Follicular Fluid Anti-Müllerian Hormone Concentrations and Pregnancy Outcome in Intracytoplasmic Sperm Injection (ICSI) Cycles

Abstract

SUMMARY I CSI was first applied to human gametes in 1988 (Hamberger et al., 1988). It was first used in cases of fertilization failure after standard IVF or when few sperm cells were available. The first pregnancies were reported in Belgium in 1992 (Palermo et al., 1992). Intracytoplasmic sperm injection (ICSI) is now one of the most successful and viable techniques in assisted fertilization (Nagy et al., 1995). In those who have no identifiable or correctable causes, ICSI provides new hope for infertility (Chow et al., 2006). ICSI can improve previous fertilization limitation on conventional IVF (Zhonghua et al., 2005). ICSI is indicated primarily for treatment of male factor infertility. It may also be useful in the following clinical situations: failed fertilization in a prior IVF cycle, preimplantation genetic testing of embryos, fertilization of previously cryopreserved oocytes and in vitro maturation of oocytes. ICSI is also used for treatment of borderline semen parameters and selected types of female infertility, such as some morphologic anomalies of oocytes and anomalies of the zona pellucida (Fertil Steril et al., 2008). Recent advances in the understanding of ovarian stimulation, the techniques of oocyte retrieval, the handling of gametes, the methods of assisted fertilization and improved conditions of culture media have steadily increased the fertilization rate in cases of assisted reproduction. Fertilization rates of 70-80% can now be expected when conventional insemination or intracytoplasmic sperm injection (ICSI) are carried out. However, there has not been a corresponding increase in implantation rates, which have remained steady at 10-15% for a long time (Huang et al., 2000). Folliculogenesis, the primary function of the mammalian ovarian follicle is the release of an oocyte capable of being fertilized by a sperm. This involves the growth and maturation of the follicle as well as the enlargement, ovulation and resumption of meiotic division of the egg (Richards, 1980). Anti-müllerian hormone (AMH) is a member of the TGF (transforming growth factor)-beta family and is expressed by the small (<8 mm) preantral and early antral follicles. The AMH level reflects the size of the primordial follicle pool, and may be the best biochemical marker of ovarian function across an array of clinical situations (Dewailly et al., 2014). AMH plays a fundamental role in gonadal differentiation during fetal period and inhibits the formation of mullerian ducts in male fetus (La Marca et al., 2009). AMH is secreted by the ovarian granulosa cells into blood flow and follicular fluid in adult female, although its concentration is much higher in the follicular fluid (La Marca et al., 2009). AMH production is independent of FSH and inhibits FSH-induced follicular growth (Ebner et al., 2006). It also has a direct autocrine paracrine effect on the granulosa cells, oocyte function and embryo quality (Silberstein et al., 2006). In adult women, AMH levels gradually decline as the primordial follicle pool declines with age AMH is undetectable at menopause. The AMH level appears to be an early, reliable, direct indicator of declining ovarian function. It may play an especially useful role in identifying reduced ovarian follicle pool in certain types of patients, such as cancer patients and patients who have had significant ovarian injury from radiation or surgery. In patients planning IVF, AMH level correlates with the number of oocytes retrieved after stimulation, and is the best biomarker for predicting poor and excessive ovarian response (Anckaert et al., 2012). Follicular fluid anti-mullerian hormone (FF AMH) level is probably a marker of the qualitative and quantitative activity of granulose cells (Feyereisen et al., 2006). Although some studies have showed the relationship between the level of serum AMH, and quality of oocyte and embryo (Ebner et al., 2006), there are few studies about the relationship existing between these factors and FF AMH level (Feyereisen et al., 2006).