Anti-Mullerian Hormone as a Prognostic Marker in Intracytoplasmic Sperm Injection for Patients with Unexplained Infertility

Abstract

Infertility is inability of a couple to achieve a pregnancy after 12 months or more of regular non contraceptive intercourse. Infertility is related to age, about 4% of couples in their early 20 years are infertile with the percentage rising to nearly 20% by their late 30 years. In about 35% of these couples the problem is with the female, 35% the male, 20% both partners whilst about 10% have unexplained infertility. Management includes fertility counselling, lifestyle modifications, medical/ surgical treatment of underlying conditions, fertility medications, and assisted reproductive technologies (ARTs), such as intrauterine insemination (IUI) and in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). In recent years, efforts to optimize maternal and infant outcomes have focused on IVF/ICSI and specific procedure-related factors. Recent studies have indicated that anti-Mu¨llerian hormone (AMH) may constitute an important novel measure of ovarian reserve, with the current literature indicating that AMH is a superior marker for predicting ovarian response over either age of the patient, day-3 FSH, oestradiol or inhibin B levels, whereas the vast majority of studies have found AMH and antral follicle count to have similar predictive value. Consistent with AMH being a strong correlate of oocyte yield, AMH has recently been proposed as a useful clinical marker for the prediction of both poor- and hyperresponses to ovarian stimulation. In addition to reflecting the quantitative ovarian response, several authors have found a significant positive correlation between AMH concentrations and oocyte quality,fertilization rate and embryo morphology. Our study is a prospective study that includes 40 patients complaining from unexplained infertility and who underwent ICSI in the Assisted Reproduction Unit, Ain Shams University Maternity Hospital. Patients were selected according to following criteria: 1- Age 25-35 years old 2- BMI < 30 kg/m 3- Regular cycles 4- 4-Normal baseline hormonal profile (Day 2 values) Normal Follicular Phase (FSH) :2.5-10.2 mIU/ml Normal Follicular Phase (LH): 1.9- 12.5. mIU/ml Normal Follicular Phase (Estradiol - E2): ≤ 50 pg/ml 5- First time ICSI 6- NO Poly Cystic Ovarian Disease (PCOD) 7- NO Endometriosis by laparoscopy 8- NO Fibroid by pelvic Ultrasound