Low serum anti-Müllerian hormone levels, ovarian stimulation protocol, oocyte number, antral follicle count, age, ICSI outcome, and pregnancy rate in Iraqi women

Background: The anti-Müllerian hormone (AMH), secreted by granulosa cells in the preantral and the small antral ovarian follicles, is a predictor of the ovarian oocyte reserve. Aim: To investigate the correlation between low serum AMH levels (≤1.5 ng/mL), ovarian stimulation protocols, oocyte number, antral follicle count, age, and pregnancy outcomes in Iraqi women undergoing intracytoplasmic sperm injection (ICSI). Methodology: This study was conducted at the Rooh Al Hayat IVF Centre in Baghdad, Iraq, from September 2022 to May 2023. Two hundred infertile women with low serum AMH levels participated in the ICSI program. Women with polycystic ovarian syndrome were excluded. The mean patient age was 28.98 years, and the mean serum AMH levels were 0.96 ng/mL. Blood samples were collected on cycle day 2 or 3. Serum AMH levels were measured using a Roche Cobas e 411 analyzer. Patients were divided into groups based on their ovarian stimulation protocol into those receiving a gonadotropin-releasing hormone (GnRH) agonist and those receiving a GnRH antagonist as well as based on pregnancy outcome. Results: The preg¬nancy rate was higher in patients under a GnRH antagonist protocol, although there were no statistically significant differences (p=0.053) in the pregnancy rates between the short GnRH agonist and the GnRH antagonist protocols. There were no significant differences between pregnant and non-pregnant women regarding their mean serum AMH levels and mean age. However, there were significant positive correlations between the serum AMH levels and both the total oocyte count (r=0.870, p<0.001) and the antral follicle count (r=0.859, p<0.001). Conclusion: In assisted reproductive techniques, the pregnancy rate was higher in patients treated with GnRH antagonist protocols among women with low serum AMH levels. There were insignificantly higher AMH levels in women aged less than 20 years old, although the pregnancy rates were lower in this age group. Positive correlations were observed between the serum AMH levels and both the total oocyte count and the antral follicle count.