Anti-Müllerian Hormone Levels in Serum vs Follicular Fluid and Its Association with Clinical Pregnancy Rate in IVF Cycles: A Comparative Study in a Tertiary Health Care Center

Aim and background:In vitro fertilization (IVF) has become a mainstream treatment option for infertile couples having difficulty to conceive spontaneously.With changing demographics and societal norms, the utilization of IVF may see a dramatic rise in the upcoming years.Anti-Mllerian Hormone (AMH) is the most accepted prognosticating factor determining the success of IVF and is considered a novel predictor of ovarian reserve.The serum levels of AMH are found to have relatively minimal intracycle and intercycle variability with abysmal clinical significance.AMH produced by the granulosa cells is also compartmentalized in the follicular fluid (FF).The exact role of FF AMH is not clearly elucidated.The present study aims to understand the correlation between serum AMH measured randomly on any day of the cycle with FF AMH measured on the day of oocyte retrieval and to analyze which among the two is more predictive of clinical pregnancy rate (CPR).Methodology: This was a prospective observational study done involving 83 infertile couples with women aged 23-45 years unable to conceive spontaneously or males with abnormal semen parameters according to the WHO 2021 manual of semen analysis.Serum AMH was measured randomly on any day of the menstrual cycle prior to commencement of IVF.GnRH agonist or antagonist IVF stimulation was performed.Clear FF obtained from the cohort of all the follicles during oocyte retrieval was sent for centrifugation at 3000 rpm for 15 minutes, and the supernatant obtained was analyzed for AMH using quantitative sandwich ELISA kits (Cusabio, USA).Clinical pregnancy rate was documented by a transvaginal scan 2 weeks after a positive Beta HCG value.Results: In our study, out of 83 patients analyzed, total pregnancies obtained were 28 (33.7%),out of which two ended up in biochemical pregnancy.Clinical pregnancy rate was 31.3%.There is no statistically significant difference in the various subgroups of patients in the study population with respect to CPR.The predictive ability was found to be statistically significant with serum AMH compared to FF AMH, with a p-value of 0.03 for CPR.Conclusion: Serum measurement of AMH is a better prognostic replacement for diagnostic purposes than FF levels.In our study, serum AMH had a statistically significant correlation with various predictors of ovarian response being antral follicle count (AFC), no. of preovulatory follicles, no. of oocytes retrieved, and oocyte maturation index, and a possible predictor of outcome of IVF in terms of no. of embryos formed.A positive significant correlation of serum AMH with CPR also indirectly emphasizes its predictive value in estimating the success of IVF.In spite of the literature mentioning the importance of the close relation of FF with the developing oocyte and its possible effect on the maturity and quality of the developing oocyte, the prognostic value of FF AMH measurement has not been substantial in analyzing the success of IVF outcomes, like serum AMH.