6), seven (t7), and eight cells (t8), (tSB) and time to the start of blastulation (tSB) and to blastulation (tB). Significant inverse relationships were observed between serum AMH concentrations and tPNf, t3, t4, t5, t6, t7, t8, and tB. The AMH was positively correlated with the KIDScore and implantation rate. Increased serum AMH concentrations correlated with faster embryo development. The clinical implications of this effect on embryo development warrant further investigation.
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Affiliation(s)
- Amanda Souza Setti
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
| | - Daniela Paes de Almeida Ferreira Braga
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
| | - Patricia Guilherme
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
| | - Assumpto Iaconelli
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
| | - Edson Borges
- Fertility Medical Group, Av. Brigadeiro Luis Antonio, 4545, São Paulo - SP, Brazil01401-002
- Sapientiae Institute, Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo - SP, Brazil04503-040
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Jiang X, Cai J, Liu L, Liu Z, Wang W, Chen J, Yang C, Geng J, Ma C, Ren J. Does conventional morphological evaluation still play a role in predicting blastocyst formation? Reprod Biol Endocrinol 2022; 20:68. [PMID: 35439999 PMCID: PMC9016972 DOI: 10.1186/s12958-022-00945-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/09/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Advanced models including time-lapse imaging and artificial intelligence technologies have been used to predict blastocyst formation. However, the conventional morphological evaluation of embryos is still widely used. The purpose of the present study was to evaluate the predictive power of conventional morphological evaluation regarding blastocyst formation. METHODS Retrospective evaluation of data from 15,613 patients receiving blastocyst culture from January 2013 through December 2020 in our institution were reviewed. Generalized estimating equations (GEE) were used to establish the morphology-based model. To estimate whether including more features regarding patient characteristics and cycle parameters improve the predicting power, we also establish models including 27 more features with either LASSO regression or XGbosst. The predicted number of blastocyst were associated with the observed number of the blastocyst and were used to predict the blastocyst transfer cancellation either in fresh or frozen cycles. RESULTS Based on early cleavage and routine observed morphological parameters (cell number, fragmentation, and symmetry), the GEE model predicted blastocyst formation with an AUC of 0.779(95%CI: 0.77-0.787) and an accuracy of 74.7%(95%CI: 73.9%-75.5%) in the validation set. LASSO regression model and XGboost model based on the combination of cycle characteristics and embryo morphology yielded similar predicting power with AUCs of 0.78(95%CI: 0.771-0.789) and 0.754(95%CI: 0.745-0.763), respectively. For per-cycle blastocyst yield, the predicted number of blastocysts using morphological parameters alone strongly correlated with observed blastocyst number (r = 0.897, P < 0.0001) and predicted blastocyst transfer cancel with an AUC of 0.926((95%CI: 0.911-0.94). CONCLUSION The data suggested that routine morphology observation remained a feasible tool to support an informed decision regarding the day of transfer. However, models based on the combination of cycle characteristics and embryo morphology do not increase the predicting power significantly.
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Affiliation(s)
- Xiaoming Jiang
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China.
| | - Jiali Cai
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
- School of Medicine, Xiamen University, Xiamen, 361005, Fujian, China
| | - Lanlan Liu
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
- School of Medicine, Xiamen University, Xiamen, 361005, Fujian, China
| | - Zhenfang Liu
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
| | - Wenjie Wang
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
| | - Jinhua Chen
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
| | - Chao Yang
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
| | - Jie Geng
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
| | - Caihui Ma
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
| | - Jianzhi Ren
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China
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Ciepiela P, Dulęba AJ, Kario A, Chełstowski K, Branecka-Woźniak D, Kurzawa R. Oocyte matched follicular fluid anti-Müllerian hormone is an excellent predictor of live birth after fresh single embryo transfer. Hum Reprod 2020; 34:2244-2253. [PMID: 31725884 DOI: 10.1093/humrep/dez186] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/15/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What is the relationship between the anti-Müllerian hormone (AMH), gonadotropin and androgen concentrations within a single follicle and live birth after ICSI and a transfer of an embryo developed from the matched oocyte? SUMMARY ANSWER Among the analysed markers on the day of oocyte retrieval, AMH concentration in follicular fluid (FF) is a predictor of live birth after single embryo transfer (SET). WHAT IS KNOWN ALREADY High serum concentrations of AMH and low FSH concentrations have been associated with a high chance of pregnancy after ART. Whether there are differences in the hormonal milieu for individual follicles and whether this impacts the laboratory and clinical outcomes for the individual oocyte developing within that follicle are unknown. STUDY DESIGN, SIZE, DURATION This prospective cohort study included 322 individual FF samples from 199 infertile women scheduled for ICSI/SET over an 18-month period. Of these women, 76 provided a single FF sample, while 123 women contributed two FF samples taken from two different follicles. PARTICIPANTS/MATERIALS, SETTING, METHODS The first follicle aspirated in each ovary on the day of oocyte retrieval had the FF aspirated; the individual cumulus-oocyte complex (COC) was tracked, and the associated FF was stored at -80°C. FF AMH, FSH, LH, testosterone (T) and androstenedione (A2) levels were measured by mass spectrometry (androgens) and immunoassays. The laboratory and clinical outcomes for each individual oocyte were related to their unique follicle hormone concentrations. MAIN RESULTS AND THE ROLE OF CHANCE Of the 322 oocytes with paired FF samples, 70 (21.7%) oocytes did not fertilise. From the remaining 252 2PN embryos, 88 (34.9%) were transferred as single embryos on Day 3; of the remaining 164, 78 developed into blastocysts, and 18 single blastocyst transfers were performed. Thus, a total of 106 transferred embryos had matching FF samples. An analysis of these individual FF concentrations revealed that AMH concentrations were higher in follicles in which the oocyte developed into a top quality (TQ) blastocyst (6.33 ± 5.52 ng/ml) and whose transfer led to live birth (7.49 ± 5.03 ng/ml) than those in which there was a failure of fertilisation (3.34 ± 2.21 ng/ml). In contrast, follicular FSH concentrations were the lower for oocytes that resulted in a TQ blastocyst (5.36 ± 2.20 mIU/ml) and live birth (5.60 ± 1.41 mIU/ml) than for oocytes that failed to fertilise (9.06 ± 3.36 mIU/ml). FF AMH was the only studied marker that increased the chance of live birth (odds ratio: 1.93 [95% CI: 1.40-2.67], P < 0.001). The receiver operating characteristic analysis showed that FF AMH levels predicted live birth with a very high sensitivity (91.2%), specificity (91.7%) and an excellent AUC value of 0.954, whereas serum AMH level only had a fair (AUC = 0.711) significance as a predictor for live birth after ICSI/SET. The predictive capabilities of the interfollicular markers were not limited to the TQ embryos or blastocysts; they applied to all SET cycles. LIMITATIONS, REASONS FOR CAUTION Whether an altered intrafollicular hormonal environment reflects the developmental capacity of the oocyte or defines cannot be determined from this cross-sectional analysis. Inclusion of 21 subjects with polycystic ovary syndrome (PCOS) may have biased the findings due to a unique intrafollicular milieu associated with PCOS. WIDER IMPLICATIONS OF THE FINDINGS Our results suggest that highly competent human oocytes have an FF composition of AMH, FSH, T and A2 that is close to that in a natural cycle. Also, the relationships between intrafollicular AMH, gonadotropin and androgen levels in the same follicle support the hypothesis that FF AMH concentration may reflect granulosa cell proliferation during gonadotropin-stimulated follicle growth. Finally, the serum AMH concentration is markedly lower than the FF AMH concentration, with a moderate correlation between serum and FF AMH, implying ovarian follicle autonomy with regards to its secretory products. STUDY FUNDING/COMPETING INTEREST(S) The National Science Centre of Poland supported this work (grant number: N N407 217 040). The authors declare that there is no conflict of interest regarding the publication of this article.
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Affiliation(s)
- P Ciepiela
- Department of Gynecology and Reproductive Health, Pomeranian Medical University, 48 Żołnierska Street, 71-210 Szczecin, Poland.,The Fertility Partnership, VitroLive, Aleja Wojska Polskiego 103, 70-483 Szczecin, Poland
| | - A J Dulęba
- Division of Reproductive Endocrinology and Infertility, University of California, San Diego, 3350 La Jolla Village Dr., San Diego, CA 92161, USA
| | - A Kario
- The Fertility Partnership, VitroLive, Aleja Wojska Polskiego 103, 70-483 Szczecin, Poland
| | - K Chełstowski
- Department of Laboratory Diagnostics and Molecular Medicine, Pomeranian Medical University, Aleja Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - D Branecka-Woźniak
- Department of Gynecology and Reproductive Health, Pomeranian Medical University, 48 Żołnierska Street, 71-210 Szczecin, Poland
| | - R Kurzawa
- Department of Gynecology and Reproductive Health, Pomeranian Medical University, 48 Żołnierska Street, 71-210 Szczecin, Poland.,The Fertility Partnership, VitroLive, Aleja Wojska Polskiego 103, 70-483 Szczecin, Poland
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Kotanidis L, Nikolettos K, Petousis S, Asimakopoulos B, Chatzimitrou E, Kolios G, Nikolettos N. The use of serum anti-Mullerian hormone (AMH) levels and antral follicle count (AFC) to predict the number of oocytes collected and availability of embryos for cryopreservation in IVF. J Endocrinol Invest 2016; 39:1459-1464. [PMID: 27465668 DOI: 10.1007/s40618-016-0521-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
AIM To investigate the predictive value of anti-Mullerian hormone (AMH) and antral follicle count (AFC) on the final number of oocytes retrieved and the availability of embryos for cryopreservation in in vitro fertilization (IVF) cycles. PATIENTS AND METHODS In this prospective study, one hundred and twenty women in their first IVF treatment were enrolled. The short stimulation agonist protocol was used for controlled ovarian hyperstimulation in all cases. Serum AMH levels were measured during the menstrual cycle preceding treatment. AFC was measured in cycle day 2, just before starting ovarian stimulation. RESULTS A strong, positive correlation between AMH, AFC and the number of collected oocytes was found. The patients with available and suitable supplementary embryos for cryopreservation had higher levels of AMH and larger numbers of AFC. CONCLUSION AMH and AFC appear to be valuable markers mainly for ovarian reserve and response to IVF treatment. Serum AMH levels and AFC are significantly associated with the number of retrieved oocytes. Also, a positive correlation with the availability of supernumerary embryos suitable for cryopreservation was observed.
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Affiliation(s)
- L Kotanidis
- Laboratory of Reproductive Physiology - In Vitro Fertilization, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
- , Florou 22A Kordelio, 56334, Thessaloníki, Greece.
| | - K Nikolettos
- Embryokosmogenesis IVF Unit, Alexandroupolis, Greece
| | - S Petousis
- 3rd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - B Asimakopoulos
- Laboratory of Physiology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - G Kolios
- Laboratory of Pharmacology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - N Nikolettos
- Laboratory of Reproductive Physiology - In Vitro Fertilization, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
- Embryokosmogenesis IVF Unit, Alexandroupolis, Greece
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The impact of FMR1 gene mutations on human reproduction and development: a systematic review. J Assist Reprod Genet 2016; 33:1135-47. [PMID: 27432256 DOI: 10.1007/s10815-016-0765-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE This is a comprehensive review of the literature in this field attempting to put the FMR1 gene and its evaluation into context, both in general and for the reproductive health audience. METHODS Online database search of publications with systematic review of all papers relevant to ovarian reserve and assisted reproduction was done. RESULTS Relevant papers were identified and assessed, and an attempt was made to understand, rationalize and explain the divergent views in this field of study. Seminal and original illustrations were employed. CONCLUSIONS FMR1 is a highly conserved gene whose interpretation and effect on outcomes remains controversial in the reproductive health setting. Recent re-evaluations of the commonly accepted normal range have yielded interesting tools for possibly explaining unexpected outcomes in assisted reproduction. Fragile X investigations should perhaps become more routinely assessed in the reproductive health setting, particularly following a failed treatment cycle where oocyte quality is thought to be a contributing factor, or in the presence of a surprise finding of diminished ovarian reserve in a young patient.
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Tramišak Milaković T, Panić Horvat L, Čavlović K, Smiljan Severinski N, Vlašić H, Vlastelić I, Ljiljak D, Radojčić Badovinac A. Follicular fluid anti-Müllerian hormone: a predictive marker of fertilization capacity of MII oocytes. Arch Gynecol Obstet 2014; 291:681-7. [PMID: 25205183 DOI: 10.1007/s00404-014-3460-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/29/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The present study aimed to correlate anti-Müllerian hormone (AMH) levels in follicular fluid (FF) with oocyte maturity stages, morphological quality of metaphase II (MII) oocyte and fertilization capacity of MII oocytes. METHODS A total of 92 infertile women undergoing controlled ovarian stimulation and intracytoplasmic sperm injection were analyzed. Patients were divided into two groups according to age: <35 years (n = 43) and ≥35 years (n = 49). An FF sample was obtained from a single dominant follicle in each patient for a total of 92 follicular fluid samples analyzed. AMH levels in serum and follicular fluid were measured by enzyme-linked immunosorbent assay. Mature MII oocytes, zygotes, and embryos were assessed for morphological quality. RESULTS Serum AMH levels were significantly higher in patients aged <35 years. No correlation was observed between FF AMH level and oocyte maturation stages or morphological quality of MII oocyte. Significantly lower FF AMH levels were observed in fertilized MII oocytes than in non-fertilized MII oocytes in patients aged <35 years (2.56 ± 2.0 ng/ml vs. 4.81 ± 4.14 ng/ml; p = 0.032). CONCLUSIONS The present study revealed no correlation between FF AMH and oocyte maturity stage or morphological quality of MII oocyte. However, FF AMH might be a predictive marker for fertilization capacity of MII oocytes.
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Affiliation(s)
- Tamara Tramišak Milaković
- Department of Obstetrics and Gynecology, Clinical Hospital Center Rijeka, University of Rijeka, Cambierieva 17/5, 51 000, Rijeka, Croatia,
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Lin WQ, Yao LN, Zhang DX, Zhang W, Yang XJ, Yu R. The predictive value of anti-Mullerian hormone on embryo quality, blastocyst development, and pregnancy rate following in vitro fertilization-embryo transfer (IVF-ET). J Assist Reprod Genet 2013; 30:649-55. [PMID: 23504440 DOI: 10.1007/s10815-013-9973-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 03/04/2013] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The objective of this study was to investigate the predictive value of anti-Mullerian hormone (AMH) on fertilization rate (FR), blastocyst development, embryo quality, the outcome of the pregnancy and the live birth rate (LBR) following in vitro fertilization-embryo transfer (IVF-ET)/intracytoplasmic sperm injection (ICSI). METHOD In this prospective study outcomes were followed in 83 women undergoing cycles of IVF/ICSI within a university hospital. Basal serum AMH, follicle stimulating hormone (FSH), luteinizing hormone (LH) and antral follicle count (AFC) were measured on Day 3. Serum AMH (Gn6 AMH ) level was measured on Day 6 after the administration of gonadotrophin (Gn). AMH was measured in follicle fluid (FF AMH) on the day of ovum pick-up (dOPU). The numbers of retrieved and fertilized oocytes, good quality embryos and blastocysts were counted. Secondary outcome variables included clinical pregnancy rate (CPR) and LBR. RESULTS Spearman correlation analysis indicated that the numbers of oocytes, good quality embryos and blastocysts were associated with AMH (P < 0.05) and that LBR was correlated with FF AMH (r = 0.495, P < 0.05). No associations were found between FR and AMH (P > 0.05). Receiver operating characteristic analysis showed that the sensitivity of FF AMH at predicting CPR was 91.2%; the specificity was 86.5% and ROC(AUC) was 0.893 (P < 0.0001). CONCLUSION AMH parameters were correlated with good quality embryos and blastocysts, but only FF AMH showed a significant correlation with LBR and CPR.
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Affiliation(s)
- Wen-Qin Lin
- Reproductive Medcine Center, the First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
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McRae C, Sharma V, Fisher J. Metabolite Profiling in the Pursuit of Biomarkers for IVF Outcome: The Case for Metabolomics Studies. Int J Reprod Med 2013; 2013:603167. [PMID: 25763388 PMCID: PMC4334075 DOI: 10.1155/2013/603167] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 01/02/2013] [Indexed: 01/24/2023] Open
Abstract
Background. This paper presents the literature on biomarkers of in vitro fertilisation (IVF) outcome, demonstrating the progression of these studies towards metabolite profiling, specifically metabolomics. The need for more, and improved, metabolomics studies in the field of assisted conception is discussed. Methods. Searches were performed on ISI Web of Knowledge SM for literature associated with biomarkers of oocyte and embryo quality, and biomarkers of IVF outcome in embryo culture medium, follicular fluid (FF), and blood plasma in female mammals. Results. Metabolomics in the field of female reproduction is still in its infancy. Metabolomics investigations of embryo culture medium for embryo selection have been the most common, but only within the last five years. Only in 2012 has the first metabolomics investigation of FF for biomarkers of oocyte quality been reported. The only metabolomics studies of human blood plasma in this context have been aimed at identifying women with polycystic ovary syndrome (PCOS). Conclusions. Metabolomics is becoming more established in the field of assisted conception, but the studies performed so far have been preliminary and not all potential applications have yet been explored. With further improved metabolomics studies, the possibility of identifying a method for predicting IVF outcome may become a reality.
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Affiliation(s)
- C. McRae
- School of Chemistry, University of Leeds, Leeds LS2 9JT, UK
| | - V. Sharma
- The Leeds Centre for Reproductive Medicine, Leeds Teaching Hospitals NHS Trust, Seacroft Hospital, Leeds LS14 6UH, UK
| | - J. Fisher
- School of Chemistry, University of Leeds, Leeds LS2 9JT, UK
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